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.
What is quality improvement activity?
- Quality improvement activity can take many forms depending on the roles you do and the nature of your practice.
- You should think about the activities or work in which you have been involved that has focused on improving the quality of your practice. This could include:
- Reviewing your practice against local, regional, or national benchmarking data where this is robust, attributable, and validated. It could include morbidity and mortality statistics or complication rates, and independently verified data where available for your specialty.
- 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.
- Learning event analysis
- Evaluating the impact and effectiveness of a piece of health policy or management practice.
- Audit, including:
- Review 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.
- 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.
- Local audit: This must be evidence of effective participation in local audits of compliance with key safety alerts.
- Audit and monitoring of the effectiveness of a teaching programme.
- Audit of outcomes from clinical guidelines, devices, and innovations recently introduced, including training received and any changes to practice.
- You must actively participate in quality improvement activity relevant to your scope of practice at least once in your revalidation cycle. The amount and frequency will depend on the scale and nature of the activity.
- The type(s), amount, and frequency of quality improvement activity that is appropriate for your scope of practice must be agreed by your responsible officer, suitable person or AA/PA recommender. Your discussion with your appraiser may inform this decision.
- You must take part in regular reviews and audits of your work, and your team’s work11, this includes taking part in any national audit or outcome review if one is being conducted in your area of practice. You must reflect on the outcomes of these audits or reviews, even if you are unable to participate directly.
- You should evaluate, reflect on, and discuss the outcomes of the activity at your appraisal. This includes what action you have taken in response, and the impact over time of the changes you have made.
- 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.
Guidance on quality improvement activity
- The medical royal colleges and faculties provide advice on how different types of quality improvement activity can be undertaken by doctors, AAs and PAs working in their specialities. 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.
- The amount and frequency of your quality improvement activity will depend on the scale of the activity itself and the work you do. Undertaking the activity should allow you to fulfil the purpose of collecting and reflecting on quality improvement activity.
- Some quality improvement activities require more resource and time to undertake and evaluate the impact of, than others. This will influence how frequently you are expected to undertake quality improvement activity within a revalidation cycle.
Reflecting on your quality improvement activity
- You must collect, reflect on, and then discuss your quality improvement activity at your appraisal. You should reflect on your quality improvement activity in the same cycle the evidence was collected in.
- Your reflection should focus on:
- How the activity you carried out is relevant to your work.
- How you 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/or contributions to your professional development.
- What action you have taken, or plan to take, in response to the results. This might include developing an action plan based on the results of the activity, changing your practice following participation, and/or informing colleagues of the findings and any action required.
- 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.
11 Gmp 2024 para 13b.