QI Project Checklist for Trainees: A Practical Guide

Why this topic matters

Quality Improvement is embedded within the core curricula of all medical specialities and many allied health professions. Demonstrating engagement with QI is a mandatory requirement for ARCP and professional development. However, for many trainees, the process of initiating, conducting, and completing a QI project can feel daunting. There is often a lack of clear, consistent guidance available at a local level.

Well-structured QI projects, even on a small scale, can significantly benefit patient care, enhance team working, and develop essential leadership and analytical skills. A systematic approach helps to avoid common pitfalls, ensures appropriate governance, and increases the likelihood of successful implementation and sustained change. This checklist aims to demystify the process, providing a clear roadmap from concept to completion and portfolio reflection.

Practical explanation: What is a QI Project?

A Quality Improvement project is a systematic approach to making beneficial changes in healthcare delivery. Unlike research, which aims to generate new knowledge, QI focuses on improving existing processes and outcomes within a specific local context. It typically follows a cyclical methodology, most commonly the Plan-Do-Study-Act (PDSA) cycle, to test changes rapidly and iteratively.

Key characteristics of a QI project:

• Local focus: Addresses a specific problem within a defined clinical area or team.
• Iterative cycles: Involves small, rapid cycles of change, testing, and refinement.
• Measurement: Uses data to understand the problem, track progress, and evaluate the impact of changes.
• Team-based: Often involves a multidisciplinary team to ensure diverse perspectives and buy-in.
• Sustainability: Aims for changes that can be integrated into routine practice and sustained over time.
• Transparency and Governance: Requires registration and oversight by local QI or audit departments.

Distinguishing QI from Audit, Service Evaluation, and Research

It's crucial to correctly categorise your project, as each has different governance requirements:

• Clinical Audit: Compares current practice against a defined standard (e.g., NICE guidance, local protocol) and implements changes if shortfalls are identified. Subsequent re-audit checks if changes have improved compliance.
• Service Evaluation: Assesses how well an existing service is meeting its aims, or if a new service is achieving its intended purpose. It typically asks, "What does this service deliver, and is it meeting the needs of the population?"
• Research: Aims to generate new, generalisable knowledge, often involving recruitment of patients into studies, randomisation, or experimental interventions. Requires full Research Ethics Committee (REC) approval.

If you are unsure, always consult your local Clinical Audit or Research & Development department. Many trusts have clear decision trees to help classify projects.

Common pitfalls for trainees

1. Over-ambitious scope: Trying to solve a very large, complex problem often leads to project paralysis or failure. Start small, focus on a specific process.
2. Lack of engagement: Not involving relevant stakeholders (e.g., nurses, administrative staff, senior clinicians, patients) from the outset can lead to resistance or disengagement.
3. Ignoring local governance: Failing to register the project with the local audit or QI department can invalidate the work for ARCP purposes and bypass important safety checks.
4. Poor data collection: Not planning data collection effectively, collecting too much irrelevant data, or not understanding baseline performance.
5. No clear aim statement: Starting without a focused, measurable aim can lead to unfocused efforts and difficulty in demonstrating impact.
6. Jumping to solutions: Implementing changes without understanding the root causes of the problem.
7. Lack of sustainability planning: Not considering how changes will be embedded into routine practice once the project finishes.
8. Inadequate reflection and write-up: Underestimating the importance of documenting the project, reflecting on challenges, and presenting findings clearly for ARCP.

QI Project Checklist for Trainees

This checklist is structured around key stages of a QI project. It is intended to be a practical guide, not an exhaustive list. Each point prompts consideration and action.

Stage 1: Project Conception & Planning

• Identify a problem area: What irritates you, causes delays, or could improve patient safety/experience/efficiency? Think 'what could be better?'
• Formulate an aim statement: Use the 'SMART' (Specific, Measurable, Achievable, Relevant, Time-bound) framework. For QI, the 'AIM' statement is often preferred: "By [Date], we will [What, e.g., reduce X by Y%] for [Population/Process] at [Location]."
• Confirm project type & governance: Is it QI, audit, service evaluation, or research? Register with your local Clinical Audit/QI department and seek advice from a QI lead or supervisor.
• Assemble your team: Identify key stakeholders (e.g., ward staff, ANPs, consultants, allied health professionals, admin staff, patients/carers). Engage them early.
• Define project scope: Clearly outline what is in and out of scope to avoid mission creep.
• Identify baseline data: What data do you need to understand the current situation and measure your aim? How will you collect it? (e.g., retrospective chart review, observation, surveys).
• Review existing evidence/guidance: Are there national (e.g., NICE, Royal College) or local guidelines relevant to your problem?
• Risk assessment: Consider potential risks to patients, staff, or the organisation from the proposed changes.

Stage 2: Understanding the Problem & Designing Interventions

• Process mapping: Map out the current process step-by-step to identify bottlenecks, delays, and inefficiencies.
• Cause and effect analysis: Use tools like 'fishbone diagrams' (Ishikawa) or '5 Whys' to identify root causes, not just symptoms.
• Brainstorm solutions/interventions: Based on root causes, generate potential changes to test.
• Prioritise interventions: Which changes are most feasible, have the greatest potential impact, and are easiest to test first?
• Develop a measurement plan: How will you track the impact of your interventions? Identify key process measures (how the system is performing) and outcome measures (what is happening to patients/service users).
• Plan your first PDSA cycle: What small change will you test? How will you 'Do' it? How will you 'Study' the results? What will you 'Act' on?

Stage 3: Implementation & Evaluation (PDSA Cycles)

• Run PDSA cycle 1: Implement the small, planned change.
• Collect data: Gather the planned process and outcome measures during and after the change.
• Analyse and reflect: What did you learn? Did the change lead to the predicted improvement? What were the unintended consequences?
• Decide on next steps (Act): Adapt the change, abandon it, or scale it up for the next cycle. Plan your next PDSA cycle.
• Repeat PDSA cycles: Continue to test, refine, and adapt changes based on data and learning. Document each cycle.
• Maintain stakeholder engagement: Regularly update your team and other stakeholders on progress and seek feedback.

Stage 4: Sustaining Change & Dissemination

• Standardise successful changes: How will the improved process become standard practice? (e.g., update protocols, training, integrate into electronic systems).
• Ongoing monitoring: How will you ensure the improvements are sustained over time? What are the long-term measures?
• Present your findings: Prepare a presentation or report for your department, trust QI meeting, or local conference.
• Disseminate broadly (if applicable): Consider sharing learning with other teams or organisations.
• Write up for ARCP/portfolio: Document your project clearly, highlighting your role, the methods used, results, challenges, and your personal reflections on learning. Include evidence of registration, data, and any presentations.
• Seek feedback: Ask your supervisor or QI lead to review your write-up before submitting for ARCP.

Example in clinical practice: Reducing Delays in Discharge Summaries

Dr. Anya Sharma, an FY2 doctor, identified that discharge summaries for patients on her ward were frequently delayed, sometimes by several days post-discharge. This led to issues with continuity of care for GPs and repeat prescribing.

• Aim: "By 31st December, we will increase the proportion of discharge summaries completed and sent to GPs within 24 hours of discharge from 40% to 80% on Ward B."
• Team: Dr. Sharma engaged her consultant, the ward manager, and the ward clerk.
• Baseline data: She audited 50 consecutive discharge summaries, finding 40% completed within 24 hours.
• Process mapping & Root Cause Analysis: They mapped the discharge process. Key issues identified: doctors prioritising ward work over summaries, lack of a clear handover process for incomplete summaries, and no dedicated time for completion.
• Intervention 1 (PDSA cycle 1): Introduce a 'Discharge Summary Huddle' at 15:00 daily, where the on-call team and ward team review pending discharges and assign responsibilities for summaries due that day or the next. Result: Modest improvement, but still delays.
• Intervention 2 (PDSA cycle 2, building on learning): In addition to the huddle, the ward manager implemented a reminder system: a whiteboard list of patients due for discharge, with a column for 'summary status'. Doctors were encouraged to complete summaries immediately after discharge decisions. Result: Significant improvement, reaching 70% within 24 hours.
• Intervention 3 (PDSA cycle 3): Based on further feedback, a 'protected hour' for completing discharge summaries was piloted for junior doctors on a rolling basis. Result: Achieved 85% within 24 hours, exceeding the aim.
• Standardisation: The huddle, whiteboard system, and protected hour were formalised into ward practice. The ward manager continued monitoring compliance.
• ARCP Evidence: Dr. Sharma compiled a report detailing the project, including her aim, methods, PDSA cycles, run chart data showing improvement, and reflections on her leadership and team-working skills. She presented her findings at a trust QI forum.

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

How Lazomis can help

Lazomis provides structured tools and templates to simplify the QI project journey. Our 'QI Project Setup' tool helps you define your aim, identify stakeholders, and plan data collection. The 'PDSA Cycle Planner' guides you through each iteration, ensuring systematic testing and documentation. Our 'Data Visualisation' and 'Run Chart' features can help you easily plot your process and outcome measures, making it simple to track progress and demonstrate impact. For ARCP, our 'Portfolio Evidence Organiser' allows you to collate all your QI project documentation in one place, streamlining the write-up and submission process, ensuring all required elements are covered.

Key takeaways

• Start small with a clearly defined, measurable aim statement for your QI project.
• Engage relevant stakeholders and seek local governance approval (QI/audit department) early.
• Use systematic approaches like process mapping and root cause analysis to understand the problem.
• Implement changes using iterative Plan-Do-Study-Act (PDSA) cycles, measuring their impact.
• Document all stages, especially your learning and reflections, for ARCP evidence.
• Consult your supervisor or a local QI lead for guidance throughout the project.