How to Select a Patient Safety Quality Improvement Project

Why This Topic Matters

Patient safety is fundamental to all aspects of NHS care. Despite significant efforts, preventable harm still occurs, leading to adverse outcomes for patients, increased length of stay, and substantial costs to the healthcare system. The NHS Patient Safety Strategy highlights the importance of learning from incidents and implementing proactive safety improvements across all services.

Engaging in quality improvement is a core responsibility for all clinicians and is increasingly integrated into training curricula and professional development. However, selecting a project that addresses a genuine safety need, aligns with strategic goals, and is feasible within resource constraints can be challenging. A well-chosen project is more likely to secure leadership support, engage frontline staff, and ultimately deliver sustained benefits for patients.

Practical Explanation: Defining a Patient Safety QI Project

A patient safety QI project aims to reduce the risk of harm to patients, prevent adverse events, or mitigate the impact of harm when it occurs, through systematic, iterative change. Unlike audit (which measures current practice against a standard) or research (which seeks to generate new knowledge), QI focuses on improving a specific process or outcome within a defined local system.

Key characteristics of a strong patient safety QI project include:

• Clear Aim: A specific, measurable, achievable, relevant, and time-bound (SMART) objective.
• Patient-Centred: Directly or indirectly benefits patient safety outcomes or experience.
• Data-Driven: Relies on data to identify the problem, measure progress, and evaluate impact.
• Systemic Focus: Addresses process or system failures, rather than solely individual performance.
• Sustainable: Designed with long-term implementation and spread in mind.

Sources for identifying potential patient safety issues often include:

• Incident reporting systems: Datix, local risk registers, patient safety alerts.
• Patient and staff feedback: Complaints, surveys, ward rounds, safety huddles.
• Clinical audit findings: Gaps between current practice and national standards (e.g., NICE guidance, Royal College guidelines).
• National reports: NCEPOD, GIRFT, CQC findings, national audits.
• Local risk assessments: Departmental safety walk-arounds, PALS data.
• Benchmarking data: Comparison with similar units or national averages.

Common Pitfalls in Project Selection

When embarking on a QI journey, several common traps can hinder success:

• Problem too broad: Tackling 'all falls' or 'all medication errors' without defining a specific focus makes it difficult to measure change or identify specific interventions.
• Lack of clear data: Choosing a problem without readily available or collectable data makes it hard to baseline current performance or demonstrate improvement.
• Focus on blame, not system: Projects that aim to 'fix' individuals rather than processes rarely achieve sustainable improvement and can foster a blame culture.
• Solutions-first approach: Jumping straight to a solution (e.g., 'we need a new app') without fully understanding the root cause of the problem can lead to ineffective interventions.
• Lack of stakeholder engagement: Without buy-in from those who perform the work, implement changes, or are impacted by them, projects are unlikely to succeed.
• No alignment with organisational priorities: Projects that do not align with local or national patient safety strategies may struggle to gain resources or leadership support.
• Overly ambitious scope: Trying to solve a large, complex problem all at once can lead to project fatigue and failure. Incremental changes are often more effective.

Step-by-Step Approach to Selecting a Patient Safety QI Project

This structured approach helps teams systematically move from a broad area of concern to a focused, actionable QI project.

Step 1: Brainstorm Potential Safety Concerns

Gather your team and identify areas where patient safety could be improved. Encourage open discussion. Sources might include recent incidents, staff concerns, patient feedback, or areas of non-compliance from audits. Prioritise areas that directly relate to patient harm or high-risk processes.

Step 2: Prioritise and Select a Focus Area

From your brainstormed list, narrow down to 3-5 key areas. Use a simple prioritisation matrix or discuss using criteria such as:

• Impact: How significant is the potential harm to patients if this issue isn't addressed?
• Feasibility: Is it realistic to make a change in this area within your team's control and resources?
• Data Availability: Can you measure the current state and future impact?
• Alignment: Does it align with departmental, trust-wide, or national patient safety priorities (e.g., NHS Patient Safety Strategy, National Patient Safety Alerts)?
• Team Interest: Is there enthusiasm and buy-in from the team?

Example prioritisation tool: A simple RAG (Red/Amber/Green) rating for Impact and Feasibility, or a scoring matrix weighing each criterion.

Step 3: Define the Problem and Understand its Root Causes

Once a focus area is chosen, thoroughly investigate the problem. Avoid jumping to solutions. Tools like '5 Whys', Fishbone (Ishikawa) diagrams, or process mapping can help you understand the contributing factors and specific points of failure. The aim here is to clearly articulate what the problem is, where it occurs, when it occurs, and why it occurs.

• Example: Instead of 'medication errors', dig deeper: 'Delays in administering the first dose of antibiotics on medical admissions within 60 minutes due to pharmacy supply issues and nursing workload during peak hours'.

Step 4: Develop a Clear Aim Statement

Formulate a SMART aim statement for your project. This should be a concise, measurable goal that defines what you intend to achieve, by when, and for whom. It must be specific enough to guide your interventions and measure progress.

• Example: "To reduce the proportion of medical admissions receiving their first dose of antibiotics after 60 minutes from 45% to 15% within 6 months, on Ward X."

Step 5: Identify Key Measures

Determine how you will measure success. You'll typically need three types of measures:

• Outcome Measures: What is the ultimate impact on the patient? (e.g., rate of antibiotic administration within 60 mins).
• Process Measures: Are the new processes being followed? (e.g., percentage of prescriptions validated by pharmacy within 30 mins).
• Balancing Measures: Are you inadvertently causing other problems? (e.g., increase in nursing staff overtime, increase in prescribing errors due to rush).

Ensure these measures are practical to collect and interpret regularly.

Step 6: Secure Stakeholder Engagement and Sponsorship

Identify all key individuals who need to be involved or informed. This includes frontline staff, ward managers, senior clinicians, pharmacy, pathology, IT, and clinical governance. Crucially, secure a project sponsor (e.g., Clinical Director, Matron) who can provide strategic oversight, remove barriers, and champion your project. Explain the patient safety benefits and alignment with trust objectives.

Example in Clinical Practice: Improving Sepsis Pathway Compliance

Initial Concern: A&E staff report inconsistent adherence to the sepsis screening and management pathway, leading to delayed treatment for some patients.

Step 1: Brainstorm Potential Safety Concerns: Delays in sepsis recognition, inconsistent antibiotic administration, poor fluid resuscitation, inadequate documentation.

Step 2: Prioritise and Select a Focus Area: After discussion, the team identifies 'delayed administration of first-dose antibiotics for suspected sepsis' as a high-impact, feasible area, aligning with national CQUINs and local patient safety priorities. Data shows only 60% compliance with the 1-hour target.

Step 3: Define the Problem and Understand Root Causes: Using a Fishbone diagram, the team identifies causes: lack of immediate access to empirical antibiotics on arrival, delays in doctor prescribing, nursing workload, and lack of clarity on roles for initiating the pathway. The specific problem is '40% of suspected sepsis patients in A&E do not receive their first dose of empirical antibiotics within one hour of recognition'.

Step 4: Develop a Clear Aim Statement: "To increase the proportion of adult patients with suspected sepsis receiving their first dose of empirical antibiotics within one hour of recognition in A&E from 60% to 85% by June 2025."

Step 5: Identify Key Measures:

• Outcome: Percentage of suspected sepsis patients receiving antibiotics within one hour.
• Process: Percentage of suspected sepsis patients screened using the pathway; time from pathway activation to antibiotic prescribing; time from prescribing to administration.
• Balancing: Length of stay in A&E for sepsis patients; incidence of adverse drug reactions; nursing staff satisfaction with new process.

Step 6: Secure Stakeholder Engagement: The A&E Consultant lead champions the project. Pharmacy, microbiology, IT, and A&E nursing leadership are involved from the outset to develop and test interventions (e.g., 'sepsis pack' of common antibiotics in A&E, clearer guidelines, dedicated 'sepsis nurse' role during peak hours).

This structured approach ensures the team starts with a well-defined problem, a clear aim, and the necessary support to make a tangible difference to patient safety.

How Lazomis Can Help

The Lazomis platform supports NHS teams through every stage of their QI journey, including project selection and planning. Our QI Project Setup tool guides you through defining your problem, creating SMART aims, and identifying key measures. It provides templates for root cause analysis (like Fishbone diagrams) and helps you document stakeholder mapping, ensuring you don't miss critical engagement opportunities. The integrated Data Collection and Dashboards features allow you to easily track your baseline data, monitor your process and outcome measures in real-time, and visualise your progress against your aim, helping to demonstrate the impact of your chosen project and inform your iterative improvement cycles. This structured approach helps ensure your chosen project is robust and well-supported.

Key Takeaways

• Selecting a focused patient safety QI project is crucial for success and demonstrable impact.
• Utilise national guidance, incident data, and local feedback to identify potential areas for improvement.
• Thoroughly define the problem and its root causes before deciding on solutions.
• Develop a SMART (Specific, Measurable, Achievable, Relevant, Time-bound) aim statement.
• Identify robust outcome, process, and balancing measures to track progress and prevent unintended consequences.
• Engage all relevant stakeholders and secure senior sponsorship early in the project lifecycle.

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