Choosing a Realistic Quality Improvement Project: A Practical Guide for UK Clinicians

Why this topic matters

Many clinicians, particularly those new to QI, fall into the trap of selecting projects that are too large, too complex, or lack sufficient support. This often leads to frustration, burnout, and ultimately, an unfinished project. A well-scoped project, however, maximises your chances of successful completion, provides valuable learning, and can genuinely improve patient care or service delivery within your local NHS context.

For trainees, a successful QI project can be a significant component of your Annual Review of Competence Progression (ARCP) or portfolio, demonstrating leadership, management, and quality improvement capabilities. For all clinicians, it’s an opportunity to drive positive change and contribute meaningfully to the efficiency and effectiveness of the NHS.

Practical explanation

Choosing a realistic QI project involves a systematic approach to identifying problems, assessing their solvability, and aligning them with available resources and personal capacity. It's about finding the 'sweet spot' where a problem is significant enough to warrant improvement but also contained enough to be manageable.

• Problem Identification: QI projects start with a problem. This might be a patient safety concern, an inefficient pathway, a variation in care, or an area where national guidelines are not being met. These problems should ideally be something you encounter regularly and about which you feel passionate enough to invest time and effort.
• Scope and Scale: The most common mistake is choosing a project that is too broad. Instead of trying to fix 'all hospital discharges', focus on 'improving the communication of discharge summaries for patients on Ward X to their GP within 24 hours'. Narrowing the scope makes the project more achievable.
• Impact vs. Effort: Consider the potential impact of your improvement versus the effort required. High-impact, low-effort changes are ideal starting points. While major systemic changes might have high impact, they often require significant effort and organisational buy-in, which can be challenging for an individual project.
• Local Data and Evidence: A realistic project often stems from an observed local problem, but it should be supported by data if possible. This could be audit data, incident reports, patient feedback, or benchmarking against national standards (e.g., NICE guidelines, National Audit Programme reports). Evidence helps to quantify the problem and justify the need for change.
• Stakeholder Engagement: A realistic project considers who needs to be involved for its success. Can you identify key stakeholders and get their early buy-in? A project that requires significant involvement from unengaged or hard-to-reach colleagues will be difficult to progress.

Common pitfalls

Recognising common traps can help you steer clear of them:

• "Solution in search of a problem": Starting with a solution (e.g., "I want to implement a new app") rather than identifying a clear problem. QI is problem-driven.
• Lack of clear aim: Not having a specific, measurable, achievable, relevant, time-bound (SMART) aim. Vague aims lead to unfocused efforts.
• Ignoring the "Why": Not delving deep enough into the root causes of the problem. Without understanding the 'why', chosen interventions may not address the real issue.
• Underestimating time commitment: QI projects, even small ones, require consistent effort. Be honest about how much time you realistically have.
• Working in isolation: QI is a team sport. Trying to do everything yourself without engaging colleagues or supervisors is a recipe for stalled progress.
• Focusing on a solution outside your sphere of influence: Attempting to change something that requires significant resources or approval beyond your remit as an individual or small team.

Step-by-step approach to project selection

1. Brainstorm Potential Problems (2-4 areas):

   • What 'grinds your gears' in your daily work? What repeatedly goes wrong? What creates frustration for patients or staff?
   • Where do you see variation in practice? Where are national guidelines not being consistently met?
   • Review local incident reports, patient complaints, or existing audit data for common themes. Does your department have a QI backlog or areas identified for improvement?

2. Initial Filter - Personal Interest & Feasibility:

   • From your brainstormed list, which problems genuinely interest you? Sustained interest is crucial.
   • For each, ask: Is this problem within my clinical area of practice or closely related? Can I realistically access data for this?

3. Preliminary Scoping & Data Check (2-3 areas):

   • For the remaining options, try to characterise the problem more narrowly. What specifically needs improving?
   • Is there any readily available initial data (even anecdotal) to support the existence and impact of this problem?
   • Consider the "burden of illness" – how many patients are affected? How severe is the impact?

4. Identify Potential Stakeholders & Supervision (1-2 areas):

   • Who would need to be involved to make a change? Can you easily identify and connect with a potential supervisor or local QI lead?
   • Discuss your ideas with your supervisor, a QI lead, or experienced colleague. Their insights on feasibility and local politics are invaluable.
   • Seek advice on potential data sources and existing improvement efforts.

5. Define a Provisional SMART Aim:

   • For your top choice, draft a provisional SMART aim. For example: "To reduce the time from decision-to-prescribe to administration of the first dose of antibiotics for patients presenting with sepsis in the Emergency Department by 20% within 3 months, measured on Mondays and Tuesdays." This is specific, measurable, achievable, relevant, and time-bound.
   • This exercise helps clarify if the project is manageable.

6. Assess Resources & Barriers:

   • Time: How much time per week can you realistically dedicate?
   • Personnel: Who else do you need? Are they available and willing to help?
   • Data: Can you collect the necessary data easily? Is it already being collected?
   • Expertise: Do you have the necessary skills, or can you access someone who does?
   • Cost: Does the proposed change have financial implications? (Many QI projects are low-cost, improving efficiency).
   • Organisational Buy-in: Is there departmental or organisational support for this type of improvement?

7. Final Project Selection & Refine Aim:

   • Based on your assessment, choose the most realistic and impactful project. Refine your SMART aim with your supervisor's input.

Example in clinical practice

Dr. Amina, an F2 doctor on a cardiology ward, identifies a problem:

• Initial thought: "I want to improve patient safety on the ward." (Too broad).
• Narrowing down: Amina notices frequent delays in accessing point-of-care INR results for warfarin-treated patients, leading to delayed discharge or late dose adjustments. She also observes that some patients go home without a clear follow-up plan for their INR testing.
• Data check: She checks the ward's incident reporting system and finds several recent incidents related to delayed INR results and discharge. She also asks the ward clerk, who confirms it's a common issue.
• Stakeholder engagement: Amina talks to her registrar, the ward manager, and the phlebotomy team leader. They acknowledge the problem.
• Provisional SMART Aim: "To reduce the proportion of warfarin-treated patients with a point-of-care INR result delay exceeding 2 hours from phlebotomy request to result availability on Ward B by 25% within 8 weeks."
• Resource assessment: She has 4 hours a week dedicated to QI. The phlebotomy team agree to track timing. The ward manager is supportive. The registrar will supervise. This feels manageable.

This project is tightly scoped, has clear data points, and involves key stakeholders from the outset, making it realistic for Amina to complete within her rotation.

How Lazomis can help

Choosing a realistic QI project is the first step, and Lazomis provides tools to support your planned improvement.

• QI Project Setup: The Lazomis QI Project Setup module guides you through defining your project aim, understanding your system (using tools like process mapping and driver diagrams), and identifying key measures. This structured approach helps ensure your chosen project remains focused and achievable.
• Data Collection and Visualisation: Once your project is chosen, Lazomis Dashboards can help you track your chosen metrics. Regular, clear visualisation of your data (e.g., run charts) is crucial for monitoring progress and demonstrating the impact of your interventions, reinforcing the 'measurable' aspect of your SMART aim.
• Guidance and Resources: The Lazomis Resource Library itself offers further guides on specific QI methodologies (e.g., PDSA cycles) and data analysis, helping you to execute your project effectively after the initial selection process.

This resource supports, but does not replace, clinical judgement. Local policy, formulary and specialist advice should be followed.

Key takeaways