Context This quality improvement work was carried out at a tertiary paediatric hospital in the UK. All paediatric junior doctors in the hospital were involved and the overall goal was to improve trainee satisfaction.

Problem Junior doctors in the hospital sometimes felt unable to feedback issues surrounding their work to higher management. This was reflected in the feedback provided via the National GMC survey. On carrying out a local questionnaire amongst 48 trainees, 77% felt that they were not confident enough to approach senior management regarding work-related issues. The commonest issue was regarding the rota for trainees, with 85% expressing some dissatisfaction due to large gaps without cover. Another issue highlighted by 73% was the lack of formal educational opportunities during training posts.

Assessment of problem and analysis of its causes When analysed, 100% of trainees surveyed felt that having a lead registrar would make the process of feedback easier. The main root of the problem was the lack of a link person between trainees and management.

Intervention The role of Chief Resident in the hospital was introduced to improve communication and enhance continuity between the management and trainee teams. The role involved being formally responsible for the following:

• Delivering a robust channel of communication to and from the trainees

• Regular drop in sessions to address trainees’ issues regarding workplace

• Providing representation of trainees at formal trust meetings including hospital management board meetings

• Ad hoc one to one meeting with senior consultant colleagues regarding issues raised by or about trainee medical staff

Study design This process of improvement was qualitative in nature. Questionnaires were used regularly to analyse problems and these were then addressed according to priority.

Strategy for change To implement this plan, a job role for Chief Resident of the hospital was advertised internally. Interviews were carried out by a senior consultant involved in service improvement.

Measurement of improvement As this was mainly a qualitative process of service improvement, questionnaires were used 3 months after the role was established to obtain feedback from trainees. 43 questionnaires were completed and 95% of trainees now felt confident that they were able to communicate issues around their training to higher management via the Chief Resident. 91% also felt that they were better informed about hospital management issues as this was being relayed to them after hospital board meetings via email communication.

Effects of changes Questionnaire results have demonstrated a dramatic improvement in trainee satisfaction. Better communication between management and trainee teams has also improved the relationship between the two. Regular monthly meetings organised by the Chief Resident are now carried out between the management and trainee teams to address training issues. An active project to revise the trainees working pattern and rota structure is also being carried out, involving participation of junior doctors. Regular questionnaires every 3 months amongst trainees internally aim to assess the progress of this long-term improvement project.

Lessons learnt The main lesson from this process of quality improvement is the importance of having a consistent link between trainee and management teams in a hospital. Improving trainee experience inevitably leads to safer and better patient care.

Message for others Developing a formal role of Chief Resident should be considered in hospitals to improve the experience of junior doctors. Trainees should lead and address their educational needs and workplace issues with support from higher management via this system. This role should be longstanding with continual assessments, as it ultimately provides long-term service improvement.