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Driving improvement in practice
  1. Adele Waters

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The veterinary sector is some way behind human healthcare when it comes to the quality improvement (QI) agenda.

Traditionally, veterinary professionals have relied on ad hoc and informal improvement methodologies, for example training and mentorship.

The profession now needs to up its game

But according to Rand Europe, a consultancy firm commissioned by RCVS Knowledge to assess the veterinary QI landscape last year, the profession now needs to up its game and commit to QI work more formally, like the NHS.

Animal owners are more knowledgeable than ever before–- and also rather complaint-happy – so vet professionals need a more structured and systematic approach to driving improvement and heading off these complaints, consultants argue.

Their report and suggested QI roadmap (see p 173), which was published last month, found vet professionals broadly keen on the concept (they see it as a force for good) but they are poorly informed about it and feel they need more training to get to grips with it.

So what is QI? In a nutshell, it’s about identifying something that needs to work better (a task or process), finding a way to measure it and then taking action(s) to address it while continuing to monitor it in order to drive improvement. You may want to improve the flow of animals through a care journey, for example, and this may require you to introduce a new way of working, like triage. Change and, hopefully, progress can then be monitored and reviewed.

A key feature of QI is that it is continuous – but that isn’t about continuously doing the same thing, say consultants. The aim should be to create a cycle or ‘rhythm of learning’, with a manageable programme of activity focused on discrete improvement areas followed by learning, which is shared with colleagues. So, going back to our example, once you have established an efficient new system of triage, you can move to another area of improvement focus. In this way, they suggest, QI can be understood as a strategy for evidence-based learning.

‘We acknowledge that everyone already strives to do their best – QI is simply the framework that can make that sustained endeavour a reality,’ they say.

QI isn’t rocket science, but it does require effort and someone to take stock, review performance and think about how things could work better.

Rand suggests two ways to make QI a success. First, introduce a small number of ‘routinised and scalable’ initiatives. Second, the key to success is to ensure that approach becomes part of working, rather than something added to the existing workload. Suitable areas to start, says Rand, are clinical audits, benchmarking, significant event audits, guidelines and checklists. Building in the use of these as part of a daily routine can save time and increase safety, it says.

To drive the improvement agenda further, the consultants suggest raising the profile of QI as an operating principle, and linking it to strategic delivery and HR processes. This could be, for example, including a QI responsibility in a job description and checking performance at annual review.

But they also say a range of stakeholders are needed to support vet practices to deliver QI initiatives. For example, the university sector should build some QI foundation learning into the undergraduate course, as well as deliver QI research. Insurance companies and practice management system providers, too, need to support the changing ways of working necessary to implement QI consistently.

But as consumerism and changing client expectations are important drivers of change, perhaps the real sell for QI is that, used well, it can improve client relations.

‘Part of the business case for QI is that it could reduce complaints and help demonstrate that well-founded complaints are acted upon,’ they argue. So rather than user involvement becoming a burden on practices, it could be used as a positive force for improvement.

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