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Learning to Make a Difference Pilot Project RCP/JRCPTB

Learning to Make a Difference Pilot Project RCP/JRCPTB. June 2010. The Background:.

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Learning to Make a Difference Pilot Project RCP/JRCPTB

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  1. Learning to Make a Difference Pilot ProjectRCP/JRCPTB June 2010

  2. The Background: Quality Improvement is an interdisciplinary process designed to raise the standards of the delivery of preventative, diagnostic, therapeutic and rehabilitation measures in order to maintain, restore or improves health outcomes of individuals and populations (ACMQ). • Questions that provoked the Learning to Make a Difference project: - • “Why can’t all trainees do a quality improvement project?” • “Why can’t they do a quality improvement project instead of an audit?”

  3. Audit and CMT Audit and the CMT curriculum: Audit: To develop the ability to perform an audit of clinical practice and to apply the findings appropriately Data collection, role of audit, audit cycle, implement/contribute to audit etc

  4. Audit – Level descriptors 1 - Attendance at departmental audit meetings. Contribute data to a local or national audit 2 - Identify a problem and develop standards for a local audit 3 - Compare the results of an audit with criteria or standards to reach conclusions. Use the findings of an audit to develop and implement change. Organise or lead a departmental audit meeting 4 - Lead a complete clinical audit cycle including development of conclusions, implementation of findings and re-audit to assess the effectiveness of the changes. Become audit lead for an institution or organisation

  5. Audit of Audits November 2009 Emma Stanton Harkness Fellow:- The Harkness Fellowships (previously known as the Commonwealth Fund Fellowships) are a programme run by the Commonwealth Fund of New York City.

  6. London Deanery Trainees 8% response rate

  7. What was your motivation for undertaking audit?

  8. Who chose your audit topic?

  9. Were you given any relevant training or support on how your clinical audit could be used to improve quality of care? No

  10. On a scale of 1 to 6, to what extent did your last audit result in:1 is not at all and 6 is a great deal Number of respondees A great deal Not at all

  11. Key findings from survey November 2009 Majority (41%) of trainees undertook audit for career progression Slightly more audit topics were chosen by the Consultant (45%) rather than the trainee (43%) Only 20% of audit topics relate to patient safety Majority of trainees (64%) received no training or support in how their audit could be used to improve quality of care Nearly half of audits (46%) were not repeated; likely to be related to changing jobs Lack of enjoyment amongst trainees (23% no enjoyment at all)

  12. Can we do better?small scale change can make a difference

  13. Learning to Make a DifferenceRationale: All junior doctors are required to perform an audit as part of their training programmes. Most projects achieve little but simply consist of an initial data collection exercise with no subsequent action or second data collection. As a result they learn little and make no difference to their own practice or the experience of their patients. They learn little about the real power of clinical audit.

  14. Learning to Make a Difference The change we wish to see is that a junior doctor’s project should “make a difference” to their practice, their team work or their patients. We believe junior doctors have both appetite and talent for this activity. The intention is to alter the requirement in CMT to that of a “quality improvement project”

  15. Pilot: Pilot a “learning to make a difference” project (LMDP) (in place of audit) in 5 Deaneries with CMT 2 trainees Identify factors for success and for failure and therefore to enable role out across the UK within one year Support the project with a project steering group from DH, the Health Foundation, and NHS institute of innovation and improvement

  16. What does it involve? Each Deanery has 10-20 trainees each doing a LMDP in place of audit Each trainee has a supervisor – their educational or clinical supervisor Trainees may want to work together Decide on the project and then follow the guidelines outlined in the ‘tool kit’ Ideally trainee-led idea Project planned to take 4-6 months to complete Start August 2010; complete March 2011

  17. The overview… All about following a structured process The start of the ‘tool kit’…

  18. 1. What do I need to do the quality improvement project at the frontline? • The trainee should use the PDSA (Plan, Do, study, act) Cycle • The cycle may be used to develop, test, or implement a change on a small scale in a real work setting. It is all about the preparation. • The trainee will require support to test out • their ideas with you before they start.

  19. A WORKED EXAMPLE

  20. A WORKED EXAMPLE…. PLAN

  21. A WORKED EXAMPLE…

  22. A WORKED EXAMPLE

  23. What else do I need to do? Use a run chart to record results of your project

  24. 2. What do I need to do to be an effective supervisor for my trainee and the success of this project? 1. Listen to the idea(s) your trainee has – is it SMART? Is it aligned with your Trust’s quality and safety agenda? 2. Help them to develop their project plan using the PDSA template 3. Help the trainee identify what is needed for the project success and to remain realistic about available resources 4. Be available for regular meetings throughout the project – use the ‘planning my time’ template’ to help guide this 5. Help to anticipate and/or resolve any issues arising as a result of the project

  25. 6. Ensure all the people that need to be aware the project is taking place do know and receive appropriate updates on progress 7. Encourage, guide and support your trainee in achieving their goal and timely completion of the project 8 Timely recognition of any trainee concerns and assistance to reach resolutions 9 Managing the expectations of the trainee – realistic small scale change is what is being tested here. 10 Support will be available from your CMT PD; in addition a Quality Improvement mentor would be available for further support as required. 2. What do I need to do to be an effective supervisor for my trainee and the success of this project?

  26. The top tips for trainee success

  27. The top tips for trainee success

  28. What else do I need to do for my LMDP? Plan your time

  29. What else do I need to do for my LMDP? Keep a record of project progress meetings between supervisor and trainee

  30. What else do I need to do specific for the RCP/JRCPTB Pilot? Completion of the Pre- and Post project questionnaire by trainee, supervisor, Deanery Lead and Trust Medical Director.

  31. Pre and post project questionnaire to be completed by trainee and supervisor and deanery lead.

  32. What else do I need to do specific for the RCP/JRCPTB Pilot? Completion of Project Progression Assessment Scale

  33. THIS TELLS YOU WHERE YOU THINK YOUR PROJECT PROGRESS IS GOING… HELPS TO CONCENTRATE THE MIND ON WHAT IS HAPPENING AND THE LIKELIHOOD OF SUCCESS AND IS COMPLETED AS YOU GO

  34. What else do I need to do specific for the RCP/JRCPTB Pilot? Completion of LMDP supervisor questionnaire by the supervisor at the conclusion of the project

  35. COMPLETED BY SUPERVISOR

  36. What else do I need to do specific for the RCP/JRCPTB Pilot? The supervisor, with the trainee present, will complete an adapted ‘audit assessment tool’ to assess their competency (as they should do for audit participation; AAT is not on e-portfolio yet though and not widely used to date) and keep the record in their e-portfolio.

  37. The Quality Improvement Project Assessment Tool COMPLETED BY SUPERVISOR WITH THE TRAINEE FOR THE TRAINEE’S EPORTFOLIO The QIP Assessment tool is designed to assess a trainee’s competence in completing a quality improvement project.

  38. What else do I need to do specific for the RCP/JRCPTB Pilot? Evaluation of support given throughout

  39. WHAT SUPPORT DO I GET? Your local CMT lead Supported by QI fellows if required – ask your lead Led by Emma Vaux Emma.Vaux@royalberkshire.nhs.uk Supported by Implementation Group RCP/JRCPTB Project Manager: Martin.Norris@rcplondon.ac.uk You will be asked to grade the support given to you on completion of the project

  40. How do we know this pilot has been successful and made a difference? Process measures: Project progression assessment scale for each LMDP (completed by trainees & supervisors) Deanery Lead Action plan (completed by CMT lead) Evaluation of the overall pilot

  41. Evaluation of pilot Outcome measures Local impact on patient care: Quality improvement measures from the LMDP itself Quality Improvement Project Assessment Tool Qualitative assessment/evaluation to demonstrate acceptability and feasibility amongst participants by Questionnaire A & LMDP supervisor questionnaire

  42. Balancing measures (what are the risks? What else might we disadvantage?) Trainees no longer do clinical audit Evaluation of pilot

  43. In the longer term: Junior doctors are started on a pathway for life long evaluation and quality improvement of the service they deliver Continuous service development is seen as part of medical professionalism Roll out for all CMT trainees 2011

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