The Health Foundation’s Quality Improvement Fellowships aim to develop senior leaders to promote quality improvement in the UK.
Participants spend a year in the US at the Institute for Healthcare Improvement (IHI), a not-for-profit organisation which works to make healthcare safe, effective, patient-centred, timely, efficient and equitable. One of the participants is Dr Noeleen Devaney, Medical Director at Down Lisburn Health and Social Services Trust (now South Eastern Health and Social Care Trust). While at the IHI, she worked on a research project that looked at how to get doctors involved in improving quality. She is now back in the UK, working with NHS hospitals to help them improve patient safety.
“I’ve always been interested in improving the quality of healthcare and wanted to develop skills and techniques that I could apply both to my clinical work as a consultant psychiatrist and my role as a medical director,” Noleen says. “When I found out about the Quality Improvement Fellowships I thought it sounded like a wonderful opportunity - like something you’d dream up if you could.”
Coming to America
In November 2004, Noleen moved to Cambridge, Massachusetts to spend a year at the IHI. Her Fellowship combined structured academic learning with the development of practical skills in key areas and she worked both alongside other fellows and experts and on an individual project.
“There was a formal teaching programme of seminars and meetings conducted by experts in quality improvement from IHI,” Noleen says. “I attended an IHI course on how to improve patient safety and another on how to spread improvements across systems. We also had the opportunity to attend external courses. I chose a very intensive seven-week course in clinical effectiveness at Harvard University School of Public Health. There were so many different opportunities to learn.”
She also joined one of IHI’s ‘innovation communities’, which was set up to look at reducing hospital mortality and making hospitals safer for patients. This involved conference calls and face-to-face meetings, with people coming together from across the US to discuss their work.
For her individual project, Noleen researched ways of getting doctors involved in improving quality. “This is globally recognised as being difficult,” she says. “I found there’s no single solution but it helps to adopt a certain approach. You have to develop an understanding of medical culture and build trust with clinicians.”
“Being able to measure and demonstrate improvement with small tests of change can really help to engage people,” she continues. “And creating a vision for quality improvement that’s shared by medical staff is essential. I presented the work I did to some of the IHI forums and here in Northern Ireland and am hoping to get it into print.”
Personal development
As well as making a difference to patient safety, Noleen also developed her own skills and career. “On a personal level it was just incredible,” she says. “You don’t get many chances like that – to spend a year learning from world-class experts. On a day-to-day basis, there was continual talk about quality improvement, even informally during coffee breaks, there’s an awful lot of learning that goes on.”
“So much has happened as a result of the Fellowship,” she continues. “My trust is one of the Health Foundation’s Safer Patient Initiative sites so as part of that I’ve been able to put into practice what I’ve learned about how to get doctors involved in quality improvement.”
Since January, Noleen has been seconded for two days a week to the Eastern Heath and Social Services Board, to work with other hospitals in Northern Ireland and help them to improve patient safety. She is also working with the local university to try to get patient safety included in their medical school curriculum.
“I’m increasingly getting involved at strategic and health department levels, which is what I want to do,” she says. “Although I was working with patient safety before and was involved in continuous quality improvement it wasn’t at this level. I didn’t have the tools I can now use, or this knowledge.”
20 July 2006