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Engaging all doctors in continuous quality improvement: a structured, supported programme for first-year doctors across a training deanery in England
  1. Rob Bethune1,
  2. Eleanor Soo2,
  3. Patricia Woodhead3,
  4. Clare Van Hamel4,
  5. Joanne Watson5
  1. 1Department of General Surgery, Royal United Hospital Bath NHS Trust, Bath, UK
  2. 2Department of Radiology, University Hospitals NHS Foundation Trust, Bristol, UK
  3. 3Department of Radiology, Western Area NHS Trust, Western-Super-Mare, UK
  4. 4Severn Deanery Foundation School, Bristol, UK
  5. 5Department of Medicine, Taunton and Somerset NHS Foundation Trust, Taunton, UK
  1. Correspondence to Rob Bethune, Department of General Surgery, Royal United Hospital Bath NHS Trust, Bath, BA1 3NG, UK; rob.bethune{at}nhs.net

Abstract

The structure of postgraduate medical training rightly puts enormous emphasis on gathering clinical experience and constantly updating knowledge of relevant medical research to use in practice. At most, this can be contrasted with the slight emphasis on clinical leadership and acquiring the skills to effect change and improve the quality of care. Doctors play central roles in orchestrating the clinical management of patients across multiple settings within the healthcare system. They also routinely encounter the many problems within the systems that they work, affecting their own practices as well as those of other healthcare professionals. They thus represent a tremendous resource for identifying solutions to these problems and playing leadership roles in implementing them. However, physician training programs focus almost entirely on the knowledge and skills to manage clinical problems, with almost no training in skills related to healthcare management or effective quality improvement. In this article, we describe one attempt to improve this situation. In four hospitals in the Severn Deanery in the Southwest of England, first-year doctors carry out a structured and supported quality improvement project of their choice throughout their first year of training. To date, 30 such projects have been or are being run. This has significant benefits for both the trusts they are working for as well as for their own professional development. We describe the successes, difficulties and future of this programme.

  • Quality improvement
  • Leadership
  • Medical education
  • Patient safety
  • PDSA

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