A practical guide to quality improvement

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 2 – T E A C H I N G A N D R E S E A R C H

A Practical Guide to Quality Improvement Crowe S, Sharma S. A practical guide to quality improvement. TOG 2017;19:71–6. doi:10.1111/tog.12354

4 ~1/3 4–6 mo PDSA CYCLE STAGES PRACTICE CHANGES NOT SUSTAINED TYPICAL PROJECT TIMEFRAME

DO N' T-M IS S FA C TS

  1. PDSA = Plan, Do, Study, Act – the core structured QI cycle; repeat as many times as needed to embed change

  2. ~1/3 of practice changes are not sustained without structured technique + staff/patient engagement

  3. Process map = visual record of every step/person in a patient journey – reveals rate-limiting steps, duplication, waste

  4. Driver diagram hierarchy: primary goal → primary drivers → secondary drivers → actions/interventions

  5. Run chart essentials: time on x-axis, data on y-axis, median line, goal line, annotated interventions – choose the metric before starting

  6. Good QI project = SMART; typical implementation timeframe 4–6 months

  7. QI engagement is part of GMC revalidation (Domain 2) and a mandatory trainee competency; Francis & Keogh reports back junior doctors as agents of change

  8. QI differs from audit: uses qualitative data (surveys, focus groups) as well as quantitative benchmarking, and focuses on local population needs

FOUR QI TOOLS AT A GLANCE

PDSA cycle Process map Driver diagram Run chart

ABBREVIATION KEY

QI — quality improvement IHI — Institute for Healthcare Improvement (US)

PDSA — Plan, Do, Study, Act SMART — specific, measurable, achievable, realistic, timely

NHS — National Health Service EROS — Enhanced Recovery in Obstetric Surgery

CQUIN — Commissioning for Quality and Innovation MDT — multidisciplinary team

GMC — General Medical Council

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — Crowe S, Sharma S. A practical guide to quality improvement. TOG 2017;19:71–6. doi:10.1111/tog.12354

Clinically reviewed by NHS obstetricians and gynaecologists

MRCOG AI is an independent educational tool. It is not affiliated with, endorsed by, or connected to the Royal College of Obstetricians and Gynaecologists (RCOG).

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