Article Text

Download PDFPDF
‘Wading through treacle’: quality improvement lessons from the frontline
  1. Alice Roueche1,2,
  2. Jocelyn Hewitt3
  1. 1Medical Education Advisor (Darzi Fellow) to the Director of Medical and Dental Education, London Deanery
  2. 2Paediatric Intensive Care Unit, Evelina Children's Hospital, London, UK
  3. 3Department of Professional Development, London Deanery, London, UK
  1. Correspondence to Dr Alice Roueche, Paediatric SpR and Darzi Fellow to the Director of Medical and Dental Education Commissioning, London Deanery, Stewart House, 32 Russell Square, London WC1B 5DN, UK; alice.roueche{at}


In a time of financial uncertainty and structural reform, the National Health Service (NHS) in England needs clinical leadership to help improve the quality of patient care. Increasingly, leadership development is being targeted at doctors in postgraduate training to help prepare them for their future leadership roles as consultants and general practitioners. However, there is a risk that we are missing an opportunity here by failing to recognise the role that doctors in training can play now, during their training. As our frontline clinicians they have a unique view of the health service and the inefficiencies therein. The London Deanery has been running an educational programme called Beyond Audit to provide doctors in training with quality improvement skills. During this programme we have been given a unique insight into NHS systems as viewed by junior doctors. They have identified a wide range of small system problems that, when combined, result in large-scale inefficiency and prevent the delivery of high quality patient care. These problems they identify have implications for cost, efficiency, patient safety, team-working and patient experience. Any attempt to improve the quality of care delivered in the NHS needs to look at the system from the point of view of those delivering the care, including our doctors in postgraduate training. By empowering them to make improvements to the systems that they see, there is the potential to make significant improvement in the quality of patient care that they deliver.

  • Quality improvement
  • graduate medical education
  • leadership
  • patient safety
  • paediatrics
  • medical education

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding The ‘Beyond Audit’ programme has been funded by the London Deanery.

  • Competing interests None.

  • Ethics approval This is a retrospective observation of a training programme, not a study.

  • Provenance and peer review Not commissioned; internally peer reviewed.