Culture change and mandating quality improvement

Abstract

Background: A mandatory programme of quality improvement (QI) education was developed for newly qualified Foundation Year 1 (FY1) doctors to complete their curriculum requirements. Their perceptions were evaluated to refine the programme. Methods: The programme delivered theoretical and experiential learning. Participants were asked to form groups and to come up with their own projects addressing the areas of need that they had identified. The 9-month group project included formal teaching and a formal presentation to the hospital. There was access to facilitation and teaching throughout. Self-rating questionnaires were used to measure the effects of the programme on knowledge and motivation. In a quasi-experimental design, data were compared before and after the programme, and comparison data were collected from the FY1 of the previous year. Results: Across the domains of knowledge, attitudes and motivations, there were no significant differences between the pre-intervention group and the comparison group. Pre- and post-intervention [mean (SD) median] there was a significant increase in overall QI knowledge [2.1 (0.76) 2.0 versus 3.2 (0.62) 3.0; p = 0.000]; however, by the end the FY1s were less motivated to complete the projects [3.9 (0.54) 4.0 versus 3.4 (0.91) 4.0; p = 0.02] and were less positive about them [2.3 (0.69) 2.0 versus 3.0 (0.77) 3.0; p = 0.005]. They felt that the projects were less important for their professional development [3.89 (0.66) 4.0 versus 3.1 (0.73) 3.0; p = 0.000] and were less likely to generate positive change in the long term [2.72 (0.61) 3.0 versus 3.4 (0.92) 3.5; p = 0.007]. Doctors perceptions [of QI] were evaluated to refine a mandatory programme. Discussion: Despite delivering a successful theoretical and experiential QI teaching programme with more trainee involvement, the results suggest that mandatory participation for the completion of training risks losing the innovative and creative force of junior doctors and, for some, reducing it to a tick-box exercise.