Quality Improvement Project (QIP)

As a trainee you are in good position to identify areas of practice that frustrate you and that possibly have an impact on patient safety. During your primary care posts in ST1 /2 you are required to complete a quality improvement project with the aim of improving patient care. Audit is a type of QIP as both look at the quality of care provided with the aim of improving it and both require measurements to demonstrate change. More generally, QIPs can be about making small incremental changes and measurements which may be done weekly to test the impact of the changes. In contrast an audit has set criteria, each with their own defined standards, and has two sets of measurements over a longer time period, to demonstrate a baseline and then improvement. Completing a QIP allows change to be tested both quickly and successfully and is easier to do in a short time frame, for example in a 4 - 6 month trainee post. The QIP should be written up in the relevant section on the Portfolio and your supervisor will both assess and discuss this with you. 

How to undertake a QIP

There is a lot of information below with ideas for QIPs, if you are unsure what to do. Guidance on the tools used and completed templates which have been marked by supervisors are there to guide you. It is suggested you look at this section before starting your QIP. 

The Model for Improvement is a recognised tool for undertaking a Quality Improvement Project in a health care setting and can be used as a framework to help you. It asks three questions:

  1. Aim – What are we trying to accomplish?
  2. Measure - How will we know if a change is an improvement?
  3. Change - What changes can we make that will result in improvement?

First of all you need to decide what the aim of your project is going to be. 

Projects can be chosen following a significant event, a patient complaint; or an area of care you feel passionate about. 

Do not make your project too complicated; it needs to be completed within your primary care placement in ST1/2.

The project should aim to improve patient safety or care and be ‘SMART’.

  • Specific - do not make it too broad and chose something you are interested in. Words such as increase / reduce help to set a clear goal.
  • Measurable – ensure that there is something you can easily measure to demonstrate any change. It can be qualitative data (descriptive) as well as quantitative data (numerical data).
  • Achievable - ensure the data is easily collectable and keep the aims simple.
  • Relevant - project should be focused on patient safety.
  • Time defined – choose something that can be done in your time frame. You need to be able to complete your project in your primary care placement. 

For example a ‘SMART’ aim looking at doing 6 week baby checks in a timely manner could be ‘To improve the percentage of 6 week baby checks performed between the start of week 6 and by end of week 8’. 

The QIP template requires you to describe your QIP in logical steps. This is then reviewed and graded by your ES. word pictures to describe the grading for each section are below.

Introduction to QIPs

Training resources

QIP ideas and completed QIPS with ES feedback

Quality Improvement Project (QIP) - FAQs

Why do a QIP project?

The GMC is clear that all doctors in training will have to participate in Quality Improvement work throughout their training. The RCGP has designed a tool and process, which enables participation early in training.

When do I need to do the QIP?

The QIP project should ideally be completed in the your primary care placement whilst in ST1 or ST2. It is encouraged that you complete the QIP in the primary care setting, (assuming you have a GP post in their first two years of training, otherwise the assessment is required to be completed during the trainees ST3 year). You do not have to do 2 QIPs if you have a primary care placement in both ST1 and ST2.

Can I do my QIP in a non-primary care setting?

The idea of the QIP is for you to demonstrate your understanding of quality improvement and how this is evaluated. As GP trainees we would recommend this is done in primary care and the subject of your QIP is relevant to Primary care. If this is not possible for whatever reason, then the QIP can be done in a non-primary care setting but we would recommend you discuss this with your GP supervisor first as it is them who will need to mark the QIP and give you feedback.

Is it a mandatory assessment?

Yes.

What do I have to do?

You are required to undertake a QIP and then complete the QIP template demonstrating your learning and reflection. The project should be uploaded to provide proof of undertaking the activity in addition to completing the QIP template. Your GP supervisor assesses the QIP project and Portfolio entry and feedback is given to you by them, which should encourage further discussion. Guidance should be given by the local GP education team and/or utilising the wide range of resources available on the RCGP website to support this.

Can I fail the assessment?

The assessment is not a pass/fail exercise, however if you are consistently below expectations when assessed by your supervisor, it might be recommended to repeat the exercise, or a component of it and write a follow up learning log entry.

It is though mandatory to complete the assessment. 

What are the feedback levels?

You are given the following feedback levels: below expectation, meeting expectation or above expectation for each domain compared to the expected level of a GP trainee working in the clinical post.

What would an unsatisfactory QIP look like?

Indicators of an unsatisfactory QIP would include:
  • No team engagement,
  • No engagement of stakeholders (people affected by change including patients)
  • Minimal measurement
  • No real attempt at implementing change, just a discussion that change should happen
Please refer back to the RCGP WPBA QIP Word Descriptors to gain a further understanding of what is required within the project and write up.

Do I need to do any other QI activity during my training?

Yes. The GMC recommend that all doctors demonstrate involvement in Quality Improvement at least once a year. You are required to demonstrate that you regularly participate in activities that evaluate the quality and improvement of your work for the purposes of revalidation. When qualified, it is a requirement each year at your appraisal to demonstrate that you doctor have been involved in quality improvement activities (QIA). The definition of QIA includes a wide range of activities including Significant Events and Learning Event Analysis; this mirrors the broad definition for post-CCT doctors and ensures that you are equipped with appropriate quality improvement methods for lifelong competence. A new Quality Improvement Activity reflective learning log entry has been created to enable QIAs to be captured across the full training programme (which is separate from the required QIP in ST1/2) to enable trainees to annually reflect on QIA, as required by the GMC. The quality improvement activity should be robust, systematic and relevant your work. The QIA reflection should include an element of evaluation and action, and where possible, demonstrate an outcome or change. 

What is the difference between an audit and a QIP?

Both aim to improve patient care. Audits are more formal and tend to be done over longer time frame; an audit cycle includes setting a standard, collecting data, analysing the data, implementing change(s) and then repeating the cycle. Model for improvement is often used as framework to do QIPs. This has been shown to test changes successfully and quickly. The PDSA cycle is iterative (repetitive with the aim of approaching a desired goal and the results of each repetition used as starting point for next iteration). PDSA cycles can be done often e.g. weekly. They generally tend to generate enthusiasm and be less tiring.

Can I just do an audit?

No. The methodology is different (see above question). It is expected that specific quality improvement tools are used e.g. the model for improvement, Plan Do study Act (PDSA), process mapping, run carts, fishbone diagrams, driver diagrams and Gantt charts. See the RCGP website for further information on these tools. 

I don't know what to do my QIP on?

Ideally the QIP needs to be an identified need in the trainees local practice however there are lots of ideas on the RCGP WPBA website to help get trainees started.

What resources are available to help me?

There are a range of resources to help trainees and educators with marking and assessment of this project available on the RCGP WPBA website. These include training resources for individuals or schemes, mock examples and completed marking of these as well as a list of projects of this size which have already been completed at this stage in GP training. 

Which capabilities does the QIP map to?

The QIP contributes to evidence in the relevant capabilities: Fitness to practice; maintaining performance learning and teaching; data gathering and interpretation; working with colleagues and in teams; organisation management and leadership.

I have done a QIA, why is it not counted against my QIP?

The QIP is a new stand alone template and is counted separately to QIAs.
Page last updated: 6 January 2021 (added FAQ)

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