Context Work was done within a busy community paediatric department. The work looked at how we assess and promote quality.

Problem A lack of focus and evidence of quality.

Assessment of problem and analysis of its causes Within the department we had completed audits over the years on an adhoc basis, there were guidelines and pathways which were used but they were not always up to date. There was no universal way documentation could be accessed to see what had been done when, or when it needed repeating/updating. This meant that there was variability in the service we provided.

Intervention Initially we spent 2 days collecting data about the quality work being done already. Next we planned four interventions.

1. We created a database of audits, who was responsible for them and when they needed repeating. The database also noted if there were protocols and audit tools and if the audit had been presented.

2. We formed a centralised set of online files based on the current CQC standards. Supporting evidence was filed making it accessible to everyone in the department. Audit reports, pathways, patient information sheets, induction material and department protocols can be easily found.

3. We asked each member of the department to join a “champions” group focused on different areas of change. New trainees in the department are allocated to a group. These included:-

• Staff Wellbeing

• ASD

• ADHD

• Patient Voice

• Expectations

1. We organised a monthly “quality” meeting. This is an opportunity for the department to present any work so that we can all learn and share. Changes can be ratified quickly so consistent high quality care can be provided.

Strategy for change The most important strategy was encouraging each team member to feel responsibilty for quality. An away day allowed us to develop a shared vision and the champion groups will feed back on their progress at the monthly meetings to encourage action and momentum.

Measurement of improvement We have now completed departmental audits that are up to date and shared with the team. Our monthly meeting has a full agenda promoting and sharing best practice.

Effects of changes These changes have allowed the department to move to a more cohesive and coherent view of their work around quality. We have helped to standardise care, share good practice and maintain a quality service for the future. The staff wellbeing group has started a free fruit and lunchtime walking initiative. While the patient voice group have raised the profile of recoding this in clinic letters and meetings.

Lessons learnt One of the greatest challenges was getting colleagues to prioritise “quality” work above their clinical case load. In a busy department it can be hard find time to implement change. The quality day provided a different environment away from clinical duties to allow people to think about what we could do better.

Message for others Identifying “quality” and the evidence required to show this is the first step. Forming a central easily accessed folder containing all the information along with an index or database to assess progress is the next. Using the CQC standards as a template for our files helped us to organise our thinking in line with national standards. Engaging colleagues and encouraging personal responsibility to support ongoing improvement is also essential.