01 March 2019, Tim Burton -
Whilst a lot of medicine looks to the next miracle drug or the next high-tech treatment option, there is a simple programme that is being developed in urology right now and it is hoped to have an incredible impact for patients.
Quality Improvement (QI) is a process through which a urology department, or any hospital department, can look at the service they provide, identify areas for improvement, and then act on those areas through a structured QI process so that their service can improve.
In reality QI could improve almost anything in health care. With origins in manufacturing and engineering, QI could reduce waiting times, reduce the amount of time spent in hospital after an operation, and reduce the risk of an infection or sepsis, it could create seamless patient pathways and even save lives.
However, the reality is less straightforward, as embedding different ways of working relies on a cultural change within NHS organisations, and making that happen has often been the stumbling block to widespread improvement.
The EQUIP Research Programme has been funded by The Urology Foundation and is run by Professor James Green, a consultant urologist at Barts Health NHS Trust, and Professor Nick Sevdalis from King’s College London, who are both determined to make QI a daily part of urology practice in the UK. Other members of the EQUIP team include Dr Zarnie Khadjesari, a Senior Lecturer in Health Promotion and a steering group that consists of experts in urology and education, nurses and patients. In its early phase, EQUIP has also had tremendous support from a biomedical engineer, Ms Elena Pallari.
Their approach is a straightforward one: they have developed a QI syllabus and taught urology trainees the principles of QI so that they can begin to change the services if they need to be improved. As well as this, they are planning to train consultant urologists in QI so that they can support trainees and other team members as they implement QI projects. By 2020 half of all urology trainees in the UK will have received this QI training.
As well as improving the service for patients, it is hoped that QI will empower trainees to bring about change in their work. Often the scale of the problems facing the NHS are overwhelming for trainees, but through QI they can break off a manageable piece and fix it themselves.
As well as training urologists and trainees to perform QI projects, the EQUIP team are working are working with national organisations to facilitate QI work for trainees and with the British Association of Urological Surgeons (BAUS) and TUF are setting up a website that can be used to store information on completed QI projects that are run successfully by urology departments across the NHS.
By using this website a hospital can see what other hospitals are doing to improve their service. So, for example, if a urology department in one hospital is struggling with an increased rate of infections among their patients, they can see how a hospital in another area has found a solution to a similar solution and implement that. When reinventing the wheel costs the NHS millions ever year, the potential of this website to save time and money is huge – and it also allows trainees to link up and learn from each other.
In the future patients will hopefully be able to be more involved in QI by drawing attention to a problem they have experienced in their care and suggesting an improvement. The urology staff will then be able to identify why the problem has occurred, decide whether it is a one off event or a pattern that requires improvement and then, with the patient’s help, develop a plan to solve the problem.
QI might not be a miracle drug, but thanks to EQUIP it could be a solution to so many of the problems and frustrations that are facing urology patients in this country. It could revolutionise urology practice but more importantly, it could improve life for urology patients.
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