In this blog Dr Katie Richards, research associate, King's College London gives an overview of the key elements identified for boosting the effectiveness of quality improvement (QI) training at King's College Hospital.
Quality improvement (QI) is all about using specific methods, tools and data to really get to the bottom of complex problems and come up with and test solutions to these problems. Quality improvement training equips staff and patients with the knowledge, skills and confidence to use these QI methods and tools.
In UK hospitals, QI training and support is often provided by dedicated QI teams or staff. While training is needed for people to learn about QI methods and tools, the path from training to making a difference in healthcare services isn’t always straightforward. Healthcare services are complicated with many competing demands and constraints.
Developing a theory of change
To help us unpick this complexity, we created a theory of change for the QI training programme at King’s College Hospital. This theory of change is a diagram that lays out what activities and conditions are needed for the training to be successful (i.e., make a difference in services). We built this diagram by using information from workshops and interviews with hospital staff and patients. We tested and changed the diagram many times to make sure it reflected everyone’s views and experiences. Check out the theory of change diagram below.
View the Theory of Change diagram
“Working with King’s Improvement Science and using the Theory of Change to look at our quality improvement training programme has provided us with critical insights for strengthening our QI training, building capability and fostering a culture of improvement.” Lorraine Catt, Senior Improvement Manager, King’s College Hospital
Conditions needed for effective training
Overall, the QI training was well-received by trainees and seen as essential to provide people with the skills to improve. It was however not seen as enough on its own to improve care. Staff and patients identified several other activities and conditions needed to make the training effective. Leaders understanding and actively supporting QI was one of the most frequently mentioned factors. Leaders play a key role in creating an environment where staff and patients feel safe, supported, and empowered to share ideas and make changes. They also oversee and protect staff time for QI work. Other important activities and conditions mentioned in the study were:
- quality planning, assurance, control and improvement working well together
- engaging and plain language communications around QI
- making sure everyone, no matter their role, are listened to and involved in QI
- protected time for QI
- meaningfully involving patients and carers from the very start of a QI project and keeping them updated about progress and changes
- sharing and collaborating on QI within and outside the hospital
- making the training and data support as accessible as possible
- other practical support and resources, such as coaching and a QI website or platform.
How the findings have been used
The findings of this study have been used to provide insights into how the QI training programme and support could be strengthened at King’s College Hospital. Since the inception of the project, there has been a greater focus on communications around QI, proposed changes to the way the QI training is delivered, and the delivery of a meaningful involvement project that has successfully increased the patient and public involvement in QI at the hospital.
