How to undertake a sustainability Quality Improvement Project (QIP)

In this video Professor Ramani Moonesinghe asks you to think about approaching quality improvement projects (QIPS) in a different way.

Professor Ramani Moonesinghe is an NHS consultant in Anaesthesia and Intensive Care Medicine at University College London Hospitals (UCLH). She is an Honorary Senior Lecturer at UCL and Director of the UCL/UCLH Surgical Outcomes Research Centre and NHS England’s national clinical director for critical and perioperative care and director of the Health Services Research Centre at the Royal College of Anaesthetists.In her NHS England role she was the clinical lead for the national critical care response to the COVID-19 pandemic.

What is ‘Quality Improvement’?

The following definition has been taken from Paul Batalden, Senior Fellow, Institute for Healthcare Improvement (IHI).

Quality improvement: “the combined and unceasing efforts of everyone – healthcare professionals, patients and their families, researchers, payers, planners and educators – to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)”

How do we use quality improvement in healthcare?

Within healthcare quality improvement uses a systematic and coordinated approach to solving a problem using specific methods and tools with the aim of bringing about a measurable improvement. (The Health Foundation)

Notable examples in the NHS include:

Perioperative Quality Improvement Programme (PQUIP)

How can we use quality improvement in creating a sustainable health system for now and the future?

• In 2001 the Institute of Medicine put forward a framework of 6 domains of healthcare quality to consider whilst improving quality.

Over the years we have seen how important quality improvement (QI) has been in improving healthcare globally.

• In the United Kingdom (UK) in 2018, the Royal College of Physicians (RCP) expanded on the Institute of Medicine’s six domains of quality to include sustainability!

What do you think about the RCP decision? Should all healthcare colleges, globally, include sustainability in their quality improvement frameworks?

Here are some examples of sustainability case studies that have used and are using a quality improvement (QI) method to great effect include:

• Great Ormond Street ‘Gloves Off’ Campaign. The original paper can be read here.
• NHS Wales: Decarbonisation Strategic Delivery Plan, which has set a target shift to 80% of inhalers being low Global Warming Potential (GWP) alternatives by 2025.
• Developing a quality improvement project to tackle the desflurane problem

If you have more examples of successful case studies using the QI methodology that you would like to share please add them in the comments box below.

In the UK the Centre of Sustainable healthcare (CSH) promotes the use of Sustainability in Quality Improvement framework (SusQI), which is an approach to improving healthcare in a holistic way, by assessing quality and value through the lens of a “triple bottom line”.

The framework has been developed to integrate sustainability into Quality Improvement (QI). It demonstrates how to apply sustainability to QI at four key steps of the QI process:

• Setting goals.
• Studying the system.
• Designing the improvement effort.
• Measuring impact.