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OpenQI - Brighton innovation forum presentation Jan 2014
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OpenQI - Brighton innovation forum presentation Jan 2014


Presentation of OpenQI at the Brighton innovation forum Jan 2014.

Presentation of OpenQI at the Brighton innovation forum Jan 2014.

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  • The Healthcare industry is such a dynamic and ever changing system, there is constant drive for improving quality to benefit our patients. The time has come for everyone in the NHS to take this very seriously.
  • As from 2010, all healthcare organisations are required to publish a yearly quality report to the public about the quality of services. Part of this include clinical audit and quality improvement activities within trust. External monitoring groups include Care Quality Commission (CQC), NICE, NCEPOD and NHS Litigation Authority, NCAPOP 
  • The General Medical Council’s document, Good Medical Practice, makes clear doctors’ obligations to participate in clinical audit.
  • Clinical audit plays an important part in the drive to improve quality of patient care and thus forms a cornerstone of clinical governance. On the surface this has been dealt with through the compulsory involvement of junior doctors in clinical audit, as one of the pillars of clinical governance. 
  • Having taken part in audits in several different departments and hospitals in the last few years, I started to question the value of clincialaudits, and whether I was making any real contribution to patient care, or it is instead a data collection and tick-box exercise. I then realised that many doctors around the country share the same frustrations.
  • 2 years ago, after presenting my audit work at a Quality improvement conference hosted by The Network, and sharing experiences with people passionate about QI, my views on clinical audits changed…
  • I realised that clinical audits are a part of the wider goal of quality improvement. Instead of conducting audits to mealy collect data to measure against a standard. True quality improvement is about investigating real problems, identify solutions, and working in a team to raise standards.
  • I begin to see so many things happening everyday at work that can be improved… As much as we would like to improve quality, it all just seems like a blurry dream. The amount of support varies greatly between departments.
  • Severalmonths ago, I had an interesting twitter conversation with a gastroenterologist about QI projects. I asked her how support there are to help juniors make changes in clinical practice, and I was really inspired about her comment here… and thought, why can’t all departments have a supportive and encouraging environment like this? A QI corner for each department.
  • As all these doctors are required to do clinical audits, it is logical to engage junior doctors directly to support the trust’s and clinical services’ clinical audit programmes. – HQIP Guide to involving junior doctors in clinical audit.Junior doctors’ clinical audits can contribute directly to meeting the external requirements and expectations of an NHS trust. (CQC, NHSLA)
  • Collating the data from several “Audits of clinical audits”, the rate of completion of audit cycles are shockingly low. The question is, what happened to the 83%. What have we gained or learnt from them?
  • With such a low rate of project completion, it is not surprising that only a small amount of projects led to any change.
  • So what is going on?
  • There are 3 key elements to which barriers to undertaking valuable projects.
  • The question is: Is there good resources for doctors to come up with project ideas? Sometimes, the idea has already been done, and simply forgotten or discontinued because it didn’t work. Sometimes great project ideas are done in other hospitals which are reproducableWe just don’t have a easily accessible way to find out what has been done locally.
  • Important matters in clinical practice are more likely to lead to change in practice. When a doctor rotates into the new clinical environment, it takes a significant amount of time working in that environment before they can identify areas to improve. It is not easy to find the priorities of a department and formulate a project that is important enough to drive positive change.
  • Whenintiating a project. It is important to ask if similar projects has been done in the past to prevent “reinventing the wheel”. But without a simple way to find out whats been done in the past, we cannot grow and improve from prior knowledge.
  • Our telephone survey of 10 hospital audit department showed that all departments are required to take part in audits / QI.
  • Whilst BSUH have developed a clinical audit database, we believe this is underutilized because it is not accessible on the internet, it lacks follow up and feedback.
  • We need cohorts to pick up from previous projects, but this does not always happen. It needs to be driven by the leader of the project, and there needs to be more robust way to monitor of audit activities within each department so that projects can be recorded and handed over for later cohorts.
  • If all projects were strictly entered and monitored on an online data base. It would be easier to monitor and ensure projects are continued and completed.
  • If projects are not registered on a database, there is no record of it ever happening. Important learning points from these are simply lost.
  • It is very important to share the successes in our work, but failures are just as important lessons to be learnt. When a project didn’t go as planed, the department should learn from this so there is a better strategy in the future.
  • Similar identified problems are faced in the workplace at different departments and hospitals, however sharing of lessons learnt from local projects nationally tend to be poor. Collaboration and shared learning are key elements of successful projects.
  • Networking between departments and trust is the important part of the bigger picture. As healthcare become more standarlised, we can certainly learn a lot from what others are doing.
  • There are many ways to share ideas and form collaborations. However, these are prone to selection and publication bias. Negative results have just an important role in our learning and improving quality.
  • We went to the NHS hackday last year and realised how much innovative potentials, IT can have on improving our healthcare system.
  • And we really felt that we should embrace technology and
  • Perhaps there is a way using IT to provide a solution
  • We went to NHS hackday 2014 at Cardiff University and started building OpenQI.. And we will show you a demo of what our team has built in 2 days.


  • 1. OPEN QI MANAGE, SHARE, COLLABORATE Dr Conrad Lee (BSUHT) Dr Michael George (PHT)
  • 2. The NHS strives for continued quality improvement and innovations
  • 3. The Care Quality Commission requires all organisations to submit a Quality Account
  • 4. “You must take part in systems of quality assurance and quality improvement to promote patient safety.” - GMC Good Medical Practice 2013
  • 5. It is now compulsory for clinicians to participate in clinical audits, as one of the pillars of clinical governance.
  • 6. Clinical Audits?
  • 8. #FMLMQI twitter chat
  • 9. NHS trusts that have junior doctors have a built-in supplement to the clinical audit workforce.
  • 10. Are we utilising this process effectively to improve care quality and educate our staff?
  • 11. Multiple studies show substantial improvement in clinical care is only possible through completing audit cycles.
  • 12. Only Singh et al 2013 Venkatesan et al 2011 17% of clinical audits were Gnanaligham et al 2011 Iqbal et al 2010 Completed Guryel et al 2008 John et al 2004
  • 13. 5% Only of audits led to any change in the practice or process studied
  • 14. Considerable time and resources are wasted on projects that get
  • 15. ?
  • 16. Project initiation Project management Collaboration
  • 17. Project initiation
  • 18. Where are the resources to help generate good QI project ideas and design?
  • 19. What are the priorities of my department?
  • 20. Frontline staff often see practices that can be improved… but where can they collate these ideas?
  • 21. How can we stop reinventing the wheel?
  • 22. Kent Surrey Sussex Out of 10 hospitals surveyed in KSS… All hospitals take part in QI.
  • 23. Kent Surrey Sussex Out of 10 hospitals surveyed in KSS… All hospitals are require audit projects to be registered
  • 24. Kent Surrey Sussex Out of 10 hospitals surveyed in KSS… only 1 have an online audit database that is openly accessible to their clinicians.
  • 25. Project management
  • 26. With frequent changeovers of clinicians ... There simply isn’t enough time for re-audits to be done in a single clinical rotation.
  • 27. ? No robust project management tool for departments/ trust
  • 28. Good QI Projects are just evaporating into thin air…
  • 29. Tell people how you did… If you succeed, explain what was key to that success; If you fail, tell people why this happened. ” Going beyond audit – Riaz Dharamshi, Toby Hillman
  • 30. Networking & Collaboration
  • 31. “It is a bold agenda. We need to not just innovate, but also be sure that we are sharing those innovations all across the country” – From innovation to Action: The First Report of the Health Care Innovation Working Group
  • 32. Current collaboration methods The Sharing Good Practice event KSS prize day Clinical Audit Support Centre (CASC) annual junior doctor clinical audit conference conferences The Clinical Audit Support Centre , Leicester Journals Online National Clinical Audit Forum (NCAF)
  • 33. Senior involvement and MDT approaches are key to bringing change in clinical practise
  • 34. What … • An electronic platform for storing and sharing ideas / projects • Facilitate ease for healthcare professionals to monitor and manage QI projects • Readily and freely available on the internet • Online support and collaboration
  • 35. We should embrace the technology!
  • 37. Benefits - in summary • Increase and streamline QI activity • Greater control of QI projects • Improve continuity and completion of projects • Encourages collaboration and sharing of ideas
  • 38. Collaboration • Software compatibility • First step in regional collaboration
  • 39. The proposal • Resources and expertise to help develop and maintain this online platform • Senior / trust involvement in educating doctors in QI and increase awareness of the online platform • Structuring responsibilities
  • 40. "Our vision is that someday, through OpenQI, each hospital can share, learn, and be proud of every single Quality Improvement project they have done.”
  • 41. Acknowledgments Craig Thomas (Web developer, Cardiff) Dr Sebastian Yuen (Consultant Paediatrician, Bristol) Jo Carter (Director of SatoriLab, Cardiff) Nick Theodorou (Project manager, London)
  • 42. Acknowledgments Mark Renshaw (Deputy Chief of Safety) Eirwen Record (Clinical audit facilitator) Tom Roper (Clinical Librarian) Mr Anil Ghosh (General Surgical Registrar)
  • 43. References • •“Audit of audits in an orthopaedic university teaching hospital: eight and a half years of experience” R Singh et al; Ann R Coll Surge Engl (Suppl) 2013; 95: 59-61 •“Auditing orthopaedic Audit” E Guryel, K Acton, S Patel; Ann R Coll Surge Engl; 90: 675-678 •“Going beyond audit” Dharamshi, T Hillman; BMJ careers 2011 •“The way we see it: Quality improvement” T Hillman, A Roueche •Venkatesan M,Amin RB,Armitage A. Standards and effectiveness of the orthopaedic quality improvement process: review of a decade of audit database. OJCA 2011; 3(2). •Gnanalingham J, Gnanalingham MG, Gnanalingham KK. An audit of audits: are we completing the cycle? J R Soc Med 2001; 94: 288–89. •C M John, D E Mathew, M G Gnanalingham. An audit of paediatric audits Arch Dis Child 2004;89:1128–1129. #OpenQI THANK YOU @OpenQI Dr Michael George @drmgeorge87 Dr Conrad Lee @ckwl1