Quality improvement (QI) aims to make a difference to patients by improving safety, effectiveness, and experience of care. Embarking on QI projects allows clinicians, working as a team, to identify issues in care processes to implement interventions that can result in true improvements in quality. Opportunities for QI often reveal themselves at our workplace when we pay attention to daily pain points in care delivery. These could range from ways to deliver safer care, work more efficiently or to achieve quality standards. Some QI ideas along these themes are designing interventions to reduce paracetamol double-dosing errors, reducing specialist referrals in preoperative assessment clinics by adopting guidelines and creation of comprehensive hip fracture pathways to ensure timely fracture fixation.
To build a culture of improvement in our department, the results from a survey on QI among senior staff was instructive. Some reasons for not being motivated to embark on QI were finding the QI methodology and project registration process complicated as well as difficulty in finding team members. This served as a launchpad for initiatives to reduce the barriers to embarking on QI in the department.
A newly created department intranet page on QI now serves as a one-stop resource for staff embarking on QI projects. With a helpful pictorial guide on the steps to embark on a QI project, staff gain clarity on the process of carrying out QI as well as the grants and resources available. The site also hosts a database of ongoing and completed QI projects to avoid duplication of resources on similar projects and opens doors for staff to join projects. The site also holds links to quality improvement tools from SGH Process Transformation and Improvement (PTI) such as templates for Pareto charts and Fishbone diagrams which teams would find invaluable for their projects. Clinicians looking for QI ideas will find a blackboard area with ideas for QI sieved from Peer review Learning sessions (PRL), in-situ simulation sessions, and elective OT team debriefings to be a useful starting point. These efforts leverage on PRL sessions to be enablers of quality improvement by identifying areas for clinical process improvement from clinical incidents.
To build up the pipeline of QI talent among our staff, staff with experience as team leaders in QI projects are identified to be trained as QI coaches. Registered QI projects in the department are assigned a QI coach who serves as a mentor and resource for teams to guide them through the QI methodology and process. Teams often find the advice of QI coaches useful in focussing their project scope and identifying outcome indicators as well as the invaluable guidance of experience in managing projects. Staff are also encouraged to attend workshops in QI methodology which are regularly run by SGH PTI.
In line with growing a culture of QI and a community of practice, a quarterly QI sharing forum has been established. This provides a platform for teams to share the lessons and results of their completed QI projects. It also serves as a forum for the presentation of newly launched QI projects where constructive feedback could be received to refine projects while increasing awareness among stakeholders. Support from department leadership in recognising QI initiatives has also crystallised into the Best QI project award of the year and in recognising the efforts of individuals active in QI endeavours. Administrative support is also available to assist in electronic data extraction and project registration to reduce the time pressures on busy clinicians.
Though these initiatives to build up a culture of QI are only a few months old, early signs have been encouraging with an increase in the number of QI projects. Other fruits include greater opportunities to gain skills in and mentor in QI, avenues to exchange knowledge as a community of practice, consolidation of online QI resources and lowering of the barriers to embarking on QI.