Top tips for starting a quality improvement project

Thinking of starting a quality improvement project? Identified something that needs improving? Here’s my three top tips on setting up your project for success…

1. Start with the end in mind.

Often, the spark for improvement comes from an idea, a realisation that things would be better if we tried this new way of doing things. This is completely natural. And yet it’s the wrong place to start for quality improvement work. QI isn’t about implementing an idea, it’s about solving a complex issue where we’ll need multiple ideas and theories about what a better system might look like. So, although our minds are curious and imaginative, and often trained to consider alternative solutions, we need to work backwards when we start a quality improvement project. What is that idea aimed at achieving? What’s the outcome that this might improve? Make this the aim of the quality improvement project, not the initial idea that might have sparked the curiosity. You’ll open up the possibilities, invite more creative thinking, engage a wider group and have a better chance of improving outcomes.

2. Focus on what really matters.

Our healthcare systems are straining to meet today’s demands, and workload for our staff is going up. To give your quality improvement project the best chance of success, forget the ‘nice to have’, and focus on the critical. Wrap your quality improvement project around what truly matters. But to whom? To senior managers? To the team? To your patients, service users and families? I’d suggest starting any quality improvement project with a conversation involving all of the above. All will be absolutely key to the work, and all should be involved from the very beginning in choosing what to focus your quality improvement effort on. It’ll help ensure your project is tackling what people care most about, and it’ll build engagement and will for the work ahead. And my guess is that you won’t find too much disparity between what your patients really care about, what the team really cares about, and what senior managers really care about.

3. Improvement is a team sport

All care is delivered in teams, and so all improvement should be done as teams. There’s something powerful about a whole multidisciplinary team coming together with their patients and service users to identify their biggest improvement opportunity, and working on this together. It helps strengthen team working, it brings people together around a shared purpose, it helps connect the staff to what really matters to those they serve, and it starts to break down some of the power imbalances – both within staff, but also between staff and service users and patients.

Successful teams come together often for short huddles, find time to reflect together, and develop habits around their work. Similarly, think about how you can bring together a small project team, with representatives from all parts of the service and service users, to meet regularly about the project. Find ways to build this into the existing spaces and rhythm within the team, rather than creating a new meeting or additional ask. Role model quality improvement in the way that the team works – keep the meetings short and efficient; try standing meetings; avoid excessive note-taking. The only real purpose of coming together as a team to discuss a quality improvement project is to reflect on how the last test of change went, and plan the next test of change. So, could you start finding new and creative ways of achieving this that don’t involve meetings?

QI Essentials blog with Dr Amar Shah comes out every month. Here you can read all previous posts.