Junior Doctors and Quality Improvement – new blog

Dr Natasha Doran is a Senior Research Fellow South West Academic Health Science Network (SW AHSN) and an Honoury Research Fellow at the Universities of Bath and Exeter.  She talks to us about the qualitative study she carried out on involving Junior Doctors in Quality Improvement (QI) across the South West. The evaluation was commissioned by SW AHSN to understand the long-term benefits of a QI programme delivered across the South West.
“We wanted to carry out a qualitative study to explore junior doctors’ perceptions and experiences of the South-West Foundation Doctor Quality Improvement (QI) programme. This programme was set up in August 2010, and has now spread across 10 hospitals. To date, over 1000 doctors have completed the programme and a total of 100 quality improvement projects have been, or are being run.”
“We decided to conduct a longitudinal study using semi-structured interviews with a group of junior doctors both before and after taking part in the QI programme (2014-2015), as well as a group of doctors who had completed the programme between one and five years earlier.
Our sample consisted of 15 junior doctors, made up of 9 female and 6 male with an age range of 22 – 37 years. We carried out 22 interviews with these doctors at a number of locations across the UK.
We looked at various themes, including their initial perception of QI and change processes as well as any changing attitudes and perceptions. It was very interesting as quite a few junior doctors were fairly sceptical before the programme about whether they could make any direct and meaningful changes to the processes and systems of care within their hospital and then saw that making a small adjustment could produce really good results.”
Examples of the QI projects include: Improving the safety and timeliness of warfarin prescription; Improving the safety of weekend handover on hospital wards and Improving access to Trust guidelines for junior doctors.
Our study found that carrying out a QI project during their F1 year offsets initial scepticism among junior doctors about the value of QI in healthcare and that seeing improvements for patients reportedly raises their self-confidence and self-belief. Essentially junior doctors felt more empowered in their role to both provide and improve care and given the right support structures, they are ideally placed to engage in QI.
Quotes from our interviews include: “We did a QI project based on improving care in the hospital at night and we linked in with some of the senior consultants and management and it enabled us to have a voice with the more senior people”
“There’s a huge potential to improve systems and improve patient care as a result of that,  which I wasn’t really aware of before.” 
“I think lots of junior doctors, they don’t feel like they can make a difference, but what was evident from our QI project  is […] if you put the work into it, then it can make a big difference to patient safety” 
 “Even if it’s something small, done by one person, you can make big changes. And it’s not always easy to change a culture, but the more attention is paid to it, then the more can be changed”
Our study lends weight to the argument that training in QI at the start of their medical careers enables a new generation of doctors to enhance patient safety and improve quality of care as their careers develop.
If you would like a copy of the evaluation study please contact joanna.pendray@swahsn.co.uk or n.doran@exeter.ac.uk