Our latest blog post is from Dr Gabriella Morley, a foundation doctor who carried out a quality improvement study at BCH, using excellence reporting as the primary intervention.
A teaspoon of excellence helps the medicine improve Dr Gabriella Morley
I’ve been a doctor for 22 weeks now, and it sure has been a steep learning curve! But, you know what I’ve noticed most, during my short NHS employment, I’ve noticed that healthcare professionals go the extra mile. Day in, day out. Excellent practice happens all the time. Perhaps we take this excellence for granted, because it appears to me that it often goes unremarked. Of course, we should always be striving for excellence, and excellence should be happening daily in order to provide the best care we can for our patients. However, healthcare systems do not seem to acknowledge excellence, instead there is a focus on error, blame and mistakes. Being told off all the time is not good for anyone. It just does not motivate. So is measuring error the only way we can improve healthcare? Or, can we drive better care by measuring excellence too?
We wanted to test this idea, that excellence can help medicine improve, with a quantitative study. We looked at the drug chart documentation of antimicrobials against an audit standard in a Paediatric Intensive Care Unit (PICU). An antimicrobial prescription which met all 11 audit standards was deemed a ‘gold standard’ prescription. We determined the prevalence of gold standard prescriptions both before and after a few weeks of ‘intervention’: positive reporting via the IR2 forms. These IR2 forms are a source of positive feedback which describe excellent clinical practice. The IR2 can be filled in by anyone and are passed on to the individual via the clinical governance team, creating a positive feedback environment.
In this study the IR2 forms were used as an intervention to detail the prescriber’s gold standard documentation – their clinical excellence. After this intervention we found that there was a significant increase in the number of gold standard prescriptions on PICU. This demonstrates that positive reporting can have an impact on clinical practice and could improve patient safety.
Measuring excellence can be done and, most importantly, reporting excellence can drive better care.