“Concrete ways we can make a difference”: A multi-centre, multi-professional evaluation of sustainability in quality improvement education

Abstract

Quality improvement (QI) projects are a mandatory part of postgraduate medical training in the UK and graduating medical students must be competent in QI theory. We evaluated an educational toolkit that links concepts of sustainable healthcare with established quality improvement methodologies (the SusQI approach, available at www.susqi.org). The SusQI approach was implemented across a range of undergraduate and postgraduate nursing and medical education contexts. Educational strategies included guided online learning, live interactive webinars, small group activities and scaffolded project work. The evaluation strategy was informed by theories of academic motivation, educational value within communities of practice and behaviour change. A simultaneous nested design was tested using a mixed methods survey with input from learners and teachers. 177 survey responses were analysed to quantify and compare self-rated impacts of teaching across different audiences. Qualitative data were inductively coded into themes that were categorised according to above theoretical frameworks. Participants felt that this was ‘time well spent’ and many described transformative impacts that guided their daily professional practice beyond learning about QI. We suggest that meaningful space is found within both undergraduate and postgraduate healthcare curricula for SusQI, as a way of engaging and motivating learners to contribute to the creation of a sustainable healthcare system.

Keywords:

• Sustainable healthcare
• quality improvement
• medical education
• nursing education
• motivation

Glossary

Quality improvement in healthcare: Activities that aim improve the processes and outcomes of healthcare.

Sustainability in quality improvement: Activities that aim to improve the processes and outcomes of healthcare in ways that optimise social, economic and environmental value.

Triple bottom line: The net social, environmental and economic benefits and harms of an activity.

Acknowledgements

The authors acknowledge Stuart d’ArchSmith who was involved in the initial draft of the evaluation survey, and Professor Sue Smith from the Medical Education Research Unit of Imperial College London for her support. The authors also acknowledge the Health Foundation, Health Education England and Kings College London who funded and supported the SusQI Education Project at the Centre for Sustainable Healthcare.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Notes on contributors

Rosanna Spooner

Rosanna Spooner, BSc (Hons), MBBS, DTMH, RCPCH, is a paediatric registrar and an Education Fellow at The Centre for Sustainable Healthcare (CSH), where she teaches as part of the innovative Sustainability in Quality Improvement Education project. She recently become a member of the Association of Medical Educators and supports the SusQI Education project.

Victoria Stanford

Victoria Stanford, MBChB, BMedSci, MPH, is a junior doctor trained in Severn Deanery and has recently completed a Masters of Public Health at the Ecole des Hautes Etudes en Santé Publique (EHESP). She supports the SusQI Education project in delivering SusQI training in undergraduate and postgraduate teaching.

Siobhan Parslow-Williams

Siobhan Parslow-Williams, BSc Hons RGN, is a QI Education Lead at CSH working on a national project supporting the integration of sustainability into quality improvement healthcare education. She is a registered nurse with a background in emergency nursing, primary care, clinical research delivery, management and teaching. Siobhan graduated from the NIHR Advanced Leadership Programme in 2019.

Frances Mortimer

Frances Mortimer, BA (Hons), MBBS, MRCP, is Medical Director at CSH and led the development of the SusQI method. She initiated and directed the Sustainability in Quality Improvement Education project. She qualified in medicine from the Royal Free and University College London School of Medicine in 2003 and worked for five years in the NHS before co-founding the Centre for Sustainable Healthcare in 2008.

Kathleen Leedham-Green

Kathleen Leedham-Green, BSc, MBBS, PG Cert APHE, MA Clin Ed, FHEA, is a research fellow in Imperial College's Medical Education Research Unit. She has published extensively on educational approaches to prevention, patient activation, preparedness for practice, sustainable healthcare, innovation and quality improvement. She has a MA in Clinical Education and is undertaking a PhD in education for sustainable healthcare at the National Heart & Lung Institute.