Quality improvement: everyone’s responsibility

Using evidence to support and inform practice is part of our professional DNA.

Early in our physiotherapy career, we place attention on consolidating and building clinical skills and developing experience in providing patient care. As graduates, we bring fresh energy, insight and understanding of the use of research evidence and data, and the translation of this into practice. Retaining this energy is critical if we are continually to find new ways to improve services and patient outcomes. 

Professional responsibility

As professionals, we are responsible for ensuring the quality (safe, effective, patient-centred, timely, efficient, equitable and sustainable) of services.  Quality improvement (QI) can sound difficult or complicated – but is it? We have all experienced significant change to service provision due to Covid-19. 

We had to ask what needed to change in response to the pandemic. Now we’re asking, what have we learnt from the last 21 months? What should we keep doing? What shouldn’t we return to? What can we do better? What was surprising?

Which patients access our service?  Which groups don’t access physiotherapy? And has this changed? Why? What do patients want? 

It’s these simple questions that sit at the heart of quality improvement.

Quality improvement in practice

Learning to test improvement ideas using rigorous QI approaches has multiple benefits - for patients, for your individual career development, for the team as it improves motivation, and morale. Getting involved in service improvement activity doesn’t have to be scary. Making a change to practice doesn’t always need a big randomised controlled trial, it can be about small steps that incrementally make a big difference. What is clear though is that QI is the responsibility of us all. 

Take Holly Patterson and her colleagues, for example. They made a simple observation that activity levels of patients with cystic fibrosis (CF) were higher on the wards compared with at home. This was concerning because maintaining levels of physical activity is known to be beneficial to CF patients. So, Holly and colleagues set out to see if this could be improved. 

Spoiler alert: it could! Using plan-do-study-act cycles, they achieved a change where 100 per cent of patients were out of bed before noon compared with just 47 per cent before the improvement cycles. 

Check out their abstract on the Innovations in Physiotherapy Database.

Starting out 

Clarity at every stage of QI is key to a successful outcome. 

Spend time clarifying:

• aims
• process, including identifying leadership and the patient voice
• measures that will demonstrate the pre-change state as well as the post-QI state

Sit down with colleagues who need to support and contribute to the QI process. Be clear why the change is required.

Without getting to the root of the problem you won’t be able to design the right aims, consequently the change won’t have the desired effect. 

Finding support

There is an abundance of resources available to help you. Most organisations will have a quality department which can also support by bringing the patient voice into a QI initiative. Most Academic Health Science Networks offer introductory training. Whether you work in a team or alone, there are some fantastic resources out there to help. Find a mentor who can help you navigate your way. The new Innovations iCSP network can help connect you with peers. The CSP’s Innovations in Physiotherapy database has more than 280 examples of innovation and improvement. You can use the resources there to inform, inspire and influence your thinking.  

Whatever your role, whatever your experience – whether you are a student, support worker or a consultant physiotherapist – you have a responsibility to get involved in improving your services. Be brave and don’t worry if it feels hard, there are many pitfalls when first embarking on QI work such as persuading your peers there is a problem or that your plan is the right one. Find someone to support you and make 2022 a year of QI!

Start small, and remember the words of Desmond Tutu:

There is only one way to eat an elephant: a bite at a time.

Resources: 

• The Health Foundation’s guide to QI
• The CSP’s Innovations in Physiotherapy Database
• University of Bath’s free online CPD course ‘Quality Improvement in Healthcare’
• Institute for Healthcare Improvement’s QI toolkit
• The Q Community
• King’s Fund resources