Quality improvement lessons from the US

After a year at the IHI in Boston, being back in the hospital is a pleasure, not least as I can see patients and support their care, something that was more abstract when on the Quality Improvement Fellowship.

However in the acute sector, as everywhere else, we are seeing large reviews of staffing structures and arrangements. I recall some of the discussions we had with the sites we visited in the US: the challenge is trying to unravel the customary way we do work and in difficult times rethink completely how best to put a service back together.

During the year at the IHI we all became acutely aware of the value of the patient’s viewpoint in the dialogue. The result was a real understanding of what mattered to the patient and family in the care pathway rather than what made sense to the system. I am trying to find ways to introduce this idea in my job back here in the UK.

We need to harness the positive energy that already exists, but hospitals run at such a pace and with continuous capacity issues this can seem impossible.

In the US we saw the rigour and discipline of a 90/120-day cycle of 'research, test, adjust and present ready to implement’ work well at Bellin Health and Virginia Mason. I’m planning a mini version of this in my own department, limiting the projects to three at once. But the most important thing is asking 'what are we trying to achieve?' and clearly defining this before we start.

I’m most concerned about the new medical staff starting their career in such turbulent times. I’ve started a weekly drop in hour for them to talk and have lined up some specific presentations to share some of the concepts we explored on the fellowship, including the work we did on structured communication and patient involvement. I’m keen to understand their perspectives on this and hope it gives them greater understanding of the complexity of healthcare.

Having unboxed my Boston papers I realise how much we packed into our fellowship year. Each day I see an area that will benefit from some waste removal or greater patient input into design.

Now I can refer to a library of examples and contacts as well as direct experience of other systems of care. I feel a greater optimism myself and you this has a wonderful effect on the team. Hope and optimism, as Marshall Ganz told us, is necessary for collaborative, community action. Sometimes we seem to forget this in meetings and debates. My daily task is to put that hope back on the table.

Tricia is a Health Foundation Quality Improvement Fellow and Consultant Radiologist at Weston Area Health Trust.