Quality improvement activities (QIA) for a doctor's appraisal
This blog explains in detail all about quality improvement activities (QIA) in the context of an medical appraisal.
“Every doctor is required to demonstrate how they review the quality of their work across their whole scope of work”. (GMC)
“For the purposes of revalidation, the doctor will have to demonstrate that they regularly participate in activities that review and evaluate the quality of their work. These should be systematic and relevant to their work and should include an element of evaluation and planned future action. Where possible, these activities should be able to demonstrate an outcome or change.
The GMC states that the following areas should be considered in relation to quality improvement activities:
- Have you participated actively in the selected quality improvement processes?
- Do the selected processes reflect key elements of your professional work?
- Have you evaluated and reflected on the result of the quality improvement activity?
- Have you taken appropriate action in the form of practice change, service development or other activities in order to respond to the findings?
- Have you undertaken, or planned to undertake, a review of the changes made?” (AoMRC, 2014)
All doctors must demonstrate an ability to review and learn from their medical practice, particularly from significant events and patient care. The RCGP recommends that you should demonstrate the ability to review and learn from your medical practice by reflecting on representative quality improvement activities (QIA) relevant to your clinical work every year, with a spread of QIAs across all of your scope of work over a five year cycle.
Previously the RCGP recommended reflection on two significant event analyses and/or case reviews every year and one quality improvement project, such as a clinical audit, or service redesign, in the five year cycle. Experience has shown that, although this is still appropriate for some, for many GPs it is too restrictive, and a far wider range of ways to review and improve the quality of your practice may be appropriate. This is in recognition that some forms of quality improvement activity may be difficult to achieve in certain circumstances, such as truly peripatetic locum work, and that there is a growing understanding of the variety and breadth of excellent quality improvement activities presented by GPs.
Going forward, you are advised to choose representative quality improvement activities, appropriate to your scope of work and circumstances, that reflect how you review and improve the quality of your practice every year. QIA may take many forms, including, but not restricted to: large scale national audit, formal audit, review of personal outcome data, small scale data searches, information collection and analysis (Search and Do activities), plan/do/study/act (PDSA) cycles, significant event analysis (SEA) and reflective case reviews, as well as the outcomes of reflection on your formal patient and colleague feedback survey results, Significant Events and Complaints.
You are advised to choose the best examples of your routine primary care significant event analysis to include as quality improvement activities to demonstrate how you review and learn from significant events, but all significant events, in which you have been personally named or involved, that reach the GMC defined level of harm, must be included in Significant Events. For some parts of your scope of work, particularly relating to specific clinical skills such as minor surgery, joint injections, cervical smears and IUCD/IUS insertions (where applicable) it may be possible and appropriate to maintain a log of personal outcome data and reflect on the outcomes.
If you are in a role where there is organisational, regional or national outcome data provided, it is best practice to demonstrate how you reflect on your personal involvement and response to the information provided about your performance. You do not need to have undertaken data collection personally but your reflection should describe your personal involvement in the activity and what you have learned about your own performance in relation to current standards of good practice, including what changes you plan to make as a result, or how you will maintain high standards of performance.
No fixed number of QIA is being recommended, as some will be very brief interventions, and others will be very significant projects. The RCGP recommend that you keep in mind the principle of providing documentation that is reasonable and proportionate and does not detract from patient care, while ensuring that your QIA cover the whole of your scope of work over the five year cycle and demonstrate clearly how you review and improve the quality of your practice every year. If in doubt, discuss your plans for the coming year with your appraiser and use your professional judgement about what is appropriate.
In earlier RCGP recommendations, counting CPD credits for the time spent on QIA was discouraged, but experience has shown that all learning activities can appropriately be included as continuing professional development, providing the CPD credits are demonstrated through reflection using the usual formula: One credit = one hour of learning activity demonstrated by a reflective note on the lessons learned and any changes made.
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