Dr Hannah Laidley, AFY2, University of Leicester
Quality improvement work can feel inescapable. That’s because it is; we have to do it to progress through the foundation programme. So we might as well make it work for us and get a poster presentation out of it. ‘Easy!’ I thought. Each PDSA cycle is so short we could bash one out in 6 weeks.
Lesson One: If your project is worth doing, it won’t always be easy
The first QI project I started involved getting nursing staff to write down a jobs list instead of bleeping the surgical F1 for every job on a night shift. We were receiving over 60 bleeps each shift, mostly in quick succession, which is problematic if you are already too busy to answer. This can become a source of interdisciplinary discord when the nursing staff contact your seniors and accuse you of not answering the bleep (hasn’t that happened to all of us?!). So, it was a project that would make doctors’ lives easier, nurses’ lives easier, and filter out non-urgent bleeps so we could focus on sick patients.
A group of us (four F1s) started collecting data but keeping a tally of total bleeps and urgent bleeps proved difficult, making data collection infuriatingly slow. People were just too busy dealing with the onslaught of bleeps to write it down. Even if they knew it would make their lives easier they just didn’t have the motivation to collect data for us.
Lesson Two: Find a team you can rely on when circumstances change
Although that project flopped due to lack of data, I soon got back to it. My second QI project looked at errors in paediatric prescribing. I was asked by one of the consultants to keep track of prescribing errors so that we could find ways to improve the process. ‘Awesome!’ I thought. ‘Who doesn’t want to make prescribing safer?’
As it turned out, no one was interested in making prescribing safer if it meant they might be blamed (especially since the Bawa-Garba case was exploding in the media at the same time). No matter how much enthusiasm I brought to the project that was never going to overcome the fear people were feeling.
Our lack of data soon disheartened the group. No one was working on it, no one could be bothered to keep reminding people to fill out forms, and no one wanted to write an abstract.
Six months into the project I had a ‘sit down’ with each of my collaborators. I asked them why they had wanted to do the project in the first place, what they hoped to get out of it, and how hard they were prepared to work for those results. I wasn’t surprised to find out they did it because they had to and they weren’t prepared to do much since they had moved on from that placement and it was no longer their problem.
At that point I gave up on the whole thing. In hindsight, I should have known that a team aiming for a quick and easy project would give up at the first hurdle and in future I would have this ‘sit down’ before I started a project with anyone. I would be more exacting in deciding who I worked with to avoid wasting my time. You can’t just lead by example you have to demand excellence, or risk becoming the pushover who does all of the work.
Lesson Three: You can still learn from your failures
I still presented these two projects at departmental meetings regardless. Sure, I can’t put my data collected from 9 people in an academic journal, but the department could learn from what I had observed. Eventually nursing staff were making a jobs list without being told and all the paediatricians were discussing what prevents us from learning from our mistakes. As Thomas Edison said when he was inventing the light bulb,
‘I have not failed. I’ve just found 10,000 ways that won’t work.’
Conversations are the beginning of culture change and I was successful in starting a conversation. Or at least I think I was, but I have no data to prove it.