Guidance on supporting information for appraisal and revalidation

Your supporting information – quality improvement activity

The purpose of collecting and reflecting on quality improvement activity

  • To allow you to review and evaluate the quality of your work.
  • To identify what works well in your practice and where you can make changes.
  • To reflect on whether changes you have made have improved your practice or what further action you need to take.

The GMC’s requirements

  1. You must discuss with your appraiser or responsible officer the extent and frequency of quality improvement activity that is appropriate for the work you do.
  2. You must be able to show you have participated in quality improvement activity that is relevant to all aspects of your practice at least once in your revalidation cycle. However, the extent and frequency will depend on the nature of the activity.
  3. You should participate in any national audit or outcome review if one is being conducted in your area of practice. You should also reflect on the outcomes of these audits or reviews, even if you are unable to participate directly.
  4. You should evaluate and reflect on the results of the activity, including what action you have taken in response to the results and the impact over time of the changes you have made, and discuss these outcomes at your appraisal.
  5. If you have been unable to evaluate the result of the changes you have made or plan to make to your practice, you must discuss with your appraiser how you will include this in your personal development plan for the following appraisal period.

Quality improvement activity can take many forms

55 Quality improvement activity can take many forms depending on the roles you do and the nature of your practice.

56 You should think about the activities or work in which you have been involved that has focused on quality improvement. Examples of these include:

  1. Review of your performance against local, regional or national benchmarking data where this is robust, attributable and validated. This could include morbidity and mortality statistics or complication rates.
  2. Review or audit of prescribing activity. This could include identifying lessons for improvement and compliance with clinical guidelines and early, routine reporting of adverse reactions and near misses.
  3. Clinical audit: This must be evidence of effective participation in clinical audit or an equivalent quality improvement exercise that measures the care with which you have been directly involved.
  4. Local audit: This must be evidence of effective participation in local audits of compliance with key safety alerts Case review or discussion. A documented account of interesting or challenging cases that you have discussed with a peer, another specialist or within a multidisciplinary team.
  5. Case review or discussion. A documented account of interesting or challenging cases that you have discussed with a peer, another specialist or within a multidisciplinary team.
  6. Learning event analysis
  7. Audit and monitoring of the effectiveness of a teaching programme.
  8. Audit of outcomes from clinical guidelines, devices and innovations recently introduced, including training received and any changes to practise.
  9. Evaluating the impact and effectiveness of a piece of health policy or management practice.

Quality improvement activity should be robust, systematic and relevant to your work

57 The medical royal colleges and faculties provide advice on the type of activity that would be most appropriate for doctors working in particular specialities or general practice. Many specialities have robust and validated quality measures in place, such as national specialty databases. If you are in specialist practice you should consult your college or faculty advice.

Discuss and agree the frequency of your quality improvement activity with your responsible officer

58 You must discuss with your appraiser or responsible officer the extent and frequency of quality improvement activity.

59 The extent and frequency of your quality improvement activity will depend on the nature of the activity itself and the work you do.

Reflecting on your quality improvement activity

60 At your appraisal you must reflect on and discuss your quality improvement activity. To show how these activities have impacted on your practice and made a difference to your work you should focus on:

  1. How the quality improvement activity you have carried out is relevant to your work.

  2. How you have evaluated and reflected on the results of your activity. This may be through reflective notes about the implications of the results on your work, discussion of the results at peer-supervision, team meetings, and contributions to your professional development.

  3. What action you have taken or plan to take in response to the results. This might include the development of an action plan based on the results of the activity, changing your practice following participation, and informing colleagues of the findings and any action required.

  1. Demonstrating whether an improvement has occurred or if the activity showed that good practice has been maintained. This should be through the results of a repeat of the activity or a re-audit after a period of time where possible.