Becoming a clinician scholar

Now, we have a new case study to help us think about how we can take a quality improvement idea from practice into a model for change that other practices can use and lead to wider improvements in patient care.

At a practice meeting your colleagues discuss the strain of increasing home visit requests. The partners consider how new allied healthcare professionals joining the team, including a paramedic, could help.

Back to this QI idea… You can’t find any evidence on the feasibility/ acceptability of paramedic home visiting. So, you suggest that you could evaluate the current home visiting process, in terms of how visits are triaged, what the criteria for visiting are and whether these are appropriate, the number of visits, and who attends. You find that some patients are requesting visits inappropriately when they are not truly housebound. You also determine several are done for reassurance when an examination wouldn’t make a clinical difference, whilst others patients could have been visited by the community matron. Where visits are needed, you find that the majority of queries are not necessarily complex, eg. a simple rash.

There are a wealth of resources out there to help you approach this QI activity, but at the heart of it is your critical creative knowledge work, which is informed by your general practice wisdom to generate new knowledge in your own context. You could use an ‘off the shelf’ (evidence-based) method for setting up a new service, however, by using your knowledge work skills you can shape, adapt and re-create this evidence base to fit your context.