Team Based Quality Reviews (TBQR) across the Interface

An Interface Group in North Lanarkshire has begun conducting Team Based Quality Reviews (TBQR) across the interface with the aim of systems improvement. The team were supported by a Scottish Government initiative to spread the TBQR approach and increase adoption. TBQR use a 'systems thinking', multi-disciplinary approach to issues such as significant adverse events, negative (or positive) clinical outcomes and patient feedback. The aim is to provide team learning through a systems-based approach.

In North Lanarkshire, the Clinical Lead for Patient Safety is leading work across the University Hospital Monklands site to implement TBQR in a number of areas, using the Human Factors based Systems Engineering Initiative for Patient Safety (SEIPS) process. TBQR have been used at the interface, bringing primary and secondary care representatives together.

The TBQR meeting is a structured discussion, which begins with an explanation of the SEIPS process, ensuring the format and purpose are clearly understood. This introduction helps clarify the role of attendees and emphasises that the focus is on identifying improvements rather than assigning blame. The Interface Group reviews a selection of cases, examining each from the first presentation in primary care through to the final outcome. Patient safety is central to this approach, with systems thinking used to explore the interacting factors that contributed to the outcome and to identify ways to prevent similar issues in the future.

The strength of this work comes from conducting the reviews in a mixed-speciality environment. By bringing together GPs, secondary care physicians, community team members and pharmacists, the Interface Group creates a space where different perspectives can be explored openly. Through the discussion, the group can then identify learnings within the control of the group that can be actioned directly, as well as learnings outwith the control of the group that are escalated to the relevant departments across NHS Lanarkshire. After the meeting, a one-page summary is produced to outline the key learnings as well as next steps for taking them forward.

This collective approach supports the group to agree on practical, cross-interface actions that will improve outcomes going forward.

For more information on this case study, please contact scotland.interface@rcgp.org.uk