Patient Safety & 

Quality improvement
Presentation drawn together by Dr Fiona Hignett – Paediatric Registrar, Wessex.
With thanks to:
Kate Pryde (consultant paediatrician, Southampton Children’s Hospital)
Matt Smith (consultant anaesthetist Derriford Hospital, Plymouth)
The Royal College of Paediatrics and Child Health is a registered charity in England and Wales (1057744) and in Scotland (SCO38299).
Curriculum overview – Patient Safety &
Safe Prescribing
Learning outcome
Level 1 Establishes the importance of safe
prescribing and prescribes commonly used
medications in an appropriate manner;
recognises when a patient has been exposed
to risk and escalates care in accordance with
local procedures.
Level 2 Applies safety procedures to prescribing
practice. Applies appropriate procedures to
both prescribing and clinical care situations,
and takes safe action when presented with a
risk; identifies potential risks and plans how to
mitigate them.
Level 3 Participates in investigating, reporting and
resolving risks to patients, including through
communication with patients and families or
carers.
Evaluates safety mechanisms across a range
of healthcare settings, applying a reflective
approach to self and team performance.
Key capabilities
 Adhere to the local process following a medication error.
 Prescribes commonly used medications safely.
 Follows the local processes for reporting serious incidents and risks.
 Applies safety procedures to prescribing practice.
 Applies safety procedures to clinical care situations, reacting to
identified risks.
 Identifies and works towards avoiding and/or mitigating potential risk.
 Advises CYP and their families about the importance of concordance,
and about medications and their side effects.
 Takes account in their practice of risks to themselves and others,
including those related to personal interactions and biohazards.
 Participates in investigating, reporting and resolving serious incidents,
including through communication with patients and families or carers.
 Applies the principles of the Duty of Candour.
Underpinning knowledge
Patient safety
priorities and
risk
management

Patient
The ethics of safety & Learning from
prescribing safe errors
prescribing

Knowledge of
formularies
and
guidelines
Curriculum overview – Quality Improvement
Learning outcome
Level 1 Applies quality improvement methods (e.g.
audit and quality improvement projects) under
guidance.
Level 2 Independently applies knowledge of quality
improvement processes in order to undertake
projects and audits that enhance clinical
effectiveness, patient safety and patient
experience.
Level 3 Identifies quality improvement opportunities
and supervises healthcare professionals in
improvement projects, and leads and
facilitates reflective evaluations.
Key capabilities
 Demonstrates the ability to follow the local and national clinical
guidelines and protocols.
 Undertakes a quality improvement project under guidance.
 Proactively identifies opportunities for quality improvement. Applies
safety procedures to prescribing practice.
 Undertakes projects and audits to improve clinical effectiveness,
patient safety, and the patient experience.
 Responds appropriately to health service targets and participates in the
development of services.
 Employs the principles of evaluation, audit, research and development
in standard settings to improve quality.
 Applies understanding of national and local regulatory bodies,
particularly those involved in standards of professional behaviour,
clinical practice and education, training and assessment.
Underpinning knowledge
Quality
improvement
models and
theories e.g.
PDCA

Collecting and
Evaluation and
Quality managing
measuring
improvement stakeholder
impact
feedback

Differences
between quality
assurance.
management,
control and
improvement
Patient Safety

• “Patient safety is the avoidance of unintended or unexpected harm

to people during the provision of health care”
(The WHO & NHS Improvement)

Quality Improvement

• "The combined and unceasing efforts of everyone  to make the

changes that will lead to better patient outcomes (health), better
system performance (care) and better professional development
(learning)“
(Batalden and Davidoff, 2007)
 What is Quality Care?

QUALITY

PATIENT
PATIENT CENTERED

EQUITABLE
EQUITABLE
EFFECTIVE

EFFICIENT
EFFECTIVE

EFFICIENT
TIMELY
TIMELY
SAFE
SAFE

CENTERED

TEAM VALUES, EDUCATION TRAINING &

LEARNING, ENVIRONMENT

(Crossing the Quality Chasm IOM, 2001)

Safety & Improvement
Through the Ages…
We’re still learning…
A Promise to Learn,
A Commitment to Act
So how do we know if we’re providing
a ‘quality’ service?

Patient/parent Patient Staff su

rvey
baacckk
edb
feed Outcomes

ort
p la ints CQC Rep
Com
Audit

avo u r able
F
e nt s ‘ LfE’
Adve Ev
rse E
vents Targets
 Turning Safety & Quality
on It’s Head…
• Safety I vs Safety II
Eric Hollnagel, EUROCONTROL, 2015
 Culture & Joy 
When Something
Goes Well… #LfE
When Something Goes Less Well…
 Types of Improvement
Research Audit Quality Improvement

Judgement against set Broad aims: Improvement in

To generate new knowledge standards for ‘assurance’ any area of any organisation

Formalised methodologies and Methods range from highly

Scientific methods used best-practices for data pragmatic to in-depth statistical
collection analysis to research

Can be based on any processes

Mainly clinical areas but can where there are clear Any area of an organisation
also be non-clinical
standards

Often a planned annual

Process of approval for funding Usually identified from a
programme or mandated
and ethics approval service need
audits for quality assurance

REACTIVE PROACTIVE
 QI builds bridges between…

Scientific Delivery of
Approaches, real life
theory & medical care
knowledge

Above all it is about making the changes that improve

practice (for patients and staff)
 IHI Model for Improvement

http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
 Making Improvements
(1) Understand & Investigate the Situation

‘Diagnose’ the
• Think 6 situation
domains! • Use tools eg
Process map
beginning to
Identify a end
situation
Tools to help

Affinity/Fishbone Process Mapping

Diagram

Driver Diagram
 Making Improvements
(2) Engage hearts & Minds

‘Diagnose’ the
situation
• Think 6 • Stakeholder
aims! • Process map s
beginning to • Personal
end perspective
Engage with Staff,
Identify A Situation
Patients & Families
 Making Improvements
(3) Data Drives Improvement

‘Diagnose’ the
Collect Data
• Think 6 domains! situation • Stakeholders
• Process map • Personal • Keep it simple
beginning to end perspective • Qualitative vs
& use other tools quantitative
• Run charts are fab!
Identify A Engage with
Situation Staff & Families
Pareto Chart & Run Charts
 Making Improvements
(4) Making a Change

‘Diagnose’ the
Collect Data
• Think 6 domains! situation • Stakeholders • Keep it SMART...
• Process map • Personal • Keep it simple
beginning to end perspective • Qualitative vs
& use other tools quantitative
• Run charts are
Identify A Engage with fab! Make a change!
Situation Staff & Families
A SMART Change

• Specific
• Measurable
• Achievable
• Realistic
• Timely
 Making Improvements

‘Diagnose’ the
Collect Data
• Think 6 domains! problem • Stakeholders • Keep it SMART...
• Process map • Personal • Keep it simple
beginning to end perspective • Qualitative vs
& use other tools quantitative
• Run charts are
Identify A Engage with fab! Make a change!
Problem Staff & Families
Striving For Success..
 Resources & Reading
• Mid-Staffordshire Francis Inquiry Report:
https://www.gov.uk/government/collections/mid-staffordshire-nhs-foundation-trust-ne
ws-and-publications
• Berwick Report: A Promise to learn, A commitment to act:
https://youtu.be/xb-PjOgxHeo
https://www.gov.uk/government/publications/berwick-review-into-patient-safety
• From Safety-I to Safety-II: A White Paper:
https://www.england.nhs.uk/signuptosafety/wp-content/uploads/sites/16/2015/10/saf
ety-1-safety-2-whte-papr.pdf
• RCPCH Compass E-Learning: https://rcpch.learningpool.com
Quality Improvement
Paediatric Prescribing Principles
• RCPCH QI resources:
https://www.rcpch.ac.uk/work-we-do/quality-improvement-patient-safety
• Paediatric ePrescribing (SCRIPT)
www.safeprescriber.org
 Resources & Reading
• Staff engagement toolkit:
https://www.nhsemployers.org/~/media/Employers/Documents/SiteCollectio
nDocuments/staff-engagement-toolkit.pdf
• IHI Joy in work:
https://qi.elft.nhs.uk/wp-content/uploads/2017/07/IHI-Framework-for-Improvi
ng-Joy-In-Work.pdf
• Learning from Excellence:
https://learningfromexcellence.com/resources-and-evidence/
• Duties of a Doctor
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-
medical-practice/duties-of-a-doctor
• Serious Incident Framework:
https://improvement.nhs.uk/resources/serious-incident-framework/
• IHI Model for improvement:
http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
• The Health Foundation:
https://www.health.org.uk/
 Useful Conferences/Meetings
• http://www.ihi.org/education/Conferences/Pages/default.aspx
Next meeting March 27–29th, 2019
Glasgow, Scotland
BMJ and IHI, with strategic partners, will bring together more than ​3,000 health care
leaders and practitioners from 70+ countries
And if travelling not possible they also have virtual training modules:
http://www.ihi.org/education/WebTraining/Pages/default.aspx
• https://www.risky-business.com/london.php]
Yearly conference with Paediatrics Day
June 5th-7th, London, England
• https://www.fmlm.ac.uk/
Regular meetings with opportunities for trainees to showcase their
quality improvement work
• https://www.rcpch.ac.uk/news-events/rcpch-conference/programme-at-a-glance
Quality Improvement Committee Specialist Interest Group Sessions to attend
May 13th-15th May, Birmingham, England