Build Skills in Quality Improvement

End of Life Directions for Aged Care (ELDAC) toolkit

Palliative Care Outcomes Collaboration (PCOC)

NSW Health Clinical Excellence Commission – Last days of life

Palliative Care Outcomes Collaboration (PCOC)

Quality Improvement Project Guide (30.6kb docx) published on the BMJ Open Quality website is a downloadable, interactive document (with linked examples of articles and websites) that helps to focus QI objectives providing a systematic planning guide to high-quality QI activities.

Aspects of QI design discussed within this document include:

• Identifying an improvement model, framework or approach
• Recognising severity and nature of localised problems for improvement
• Developing primary and secondary study questions
• Application of ‘SMART’ goals (Specific, Measurable, Achievable, Relevant, Timely) to formulate specific aims
• Implication of setting on methods and ethical requirements of the activity
• Undertaking background searches for evidence about the problem and possible solutions
• Sustainability of QI activity over time
• Upscaling and changes to the intervention over time using the PDSA cycle
• Analysis of outcomes to national standards and dissemination of results.

To help with this the Standards for QUality Improvement Reporting Excellence (SQUIRE) group developed detailed guidance for reporting evaluations of QI interventions within a standardised format. This can help report writers but also reviewers. The SQUIRE guidelines are available on the SQUIRE website with detailed information on how to develop a report including a Quality improvement report submission template (16kb docx).

This interactive template addressed four critical questions about the QI activities:

1. Why did you start?
2. What did you do?
3. What did you find?, and
4. What does it mean?

There are also a variety of critical appraisal tools that can be used to assess the quality and the applicability of intervention outcomes to a localised context. The Quality Improvement Minimum Quality Criteria Set (QI-MQCS) [1] is an example of a validated and reliable critical appraisal tool for assessment of QI intervention publications within the scientific literature. This tool assists reviewers to identify higher-quality studies.

QI-MQCS provides a framework for critical appraisal in which staff can evaluate levels of quality by assessing and scoring against minimum standards for 16 content domains.

1. Hempel S, Shekelle PG, Liu JL, Sherwood Danz M, Foy R, Lim YW et al. Development of the Quality Improvement Minimum Quality Criteria Set (QI-MQCS): a tool for critical appraisal of quality improvement intervention publications. BMJ Qual Saf. 2015 Dec;24(12):796-804. doi: 10.1136/bmjqs-2014-003151. Epub 2015 Aug 26.