The Health Foundation’s Quality Improvement Fellowships aim to equip senior NHS clinicians with the tools and techniques of quality improvement. They aim to develop senior leaders who have the enthusiasm, experience and skills to promote quality improvement nationally and build organisational capability to deliver dramatically better care at the local level.
The Health Foundation’s Quality Improvement Fellowships aim to equip senior NHS clinicians with the tools and techniques of quality improvement. They aim to develop senior leaders who have enthusiasm, experience and skills to promote quality improvement nationally and build organisational capability to deliver dramatically better care at the local level.
Fellows spend a year in the USA working with The Institute for Healthcare Improvement (IHI) based in Cambridge, Massachusetts. The fellowship combines academic learning with the development of practical skills and techniques. On their return to the UK, fellows can use the skills and techniques they have learnt to make a positive influence in their own organisations.
Annette Bartley is a Quality Improvement Fellow. She is about to finish her year in the States, where she has worked on a project looking to meaningfully engage nurses and other frontline clinical staff in quality improvement.
“Quality improvement is often seen as someone else's responsibility, rather than a vital and important part of all healthcare professionals' role,” Annette explains. “Often staff at the cutting edge of care are too busy fire-fighting and doing the important job of caring. They don’t really have the time to reflect on how things could be done better.”
“I'm interested in supporting these staff, providing them with simple tools and techniques and helping to generate energy at the frontline for improving the quality of care for patients,” she continues. “Frontline staff are experts and often have the answers. We need to listen to them”
Taking time with patients
During her fellowship year Annette worked on a project, called ‘Transforming Care at the Bedside’, an initiative supported by the Robert Wood Johnson Foundation in collaboration with the Institute for Healthcare Improvement (IHI). The purpose of the project was to develop one or more models of care at the bedside to make care safer and more personalised for patients and more efficient and effective for staff.
For instance, the project aims to increase the percentage of time nurses spend in direct care with patients, from the current level of around 30 per cent to 70 per cent. This could be at the bedside in acute care but is equally as applicable to home and community hospitals.
“Staff are actively encouraged to generate ideas about improving care and the enthusiasm I witnessed as I visited the pilot hospitals across the States was unlike anything I have seen in my nursing career,” Annette comments. “Nurses really enjoyed the creative freedom of being able to come up with their own ideas, test them and make decisions about their effectiveness. They clearly and rightfully ‘owned’ quality in their units.”
“Early indications show some promising results,” Annette continues. “Adverse events have been reduced, cardiac arrest rates have plummeted, some units have gone without any patient falls for nearly a year, and patient and staff satisfaction is continually improving. One US pilot site, Cedars-Sinai Medical Center in California, has recently met the 70 per cent target, meaning that nurses there now spend almost double the amount of time in direct care.”
A key focus of the project is on teamwork. “The premise is that if you haven’t got the vitality and teamwork at the front line of care, then you’re not going to get the safety, reliability or buy-in and therefore you’re not going to get a good output,” Annette explains. “So the idea is that you not only address safety and reliability, but you also look at how to develop teamwork, how to keep staff energised and how to empower them.”
There is also an efficiency angle. “We look at which aspects of care really add value for the patient, as well as the things nurses or healthcare practitioners do that add no value and could be done by someone else or taken away. So it’s about looking at effective use of time and resources,” Annette says.
Benefits of the scheme
Annette has benefited both personally and professionally from the experience. “The fellowship was broader than just this project because it gave me an opportunity to visit another country and understand the complexities of different healthcare systems,” she says. “It made me really appreciate the value of the NHS."
"We had access to experts and took courses at the IHI and Harvard where we learned about the methodologies of quality improvement," Annette continues. "I also worked closely with the programme design team so I was able to experience first hand the thought and effort that goes into a programme of this nature. The fellowship helped create a network of colleagues and contacts, so when I go back to the UK I’ve got a variety of sources that I can call on to further develop this work.”
Annette already has plans to apply her learning from the fellowship back in the UK. “I’m based in Wales so I took this to the Welsh Government and they asked me to pilot the model in my own organisation, Conwy and Denbighshire NHS Trust, plus another in South Wales, to see if we can get the same results,” she says. “The idea is that we’ll have a model in the UK which will use a much more multidisciplinary approach and will show how teams can work together to achieve the best outcomes in terms of quality care.”
"The approach of ‘Transforming Care at the Bedside' has the potential to re-energise the nursing and healthcare workforce, raise staff morale and achieve real benefits for patients who after all are the very purpose of our being,” Annette concludes.
17 July 2007