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Becoming a clinician scholar

By extending and expanding our knowledge work skills as clinician scholars in our daily clinical practice, we also start to develop our confidence.
Paramedic taking a lady's BP at home (Source: CDC)
© Unsplash @CDC

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.
Is this similar to a challenge you have faced in practice? Comment in the section below to share your experience with others!
It is an opportunity for a quality improvement activity. QI has been described as the use of methods and tools to continuously improve the quality of care and outcomes for patients. QI matters for our patients and health system, but also for each of us individually, and for the teams we work in.
Previously we have considered applying knowledge work skills to manage clinical problems for individuals, but what about the bigger picture?
This is where QI comes in, the opportunity to apply the 4 principles of knowledge work to discover what works and what doesn’t, to integrate that information into an explanation for the change, to apply this idea by generating suggestions for change and implementing modifications that we can all learn from. To complete the QI cycle the next stage is to critically reflect on what went well and what needs changing for next time.
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.

© University of York/HYMS
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