Regional audit in Mersey
Will region wide audits and projects 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.
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.
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.
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 and quality improvement 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 always! We are very open that we are undertaking a learning process. Matt and Nick led the way when they started MAGIQ and they are still around to give us tips and help us learn how to get projects off the ground! 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 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. A couple of people involved in MAGIQ have been to their annual meeting each year to share ideas and find out what's been happening in other regions. They also run big projects that you might have heard of such as DALES and iHype.
How can I contact MAGIQ?