Candid reflections: National QI  

Dale Kirkwood, February 10, 2023

Working across four nations, across four different health systems, to deliver a national improvement programme is challenging at every step in the process.  We want to share our journey with you as we transitioned from a national audit programme to a national quality improvement programme.   

Historically, RCEM undertook annual national audits in three key subject areas that changed each year.  In 2018 the RCEM elected to change from an audit framework to that of QI in the hope that it would help drive improvements in EDs across the four nations. 

A small national team that was equipped to develop audits was not sufficient to facilitate QI on such a scale.  This hybrid programme took its toll on the small team as they continued trying to develop three annual topics in a more complex way than simple audits.  Timeframes were tight and of course, there was that little thing called Covid.  Not only was the programme impacting the team, but also reflected that it was not inspiring local QI. 

We decided to form smaller topic groups from the overarching committee.  They briefly meet every month to make decisions involving the RCEM secretariat to direct clinician-informed outputs.  We proceeded to lengthen the projects’ life cycles to two years or longer.  This also extended the time available to each topic group to explore the rigour of research related to the underpinning topic, relevant standards, metrics selection, questionnaire and portal development, and piloting prior to launch.  Each topic team feeds into the overarching QA&I committee where the general programme strategy and steer are discussed quarterly. 

At transition, our original team was small and would have prohibited restructuring into topic teams.  We needed to build capacity and hopefully retain members.  We sought to recruit a diverse, capable team motivated to own their projects and drive them forward. 

Successful recruitment in December 2021 resulted in formation of topic teams combining trainees, SAS, Consultants, ACPs, QI professionals and subject matter experts from other working groups in the College and beyond.

These have now come together to lead in the 2022-25 cycles “Care of Older People” and “Mental health and deliberate Self-harm”. We have also included representations from the Environmental and EDI committees to integrate these priorities across all aspects of our work. 

A lot of change is afoot, and we will undoubtedly be challenged along the way. We welcome this creative friction to push the teams across the four nations to continue to refine and innovate as we seek to improve our healthcare systems.  

We welcome all feedback and look forward to working with you all over the coming years, simultaneously addressing patient health needs and helping members meet training requirements and develop into effective quality professionals. Together we can overcome this wicked problem.  

Dale Kirkwood