Contents

  1. 1 Regional audit in Mersey
    1. 1.1 Will region wide audits actually change anything?
    2. 1.2 Do regional audit groups actually work?
    3. 1.3 Can regional Quality Improvement actually work? Is best practice transferable?
    4. 1.4 It’s been tried before in Mersey and failed, why should it work now?
  2. 2 Working with hospitals
    1. 2.1 Why should hospitals collaborate with MAGIQ?
    2. 2.2 Will this generate more work for audit departments?
    3. 2.3 Hospitals won’t want you releasing information regarding their performance will they?
  3. 3 MAGIQ data
    1. 3.1 How will you manage the restrictions on collecting and using data re Caldicott, etc?
    2. 3.2 If you are collecting data via the website what’s to stop malicious data entry ruining projects?
  4. 4 Trainees and MAGIQ
    1. 4.1 Who can suggest projects to the group?
    2. 4.2 What’s in it for people who contribute?
    3. 4.3 Will it mean more work?
    4. 4.4 What if people just want to be project leads without contributing to previous projects?
    5. 4.5 Is this a closed shop with a few people creaming off the credit for other people’s work?
  5. 5 Structure of MAGIQ
    1. 5.1 What makes you think you know what you’re doing?
    2. 5.2 Have you done anything like this before?
    3. 5.3 Why are you setting up MAGIQ, is this just for your CV?
    4. 5.4 Why don’t you just join NWRAG?
    5. 5.5 Are there any other specialties in the region with their own equivalent?
    6. 5.6 Why don’t you get other specialties involved?
    7. 5.7 Will MAGIQ do research?
    8. 5.8 What’s to stop MAGIQ failing once the original team leaves? Is the group sustainable?
    9. 5.9 Why don’t you have a committee?
    10. 5.10 What is your relationship to RAFT?
  6. 6 MAGIQ online
    1. 6.1 Why do you have a website? Why not just use social media?
    2. 6.2 Will you be on Twitter?
  7. 7 How can I contact MAGIQ?


Regional audit in Mersey

Will region wide audits actually change anything?


Some audits have a positive impact on clinical practice. By focussing on good projects, incorporating principles of good QI, and aiming to improve practice from the start, we will produce better projects and increase the likelihood that trainees’ time invested in the project will have a positive effect on patient care.


Do regional audit groups actually work?


The outcomes will depend on how much we put into it. Some regional audit groups have been very successful. The South West Anaesthesia Research Matrix (SWARM, www.ukswarm.com) has been operating since 2012 and has been very successful. The RTIC Severn trainee collaborative developed the emergency intubation checklist featured in the NAP 4 report (www.saferintubation.com).


Can regional Quality Improvement actually work? Is best practice transferable?


A key feature of QI is recognition of the importance of local context. Some practice may not be transferable. Also, some projects may not be applicable to all centres eg obstetric based projects. However, the commonalities of anaesthesia, the challenges faced, and similarities of approach exceed the differences. Also, whilst practice may not be transferable, performance outcomes should be comparable and hence multicentre projects can still offer a benchmark of practice.


It’s been tried before in Mersey and failed, why should it work now?


MAGIQ could still fail but we’ve tried to learn the lessons from the previous trainee audit group in the region. Currently MAGIQ’s assets include a website (with ipad compatibility), detailed manual of operations, and a plan of future projects. MAGIQ has already successfully completed a region wide audit of anaesthetic trainee audit activity.


Working with hospitals

Why should hospitals collaborate with MAGIQ?


Anaesthetic departments and individual consultants need to demonstrate an engagement with audit and quality improvement for appraisals. Working with MAGIQ would contribute to this, offer access to better planned trainee projects, as well as allowing for local adaptation and customisation. Local data from MAGIQ projects would be available for individual hospital clinical governance but also the regional data can be used as a benchmarking tool. Coordinating MAGIQ projects will reduce some of the attrition of projects caused by frequent trainee rotations. Audit departments struggle to get audit reports completed; MAGIQ projects due to their central organisation are more likely to produce finished reports.


Will this generate more work for audit departments?


At a local level there will still be the same amount of audit activity, except that activity will be replicated across hospital trusts. Better planning of projects will facilitate better quality audit / QI projects.


Hospitals won’t want you releasing information regarding their performance will they?


Lots of hospital performance data enters the public domain eg Hospital Episode Statistics, Consultant Outcomes. The NHS is a transparent organisation. We do of course have to be sensitive to how we manage their data and consider measures such as only use of average data or anonymising data.

MAGIQ data

How will you manage the restrictions on collecting and using data re Caldicott, etc?


MAGIQ is very conscious of the need for good information governance. All projects submitted to audit departments will be vetted by the hospital information governance body including the Caldicott guardian for that trust. However, with a little thought we can develop projects wherein personal identifiable information will not be collected and hence much fewer restrictions placed on its use.


If you are collecting data via the website what’s to stop malicious data entry ruining projects?


This is a concern to MAGIQ and quality control of the data is essential. That’s why we are currently considering a 2 step model of data entry with some parts of the dataset only being entered by verified contributors.

Trainees and MAGIQ

Who can suggest projects to the group?


Anyone; we welcome ideas for consideration from trainees, anaesthetic departments, audit departments, and anyone else with a good idea. Ideally those generating the idea will lead on the project but this does not have to be the case.


What’s in it for people who contribute?


People have to undertake audit as part of their ARCP requirements. MAGIQ contributions will be acknowledged like any other audit activity and will be recognised with MAGIQ issued certificates. Through well thought out projects contributors will be more likely to see an actual clinical benefit for the time they contribute. Also, contributors can take advantage of the support and advice from others undertaking similar projects and from the MAGIQ team and their links to the audit departments. For those leading projects they will be able to gain valuable CV points from managing regional projects, and any authorship credits.


Will it mean more work?


For those undertaking the projects at the hospital level the amount of work is comparable to what happens already and likely to be less given the support and planning of the project leads. The commitment from project leads may be more but the recognition and rewards for the CV will be greater too.


What if people just want to be project leads without contributing to previous projects?


It is hoped that there will be a collaborative spirit to the group. Those people undertaking the projects at the local hospital level will in time lead projects of their own and their contribution will be ‘paid forwards’ as new projects roll on. Project leads will be expected to get involved with their own projects at their respective hospitals.


Is this a closed shop with a few people creaming off the credit for other people’s work?


We want everyone to get involved with MAGIQ. We want to be a collaborative and inclusive group. There are many ways to get involved including submitting ideas, undertaking projects at the local hospital level, developing and coordinating projects at the regional level, or as part of the MAGIQ group. Those doing MAGIQ projects at the hospital level will get similar credit as they would already be doing local projects. The MAGIQ group would not take credit for individual projects; this would go to the project leads and hospital leads.


Structure of MAGIQ

What makes you think you know what you’re doing?


We don’t! We are very open that we are undertaking a learning process. We have undertaken literature review work on this area but we have no practical experience in running an audit group or in doing quality improvement. We are aiming to build in processes that will develop the group’s expertise such as project reflection and feedback that will be subsequently available to contributors. Also, in the region we are lucky to have trainees with expertise with QI.


Have you done anything like this before?


We have already undertaken a multicentre project in the region involving 10 different sites so appreciate some of the challenges this brings. The information gained from this project has given us some insights into how we undertake future projects.


Why are you setting up MAGIQ, is this just for your CV?


There are 11 regional audit groups in the country. Mersey is missing out! There are much easier things we could be doing for our CV.

Why don’t you just join NWRAG?


Even though the Mersey Deanery has joined with the North West, it still possesses a separate identity. The compactness of the deanery, the strong interhospital links, and the small but well connected group of anaesthetists make for an ideal opportunity to undertake region wide projects.


Are there any other specialties in the region with their own equivalent?


We are not currently aware of any but would welcome being corrected on this.


Why don’t you get other specialties involved?


We recognise that multi-disciplinary involvement is an important factor in effective Quality Improvement and would certainly like to work with other specialties. Initially we are focussing on anaesthesia because that is what we are familiar with and therefore ought to be easier to establish the group before branching out.


Will MAGIQ do research?


Currently MAGIQ is focussed on audit and Quality Improvement. We believe that this offers the greatest benefit to patients and trainee contributors. Also, organising research is much more complex and time consuming (eg ethics committee) than QI. In the future, with the experience and networks that MAGIQ develops, there may be opportunity for an off-shoot group but at the moment the focus is on establishing a QI group. Quality Improvement is a growing field with increasing recognition and is no longer the ‘poor cousin’ of research.


What’s to stop MAGIQ failing once the original team leaves? Is the group sustainable?


It is recognised that during the start-up phase of regional audit groups it is useful to have a small entrepreneurial core of individuals that can adapt and undertake work in a flexible manner. Later a more ‘horizontal’ cooperative is more appropriate. During the early phases, foundations and momentum can be built in the form of routines of operation and successful projects which will carry on once the original team leaves.


Why don’t you have a committee?


We want to encourage a collaborative and inclusive group of MAGIQ contributors and we feel that committees aren’t always favourable to this. We would ideally like the group to become a horizontal cooperative eg a flat organisation similar to many tech’ businesses. How MAGIQ develops will be down to its members at the time.


What is your relationship to RAFT?


RAFT is the Research and Audit Federation of Trainees. We met RAFT earlier this year at the GAT meeting in Manchester and have continued to develop links with the group. There is a national RAFT project planned for 2016 and hope that MAGIQ will be able to contribute to this.


MAGIQ online

Why do you have a website? Why not just use social media?


Having a website of our own has more versatility than offered by social media platforms. It can be a source of news, a repository for information on QI, and previous projects. It also allows people to submit projects to the group and provide a data entry portal for MAGIQ projects. It also allows a nifty icon to appear when you save it to your homescreen on your phone or tablet!


Will you be on Twitter?


We are looking into it.




How can I contact MAGIQ?