BN (Hons) Nursing

Adult and Mental Health

M25606
Service Improvement Project:
Assessment Guidance
Module Coordinator: Lisa Hyatt
Welcome to your Service Improvement Project module. This module will bring together
your learning across the nursing curriculum. In particular, this module builds on what you
have learned in Evidence Based Decision Making and Engaging with Service Improvement
at level 5.

In this module, you will identify an area of practice that you would like to change. You will
explore the root causes of that particular issue, look at the evidence base for care in the
context of the issue, and present a proposal for testing and evaluating a change in practice
that will improve care.

It is expected that you will undertake independent study for this module: there are 20 hours
of timetabled contact time (which includes online seminars), and 180 hours of independent
study over the academic year. You will be assigned a project supervisor to support you with
your project and you have up to 6 hours of project supervision.

This guidance document will support you with the structure and expectations of the module
assessments, and is to be read alongside the general guidance for assessments within the
School for Health and Care Professions (SHCP) handbook available on Moodle. There are 2
assessment artefacts for this module: a project report and a conference-style poster.

Artefact 1: Service improvement project report (3500 words)

Artefact 1 requires you to articulate a problem you have identified in practice, the evidence for care
in the context of the issue and present a proposal for testing and evaluating a change that you feel
will improve care. You are expected to write at the required level 6 standard, which includes
supporting your ideas with academic references, and offering a critical analysis and synthesis of the
evidence base to support improvement in practice. The marking criteria for this assignment is
available here.

The report should fully discuss the problem in practice that you have identified and articulate the
root causes contributing to the problem. You should present your methodology for searching the
academic literature in a systematic way, the results of the papers that have been retrieved and a
discussion of how the findings have informed your recommendations for a future improvement
project. The report culminates in your proposal for testing and evaluating an idea for change.

As this is a theoretical project, you will not collect data while in practice, but you are expected to
demonstrate an understanding of how data is important in testing and evaluating change.

As it is expected that you undertake individual study for this module, the layout and structure of your
project report is entirely for you to decide, as long as you meet the requirements of the marking
criteria. You are expected to make good use of tables, diagrams, charts, text boxes and images in the
main text of your report. These are not included in the word count of the assignment, but will be
marked. You can make use of subheadings to provide clarity to your work. You are not expected to
include appendices, unless you wish to include information which is not your own work to add

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context or clarity to your report (for example, including a NEWS2 chart, or checklist that is in use in
your setting). The total word count for this assignment is 3500 words.

You will be assessed on how you manage the project process, including how you engage with your
supervisor, therefore it is important that you work professionally with the supervisor allocated to
you. The marking criteria for artefact 1 shows what is expected to achieve good marks for your
management of the project process. There will be a suggested template for you to record your
project management process available to you on Moodle.

The following is a suggested structure for your report. There are suggested word counts for each
section in brackets.

Title

The title of your project report should accurately reflect what your improvement project is about. For
example, ‘Improving fluid balance chart documentation in an acute medical ward’.

Introduction (around 700 words)

Why did you choose this topic?

You should start by introducing the particular issue/problem you have met in practice and why this is
a concern. For example, you have observed an aspect of care requiring improvement, a local clinical
audit has identified below standard care, or a patient or member of the public has provided feedback
on an aspect of care that could be improved. You should clearly articulate why this is an issue,
supporting your ideas with academic references. You may want to reference particular clinical or
professional guidelines, policies or standard operating procedures (SOPs) that you feel care is not
aligned with.

Your introduction should examine the root causes of the particular issue you have described, with
reference to academic literature to support your ideas. Within the lectures for the module, you are
introduced to the fishbone diagram (Ishikawa, 1968) to help you piece together the contributing
factors to a particular problem. You could include a copy of your fishbone diagram in your report to
help illustrate the many factors involved in the issue you are describing, and the complexity of the
systems involved in providing care.

The introduction should conclude with a selection of one of the root causes from your fishbone
diagram, and a justification for this with support from academic references, to move forward into
your literature review.

You should end your introduction with an aim for your project overall, i.e. to understand the context
and circumstances behind the problem you are looking at in more detail in order to propose a
change likely to elicit a service improvement.

Literature review (around 1500 words)

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It is important to undertake a literature review to understand the evidence for care in the context of
the problem/issue you have selected from your root cause analysis. The literature review should
explore your problem/issue in detail and also potential solutions to the problem. For example, if you
would like to improve the documentation practices of a team, you could explore the barriers and
facilitators for staff in completing the documentation, and also identify how the barriers have been
resolved in other settings. Guidance on your literature review can be sought from your project
supervisor.

The purpose of this literature review is to fully understand the problem and its contributory factors,
therefore you are able to include original research, systematic reviews, and non-research
publications in your literature review. This type of review is known as a rapid review and is designed
to gain as much knowledge about a topic with limited resources (Ganann, Ciliska & Thomas, 2010).

In your report, you will need to articulate the following:

Literature search methodology: what did you do to find the papers you will review?

This section should clearly document your approach to finding the relevant literature in a way that
someone else could take your strategy and retrieve the same papers. You may need to do several
searches in order to fully understand the context of the problem. Your supervisor will be able to
provide guidance on this, in relation to your specific project.

You should have clearly defined inclusion and exclusion criteria (methodology, publication year,
translations, international studies etc.) and provide a justification for these, with the support of
academic references where appropriate.

You should have a clearly explained and justified search strategy, including the databases that you
used to search for literature (for example, CINAHL, PsycINFO, MEDLINE, PubMed, Cochrane, etc.). You
should also have a strategy for searching the grey literature. The search strategy should include
justification for how you decided which search terms you used, and the steps you took to refine the
search such as using Boolean operators, wildcards and truncation.

You should record the number of results you gained at each stage of your search and should normally
present this using a PRISMA flow diagram such as this (Moher, Liberati, Tetzlaff & Altman, 2009).

Literature search results: what did you find?

In this section you will describe the papers you have found in your search and their findings. You may
wish to consider presenting the key results in a table within the main text of your report.

Literature search discussion: what were the key themes identified in the literature? What is your
rationale for your proposed change?

It is expected in this section that you consider the strengths and limitations of the included papers,
and the limitations of your literature search. You could use a critical appraisal tool to support you,

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e.g. Critical Appraisal Skills Programme (CASP; 2019), or the critical questions table introduced in the
SIP module (Wallace & Wray, 2016). If you are using a CASP checklist, you should ensure that you
select the one most appropriate for the type of paper you are reviewing.

You should offer a synthesis of the papers you have read, bringing together key themes from each of
the papers and relating them back to the issue you have observed and the relevance to your project.
This section should culminate in providing a rationale for the improvement that you are proposing.
This will involve returning to what you set out to do and discussing your findings in the context of
what you initially identified - what have you learned and how has that informed the change you
propose to make?

If you have identified several possible change ideas to explore, you should present a rationale for
prioritising one idea to take forward into your literature review, drawing on academic references to
help support your ideas.

The literature review should end with an aims statement for the next part of your report, indicating
your specific idea for change.

Implementation Strategy (around 1000 words)

In this section of your report, you will draw on improvement science methodology, and leadership
and change management theory to describe how you propose to implement, test and evaluate your
change idea in practice. This should include providing full details of the change to be made, with
academic references supporting your ideas where appropriate. Please be mindful that there are
many non evidence-based business websites describing organisational change and quality
improvement. It is expected that you think critically about the sources you reference to support
your ideas.

You could use the Model for Improvement (Langley et al, 1996) as a framework for structuring this
section of your report. However the structure of this section is entirely up to you as long as you meet
the criteria described in the marking rubric, and the work you present flows well.

In addition to describing how you will prepare for and implement the change, you should include a
critical discussion on:

Who will be involved in the change?

This includes describing who will be in your improvement team leading the change in practice, as
well as identifying the key stakeholders who will be affected by the change you are proposing. You
should also include information on how you will work with patients, families and carers in the service
improvement.

How will you communicate with your key stakeholders?

You should present a strategy for the communication of the intentions of your project to your key
stakeholders, with a rationale for the method, content and frequency of communication to each
stakeholder based on their relative power and level of interest in the project (Mendelow, 1991). For
example, this may be through social media, team meetings, organisational publications, emails or

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team huddles. Ensure that you have academic references to support your choice of communication
method.

How will the change be managed?

Here you should discuss the psychology of change, drawing on key change theories, e.g. diffusion of
innovation (Rogers, 2003), to help understand how stakeholders in an organisation may respond to
change, what you might look out for and how you will support people who seem to be resistant to
change.

How should the change be evaluated and how long for?

You should provide information on how you plan to test the change, perhaps with a Plan, Do, Study,
Act (PDSA) cycle (Langley et al, 1996) or similar framework.

You should detail what data you might collect to evaluate the success of the change. In the SIP
module, you will learn about having a ‘family of measures’ (Donabedian, 2005): outcome measures,
process measures and balancing measures, and presenting and analysing data to evaluate the
impact of the proposed change. You should consider how you might collect the data: perhaps
through an audit, a focus group, or by observing practice. You should also discuss how and when you
will make a decision on whether to adopt, adapt, or abandon your change idea.

Conclusion (around 300 words)

Lastly, as with all academic writing, you should present a short conclusion to your project report
where you reflect on where you started with the project and what you have learned whilst
undertaking it. You should also articulate the limitations of your project. You might also wish to
reflect briefly on what might be the next steps for utilising your improvement knowledge and skills as
a newly qualified nurse.

Artefact 2: Service improvement project conference poster (500 words)

Artefact 2 requires you to present a poster disseminating the key messages from your service
improvement proposal. There is a template poster on Moodle, which has been designed deliberately
bland so that you can get creative and put together a poster with impact.

It is key here that you don’t simply cut and paste sections from your project report, but you pick out
the key messages in each section and summarise them concisely, ensuring you meet the criteria
described in the poster marking rubric.

Your project supervisor can support you with the design and content of your poster.

References

Critical Appraisal Skills Framework (2019) CASP checklists. Retrieved from

https://casp-uk.net/casp-tools-checklists/

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Donabedian, A. (2005) Evaluating the quality of medical care. The Milbank Quarterly 83(4) 691-729.

Ganann, R., Ciliska, D. & Thomas, H. (2010) Expediting systematic reviews: methods and implications
of rapid reviews. Implementation Science 5 (56) DOI: https://doi.org/10.1186/1748-5908-5-56

Ishikawa, K (1968) Guide to Quality Control. Tokyo: JUSE

Langley, G.L, Moen, R., Nolan, T.W., Norman, C.L. and Provost, L.P. (2009) The Improvement Guide: a
practical approach to enhancing organisational performance (2nd edition) San Francisco: Jossey-Bass
Publishers.

Mendelow, A. (1991) Environmental scanning: the impact of the stakeholder concept. Retrieved from
https://pdfs.semanticscholar.org/3579/ca37344c69961bbc2468ef9addf212200e39.pdf

Moher, D., Liberati, A., Tetzlaff, J., Altman D.G. and The PRISMA Group (2009) Preferred Reporting
Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. British Medical Journal
339: b2535. DOI: 10.1136/bmj.b2535.

Rogers, E. (2003) Diffusion of Innovations (5th edition). New York: Simon and Schuster

Wallace, M. & Wray, A. (2016). Critical reading and writing for postgraduates. London: Sage.

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Appendix 1: Artefact 1 (project report) marking rubric

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Appendix 2: Artefact 2 (project poster) marking rubric

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Appendix 3: Template record of project process

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