Thursday, 17 October 2013


The two letter acronym QI may refer to several things. One is a television quiz show hosted by a personal hero of mine, Stephen Fry. In this context, QI stands for "quite interesting". In a context closer to my heart, it also stands for "quality improvement".

 I was first introduced formally to the concept of quality improvement during my MSc module on "Organising and Delivering High Quality Care", where the motivational and enigmatic Prof Mitch Blair and Dr Bob Klaber (and several of their colleagues) gave us an overview of the concept. Quality Improvement very much does what it says on the tin. It's all about facilitating anything which improves quality. In a healthcare setting (my main focus as that is where I work), this is about ensuring high quality care for all patients. "High quality" may sound a bit fluffy and I was challenged when I suggested at the recent Faculty of Medical Leadership and Management conference that all that we do as healthcare professionals should be underpinned by a desire to provide high quality patient care; it was suggested that we ought to actually focus on delivery of safe care. For clarification, when I refer to the concept of quality in healthcare, I refer to the definition proposed by Don Berwick from the Institute for Healthcare Improvement in the States. He describes high quality care as that which is "safe, effective, patient-centred, timely, efficient, and equitable". As a doctor working in the NHS, that seems like as good a definition as any, and given that it was proposed by one of the world experts in patient safety, I feel relatively justified in saying that providing high quality patient care is not at odds with providing safe patient care!

A worry of mine at the moment is that QI in some establishments is not driven by the desire to improve care. This may sound odd - surely if someone is carrying out a QI project then by definition they wish to improve quality of care? Unfortunately, I fear there is a very real danger that, much like audit (and, to a lesser extent, research), doctors in training see it solely as a tick box exercise which is carried out purely for CV-boosting purposes. I am not alone in holding this concern. I have asked several of my senior colleagues why they feel there is so little drive towards QI amongst my contemporaries, and they have all given me similar replies - we aren't in a competitive deanery, so people don't feel they need to undertake these CV-boosting tasks. To me, this completely misses the point. As healthcare professionals, our motivation should not be solely to get our next job or to pass our ARCP as painlessly as possible. We should be motivated by a desire to provide high quality patient care.

Let's not forget why we went into medicine in the first place - we (mostly) went into this field for the patients. They must still be our focus. Ward rounds, clinics, GPs, ED... They're all there with the aim of providing patient care.

We should *want* to continually improve care, not only to boost our own CVs, but because if providing the best possible care to our patients no longer drives us, we probably need to start thinking about a change of career!

 **addendum** It has been pointed out to me that the definition of quality I quoted comes from the Institute of Medicine; this was modified by the IHI when creating their own goals. Apologies for any confusion caused.