Join the members group    Follow Us

Quality Improvement Activity (QIA)

 

GMC Good Medical Practice requires doctors to monitor and improve the quality of their practice (para 13). Review of practice (evaluating the quality of your professional work) through Quality Improvement Activities (QIA) is thus an integral and mandatory part of revalidation and as a doctor with a licence to practice you are required to demonstrate that you regularly participate in QIA that allow you

  • to review and evaluate the quality of your work
  • to identify what works well in your practice and where you can make changes
  • to reflect on whether changes you have made have improved your practice or what further action you need to take. 

 

Frequency

The GMC requires that you must be able to show you have participated in QIA that is relevant to all aspects of your practice at least once in your revalidation cycle but that the extent and frequency will depend on the nature of the activity and should be discussed with your appraiser or responsible officer. The Faculty is a non-employing designated body and therefore direct oversight of a doctor’s practice is not possible as it is for employers. Therefore Faculty requirements are that you should provide QIA that is relevant to your practice annually. Over your cycle you must provide QIA meeting GMC standards for all aspects of your practice. 

 

Format and Content

You should evaluate and reflect on the results of the activity, including what action you have taken in response to the results and the impact over time of the changes you have made, and discuss these outcomes at your appraisal. If you have been unable to evaluate the result of the changes you have made or plan to make to your practice, you must discuss with your appraiser how you will include this in your personal development plan for the following appraisal period. The GMC requires that your QIA is robust and, where appropriate, systematic. You should ensure that is sufficiently evidenced that your appraiser can be confident in the validity of the activity. You should focus on demonstrating:

  • how the quality improvement activity you have carried out is relevant to your work.
  • how you have evaluated and reflected on the results of your activity. This may be through reflective notes about the implications of the results on your work, discussion of the results at peer-supervision or team meetings and contributions to your professional development.
  • what action you have taken or plan to take in response to the results. This might include the development of an action plan based on the results of the activity, changing your practice following participation, and informing colleagues of the findings and any action required.
  • whether an improvement has occurred or if the activity showed that good practice has been maintained. This should be through the results of a repeat of the activity or a re-audit after a period of time where possible.

Examples 

QIA can take many forms depending on the roles you do and the nature of your practice but they must be robust, systematic and relevant to your work. You should participate in Activities that are your own work or responsibility and where the work has been part of a team effort your role must be clearly explained. GMC examples of QIA from the updated key document Guidance on supporting information for appraisal and revalidation (2018) include: 

  • Review of your performance against local, regional or national benchmarking data where this is robust, attributable and validated. This could include morbidity and mortality statistics or complication rates.
  • Clinical audit. This must be evidence of effective participation in clinical audit or an equivalent quality improvement exercise that measures the care with which you have been directly involved.
  • Case review or discussion. A documented account of interesting or challenging cases that you have discussed with a peer, another specialist or within a multidisciplinary team.
  • Learning event analysis.
  • Audit and monitoring of the effectiveness of a teaching programme.
  • Evaluating the impact and effectiveness of a piece of health policy or management practice.

Many doctors revalidating through the Faculty undertake clinical work and so the above GMC examples will be self-explanatory in relation to that part of their scope of work. However most pharmaceutical physicians also or entirely work in a non-clinical setting. The GMC requirements are the same and there are a large number of opportunities for relevant QIA. The key is to take the principles underpinning QIA and apply them to your work, which is something all doctors can do regardless of the nature of their practice. Below are some real life examples that when appropriately evidenced with reflection, learnings, changes in practice and re-evaluation would meet GMC requirements.  

 

  • Audit - It may be difficult for MHRA and FDA audits to be used as any individual doctor may not play a sufficient role especially in a large company but they can be appropriate, for example, in a smaller company and where the doctor is responsible for the medical department. There are however many other opportunities for audits of a doctor’s own or their department’s work. Examples are PMCPA audits, financial and expenses audits for doctors running their own company or CEO of a company. Also audits of  informed consent procedure, departmental honorarium/grants, medical information letters, code of practice issues, regulatory submissions and reviews, ethical committee submissions, NICE submissions, safety monitoring. There are a wide range of outcomes that could be subject to an audit.

 

  • Case Reviews - these are the most common QIA, but what is important is the writing up of what the doctor would do differently and better next time. The opportunities for case reviews where a doctor’s work has been subject to critique by peers or seniors is endless and examples include;
  • healthy volunteer initial dosing
  • loss to follow up in clinical studies (identified problems, analysed causes and developed an immediate and also longer-term solution with principles to guide future decision making)
  • review of work by scientific advisory board (e.g. tox /ADR review)
  • significant ADR(s) in a study or post marketing
  • promotional copy that was subject to inter-company correspondence
  • promotional copy that had significant alterations before use
  • successful and unsuccessful regulatory submissions (eg IND applications, protocol variations, ethics committee submissions)
  • mock resuscitation exercise
  • patient materials reviewed by patient panels
  • review of promotional material processes
  • protocol reviewed by internal or external review committee
  • named patient programme where there had been a significant event
  • approach to managing a personal health matter which impacted on professional work
  • case review of training delivered with changes made in light of delegate feedback
  • case review of managing a direct report with a performance problem 

 

  • Health Policy, Management Practice - this could be an SOP that the doctor has written or updates for a particular reason and it would include what was done and why, the intended impact, how that will be monitored and, either for that appraisal or as a carry forward in the PDP, the evaluation of the outcome of the SOP to determine whether it has achieved its objectives.

 

There are many other examples can be considered as a critique of one’s own work which if followed by a demonstrable change in practice where indicated would meet the requirements, for examples submitting a manuscript for peer review, the comments, the changes and the learnings for next time, with appropriate documentation - as with any QIA. Acting as a peer reviewer would be CPD as it is not a critique of one's own work but the work of another.

 

Additional Points

For all QIA it is important to demonstrate one's own input and role and of course write up with reflections, learnings and what will be done differently next time. Whilst there is clear benefit to undertaking personal activities in this area, the GMC does not require QIA to be individually driven by the doctor. Activities undertaken within a team, practice, department, organisation or nationally may all comply with the criteria for QIA. The consistent requirements are that the doctor is able to analyse the data presented, identify its relevance to their practice and indicate actions which they have taken or plan to take as a result. 

 

Pharmaceutical physicians have considerable opportunities for their work to be evaluated by others, to learn from that and to make changes in their practice. So often it is just a matter of documenting what happens in the course of one's normal work but for some doctors it has been an impetus to undertake a review/audit of a particular aspect or piece of their work that they would not otherwise have done - which is great as revalidation is about improving quality not just demonstrating quality.