Dr Malcolm Daniel Medical Lead for Quality Improvement

About me

Malcolm is a Quality Improvement Fellow, and Medical Lead for Quality Improvement and Consultant in Anaesthesia and Intensive Care at Glasgow Royal Infirmary.

He has been a Consultant in Anaesthesia and Intensive Care at Glasgow Royal Infirmary (GRI), part of NHS Greater Glasgow and Clyde, for 13 years. This is the largest NHS Board in Scotland, providing healthcare to 1.2 million people.

Malcolm graduated from the University of Aberdeen Medical School. Following his house jobs, he trained in general medicine in Aberdeen. He then trained in anaesthesia in Aberdeen, Glasgow and San Francisco. Malcolm’s clinical commitments are providing perioperative care to people undergoing vascular surgery, and clinical care in intensive care.

While undertaking research at the University of California, San Francisco, in the early 1990s, Malcolm became interested in linking published evidence to practice. He developed skills in evidence-based medicine, and was one of the founders of the Scottish Intensive Care Society Evidence-Based Medicine Group.

As a consequence of this and other work, he was asked to become a Clinical Adviser for NHS Quality Improvement Scotland to contribute to the development and design of quality assurance standards and reviews for anaesthesia services. The first round of self-assessments, reviews and reporting was completed in 2005. This was the first national review of anaesthesia services in the UK.

Malcolm is now the chairman of the project group responsible for the repeat review of anaesthesia services in Scotland looking at the progress that has been made since the 2005 reports. He led the Scottish Patient Safety Programme ICU work in GRI. The improvements made have been both dramatic and sustained in a way not  previously seen. This has led to reductions in adverse clinical outcomes such as ventilator-associated pneumonia, and catheter-related blood stream infections. In addition, work on setting and reviewing daily goals has contributed to a reduction in the average length of patient stay in ICU of 1.5 days.

Malcolm benefited from being appointed to the first cohort of the Scottish Patient Safety Programme Fellowship, which was supported in part by the Health Foundation. In his Quality Improvement Fellowship he will focus on how to improve patient flow. While Malcolm has made progress improving the patient flow at the ICU he works in, he is aware that flow must be improved across the hospital system.

The particular areas of patient flow he will look at are transfer of patients between different levels of care within a hospital, and smoothing the flow of elective surgical patients. These are both areas the Institute for Healthcare Improvement works on. Malcolm is interested in exploring the links between improvements in flow and improvements in patient safety, efficiency, and reduction in healthcare costs.   

NHS Scotland has just launched a new Quality Strategy which aims to put quality right at the heart of NHS Scotland. Building on the success of SPSP, the purpose of the strategy is to develop a system that delivers patient-centred, safe, and effective care, while ensuring efficiency, equity, and timeliness are embedded within the actions taken. The aim is to make Scotland a world leader in health care quality. Malcolm’s aim was to take what he learned and achieved in the fellowship year to contribute to this national Quality Strategy. Malcolm wanted to lead patient safety and quality improvement work locally in the hospital and NHS Board in which he works, and across Scotland.