Quality improvement activities

Every doctor is required to demonstrate how they review the quality of their work across their whole scope of practice.

The GMC says

The purpose of collecting and reflecting on quality improvement activities: 
  • 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

  • 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.
  • 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.
  • 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.
  • 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.
  • 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.

The RCGP recommends that you demonstrate the ability to review and learn from your medical practice by reflecting on representative quality improvement activities (QIA) appropriate to your scope of practice and circumstances every year, with a spread of QIAs across your whole scope of practice over a five-year cycle.

No fixed number of QIAs is recommended, as some will be very brief interventions, and others will be very significant projects. The RCGP recommends that you keep in mind the principle of providing documentation that is reasonable and proportionate and does not detract unduly from patient care, while ensuring that your QIA covers the whole of your scope of practice over the five-year cycle and demonstrates clearly how you review and improve the quality of your practice every year. If in doubt, use your professional judgement about what is appropriate and discuss your plans for the coming year with your appraiser.

You are advised to think about the quality not quantity of your QIA.

If you have not been able to evaluate or reflect on the impact of any QIA, then plans to do so should form part of your agreed PDP for the coming year.

Changes made should be shared and strengthened where they are an improvement, or reversed where they are not.

QIA may take many forms, including, but not restricted to, taking action as a result of:

  • cases - reflective case reviews
  • data - large scale national audit, formal audit, review of personal outcome data, small scale data searches, information collection and analysis (search and do activities), plan/do/study/ act (PDSA) cycles
  • events - learning event analysis (LEA) and significant event review (see the definition of a SE below)
  • feedback – improvement activities undertaken as a result of the outcomes of reflection on your formal patient and colleague feedback survey results, other solicited and unsolicited feedback, compliments and complaints.

For some parts of your scope of practice, particularly relating to specific clinical skills such as minor surgery, joint injections, cervical smears and IUCD/IUS insertions (where applicable), it is appropriate and necessary to maintain an ongoing log of personal outcome data and reflect on the outcomes at least once in the revalidation cycle.

If you are in a role where there is organisational, regional or national outcome data provided, the RCGP recommends that you demonstrate how you reflect on your personal involvement and respond to the information provided about your performance for your appraisal.

You do not need to have undertaken data collection personally, but your reflection should describe your personal involvement in the activity and what you have learned about your own performance in relation to current standards of good practice, including what changes you plan to make as a result, or how you will maintain high standards of performance.

Where appropriate to your scope of practice, the RCGP recommends you choose the best examples of your routine primary care learning event analysis to include as QIA to demonstrate how you review and learn from both positive and negative events and incidents.

All significant events, in which you have been personally named or involved, that reach the GMC defined level of harm, must be reflected on and declared as significant events (see below). It is likely that in many cases the learning from them will also lead to quality improvement activities.

Next: Significant events >

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