GP training: Writing up a quality improvement activity for your e-portfolio

In the first of two articles, a typical e-portfolio entry is used to explain the theory and practice of recording a quality improvement activity (QIA). By Dr Prashini Naidoo

(Photo:  fizkes/Getty Images)
(Photo: fizkes/Getty Images)

What is a QIA?

A QIA is about identifying and changing areas of practice that frustrate you, so that you can improve patient safety and patient care. QIAs are about making small incremental changes and measuring these, even weekly, to test their impact.

The Model for Improvement framework can help you to plan QIA. It asks three questions:

  1. Aim – What are you trying to accomplish?
  2. Measure – What data can you collect that will be evidence of improvement?
  3. Change – What (cyclical or iterative) changes can you make that will improve the situation?

The idea for a QIA can come from a significant event, a patient complaint, or an area of care you that interests you. As you will see from reading the QIA provided below, it can be tricky to choose the right tools to collect the right data, to provide evidence that you have made the improvements.

An example QIA

Read through the learning log entry below on improving a monthly clinical meeting. As you read through, ask yourself the following questions:

  • Did the project aim to improve patient safety or care?
  • Did the project ask a specific question and set a clear goal?
  • Were the right tools used to collect data?
  • Was the right data collected? Data can be qualitative (descriptive) and/or quantitative (numerical data).
  • Was the data easily collectable?
  • Was the data presented well?
  • Could the project be completed in 2-4 months?

Project title
Making the Wednesday professional development meetings (PDM) more relevant, useful and focused.

Why it was chosen
Staff attending the PDM grumbled that the meeting ‘rambled’ on, lost focus and over-ran. Some clinicians with clinics after the PDM, left the meeting before it ended, to start their clinics, or started their clinics later, which was stressful.

I offered to chair the PDM on MS Teams and bring in a new format to see if we could cover the topics in a more concise manner.

I read literature on facilitating meetings to understand best practice.1,2 I designed a feedback form, which I emailed out to participants immediately after each meeting as the literature suggests feedback given as quickly as possible after the event is likely to be most useful.3   

Project aim
I chose a before and after survey to evaluate my chairing of the meeting. The questions I wanted to answer were whether there was a discrepancy between what was planned and what actually happened at these meetings (focused?); whether the attendee had take-home messages that would change their practice (useful?); and what topics future meetings should cover (relevant?).

I asked attendees for informal feedback, but also created a MS Form that I emailed to participants after the meetings. I used their feedback to prepare the next meeting.

I will know that the changes I made to the meetings are an improvement if feedback is positive and we ended on time, allowing clinicians to start clinics on time.

Describe what baseline data or information you gathered
I collected my baseline data on 28 Oct 20 from talking to participants and reviewing the MS Forms. Unfortunately, only 2 of 6 clinicians completed forms. This showed:

  • Participants commented that the discussion stuck to the outline I had emailed out in advance of the meeting (NICE guidance and a podcast).
  • They preferred the podcast to reading.
  • Informal feedback highlighted that I ensured that everyone participated, and I kept us focused on the objectives of the session.
  • One doctor commented that I did not have a strategy for encouraging the contribution of participants who had not listened to the podcast or completed the reading in advance of the meeting.
  • I reflected that I could have had a short list of the main learning points from the podcast/reading to screenshare in future meetings. 

Describe what subsequent data or information you gathered
On 25 November I reviewed feedback and reflected on the second meeting. Prior to the meeting, I made the following changes:

  • I emailed the resources three weeks in advance. This included links to a short YouTube video and a 30-minute podcast.
  • I sent out the questions I intended to discuss so that attention could be focused.
  • I emailed a reminder two days before the meeting so invitees could prepare.

Five people completed the second feedback form:

  • People were not bothered by the discrepancy between what was planned and what actually happened. Avg score 1.17 (1 = not bothered; 5 = intensely bothered)
  • People found the points raised by our discussion very useful and commented on how they would change the practice
  • Nobody mentioned the summary of learning points I screenshared.
  • People like case-based discussions.
  • One clinician asked if we could invite an ‘expert’ patient and would welcome the voice of patients in future meetings.

This gave me ideas for planning the next meeting.

How did you plan and test out your changes?
For the next meeting, I will be less ambitious in the amount of pre-meeting work I set. I need to shorten the agenda so we finish on time. I will speak to clinicians to identify a suitable ‘expert’ patient and invite them to the meeting. I will collect feedback using the same feedback form. People are getting used to filling in this form.

How have you engaged the team, patients and other stakeholders throughout the project?
I did not talk to all the clinicians who attended the meeting, but I did email the feedback form to all of them. If I invite patients or the wider team (eg community midwives or pharmacists) to future meetings, I intend to email them for their feedback. The feedback form is on Microsoft Teams, in the PMD channel, and the link can be easily emailed to all participants after each meeting.

Summarise the changes as a result of your work and how these will be maintained.

  • If pre-discussion reading is required, send meeting invites early.
  • Follow-up with a reminder two days before the meeting.
  • Have a list of main learning points to share to those who didn’t complete the homework.
  • Use varied resources, not just reading materials, but podcasts and online videos too.  However, do not send too many resources. Select the most useful one.
  • Try to talk around a case, patient, or summary of guidance. Where appropriate, invite an expert patient or colleagues from the wider team.
  • When chairing, keep the discussion focused on the session’s objective. For me, this means being quite clear what my two main take-away messages are and bring the discussion back to this if it veers off-track. 
  • Email the feedback form immediately after the meeting. Share the feedback when preparing for the next meeting, explaining my reasons for the next meeting preparation.
  • For the next meeting, I will time the start and end, so I can collect evidence of running to time. I forgot to do this for the first two meetings.

What have you learnt and have you got any outstanding learning needs?

  • I learnt I need to bring out the views of the other clinicians before I share my views.
  • I want to improve my choice of pre-discussion resources. I am drawn to certain articles and podcasts. I should ask others what they use.
  • I need to find out the quickest, easiest way to ‘minute’ these meetings, as a record of decisions and also to show at a CQC inspection. A trainee at VTS mentioned how their practice uses Planner. I found a YouTube video4 and could try to adopt this. 

The second article on QIA covers how one GP trainer marks this write-up, but before you read it, please decide what grade you will award.

Read how a trainer would mark this QIA here.

  • Dr Prashini Naidoo is a GP trainer in Oxford. She has written three books on how to pass the CSA. The latest book CSA Practice Cases for the MRCGP was published in January 2016.

References

  1. Bradford VTS online resources. Facilitation and facilitating groups
  2. Keltie R, Sampson R, Taylor M. Remote Facilitation: A rough guide. Compiled by Mark Taylor, Rod Sampson & Rachel Keltie. NHS Education for Scotland (NES); NHS Highland, May 2020.
  3. O’Hara C. How to get the feedback you need. Harvard Business Review, 15 May 2015
  4. https://www.youtube.com/watch?v=To2EHXgqcJc

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