Quality (improvement) over quantity

01 May 2019

Dr Charlotte Holroyd, Senior Consultant

The NHS aims to deliver excellent clinical care to patients and their families across the UK. In the context of considerable strain due to rising demand, financial constraints and workforce shortages, Quality Improvement (QI) in the NHS is more important than ever.

QI is a systematic approach to identify areas for improvement and implement changes to enhance care and patient outcomes. Each day, hundreds of individual QI projects are undertaken by healthcare teams across the NHS. The question is, how can we ensure that this effort is delivering quality over quantity?

Share success

QI projects are often developed when healthcare professionals identify an area of change within their own clinical environment. In many ways, this ‘bottom-up’ approach is integral to the QI process. Healthcare professionals have a unique insight into the intricacies of their working environment and thus how the delivery of care could be improved. However, it can be argued that this ‘local’ approach may limit the wider positive impact that individual QI initiatives could have across different specialties or healthcare providers.

QI is gaining momentum and routinely sharing successes across specialties, Trusts and nationwide is key to enhancing patient outcomes. During my clinical training, I witnessed first-hand how QI successes can be implemented in different hospitals and co-led a project within my department to successfully introduce a well-established proforma to improve the quality of handover in obstetric anaesthesia1. National programmes are currently working to enhance shared learning and best-practice across the NHS, demonstrating the scalability of QI and its potential to improve patient care.

Be systematic

Although many QI projects are developed locally, QI methodologies should still be systematic. There is a drive to provide healthcare professionals with tools and frameworks from which to design their QI initiatives, thus increasing efficiency of the QI process and enabling results to be shared more easily. NHS Improvement have developed a series of nearly 100 Quality, Service Improvement and Redesign (QSIR) tools available online to provide healthcare professionals with a framework for their QI design: https://improvement.nhs.uk/resources/quality-service-improvement-and-redesign-qsir-tools/.

In addition, the Royal College of General Practice has provided a free ‘QI Ready’ resource for GP practices to guide QI activities: https://qiready.rcgp.org.uk/.

Provide training

Participation in QI is part of the role of a doctor and is a requirement for GMC revalidation3. Previously, trainee doctors would have undertaken clinical audit projects with little formal training. However, the scope of QI initiatives has expanded significantly in recent years and The Academy of Royal Medical Colleges recommends incorporating a curriculum of QI activity at all stages of medical training3 which will equip professionals with relevant skills, as well as building capability and leadership.

QI is not simply a current ‘buzzword’ in the NHS but a mindset backed by a series of methods and tools that will help ensure continuous improvement for patients today and tomorrow. If you are interested in finding out more about quality improvement you can find out more from PPL here: http://pplconsulting.co.uk/perspective/the-planning-is-over-and-winter-has-begun.


  1. https://bmjleader.bmj.com/content/1/Suppl_1/A2.1
  2. https://www.gmc-uk.org/registration-and-licensing/managing-your-registration/revalidation/guidance-on-supporting-information-for-appraisal-and-revalidation/your-supporting-information—quality-improvement-activity
  3. http://aomrc.org.uk/wp-content/uploads/2016/06/Quality_improvement_key_findings_140316-2.pdf