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HORUS Reflection Help! 'Quality Improvement: take an active part in processes to improve the quality of care (HLO 2: 9)'

  • Medics & Me
  • 5 days ago
  • 7 min read

Whether you're an FY1 just finding your feet or an FY2 refining your final sign-off, the Quality Improvement (QI) section of your foundation e-portfolio can sometimes feel vague or intimidating. But don’t worry- it doesn’t have to be! This section is your opportunity to showcase your ability to think critically, contribute meaningfully to patient care, and engage with a core element of NHS practice: continuous improvement.


QI also plays a significant role in applications for Junior Clinical Fellow, Educational/Research Fellow or speciality trianing so it is great to have these reflections as you go along, then you can easily refer back prior to an interview.


In this post, we’ll break down exactly what to include in the QI section of your portfolio using the key headings you’ll find in HORUS, including real examples and tips for success. You’ll learn how to structure your QI reflections, what counts (yes, even a small audit or a teaching session on QI!), and how to make your entries shine for your Annual Review of Competence Progression (ARCP). We’ll also show how to incorporate recognised QI guides like TIPSQI and reflect on using national guides or tools.


By the end of this post, you’ll feel more confident in writing up your QI contributions- whether you've led a project, contributed to one, or simply taken time to understand the QI process. Remember though , to pass ARCP you need to have contributed during F1 and led a QI in F2.


Let’s get started with how to structure a strong QI entry in your portfolio, and make it ARCP-ready!


1. Quality Improvement (QI) Project Involvement


Title Example: "Improving Pre-Operative Documentation of Airway Assessment in Elective Surgical Patients at [Your Hospital Name] to ≥90% Compliance by the End of a 3-Month Period"


  • What to Include (full example):

    • Project Aim and Scope:

      This project aimed to improve the consistency and quality of pre-operative airway assessment documentation by anaesthetists for elective surgical patients. A baseline review showed incomplete or absent documentation in a significant number of cases, which could compromise patient safety and delay surgical lists. The goal was to raise compliance to ≥90% within a 3-month period.

    • Role and Responsibilities:

      As a Foundation Year 1 doctor, I conducted the initial baseline data collection by reviewing anaesthetic charts over a 4-week period. I collaborated with the anaesthetic team to design a simple airway assessment prompt and integrated this into the pre-op documentation process. I also delivered a brief presentation at the departmental audit meeting to introduce the intervention and later assisted with re-auditing.

    • QI Methodology Used:

      I used the Plan-Do-Study-Act (PDSA) cycle methodology:

      • Plan: Identified gaps in documentation and designed a standardised prompt.

      • Do: Introduced the intervention with support from the department.

      • Study: Re-audited the documentation rates at 6 and 12 weeks.

      • Act: Adjusted the approach after feedback, including adding the prompt to the theatre checklist.

    • Stakeholders Involved:

      • Anaesthetic consultants and trainees

      • Theatre nursing staff

      • Pre-operative assessment nurses

      • Surgical junior doctors (to ensure consistency during handover)

      • Clinical audit department

    • Outcomes or Results:

      • Baseline compliance was 52% (complete documentation).

      • After the intervention, compliance improved to 84% at 6 weeks and reached 91% by the end of 3 months.

      • Staff reported greater confidence in knowing a thorough airway assessment had been completed pre-operatively.

    • Challenges and Adaptations:

      Some anaesthetists were initially reluctant to change their documentation style. To address this, I gathered informal feedback and worked with the clinical lead to ensure the new prompt was incorporated into the theatre handover checklist. I also added laminated reminders to the anaesthetic rooms, which helped reinforce the intervention visually.


2. Clinical or Patient Safety Audits


Title Example: "Audit of Critical Medication being Missed in the Emergency Department in December 2024"


  • What to Include:

    • Audit Aim and Rationale: Provide a brief explanation of the purpose of the audit. What were you trying to assess or improve (e.g. medication error rates, adherence to infection control protocols)?

    • Methodology: Describe the audit process- how data was collected (e.g. patient charts, incident reports/ DATIX), sample size, and timeframe.

    • Findings and Analysis: Share key findings, particularly any discrepancies or areas of concern. Did you identify trends (e.g. higher medication misses with a certain drug or during specific shifts)?

    • Recommendations for Improvement: Detail any recommendations you made or changes implemented based on the audit findings.

    • Follow-up Actions: If relevant, mention any follow-up audits or continuous monitoring to track whether improvements were sustained.

    • Impact of Changes: Discuss how the recommendations were implemented and any impact on clinical practice, patient safety, or staff behaviour.


3. Implementation of Change in Practice


Title Suggestion: "Introducing a New Protocol for Uro-Sepsis Management in the (your hospital) ED for patients over 70"


  • What to Include:

    • Identified Issue and Rationale: Explain the clinical issue that prompted the change (e.g. delays in sepsis recognition leading to poor outcomes).

    • Role in Change Implementation: Outline your involvement, whether you helped design, communicate, or implement the new protocol or guideline.

    • Collaboration with Teams: Detail how you worked with the relevant teams (e.g. clinicians, nursing staff, infection control teams) to introduce the change.

    • Implementation Process: Describe how the change was communicated to the team, any training or resources provided, and how adherence was ensured.

    • Monitoring and Evaluation: Discuss how you monitored the success of the change (e.g. audits, feedback from staff) and any early outcomes.

    • Feedback from Stakeholders: Include feedback from staff or patients if available, highlighting whether the change was well-received and effective.

    • Sustainability: Discuss any steps taken to ensure the change was embedded into routine practice (e.g. regular reviews, updates to training).


4. Quality Improvement Training and Workshops


Title Example: "Attending a QI Training Workshop on PDSA Cycles"


  • What to Include:

    • Course or Workshop Overview: Mention the QI training or workshop attended (e.g. PDSA cycle workshop, Lean management principles).

    • Content Covered: Summarise the key concepts or tools you learned (e.g. PDSA cycles, root cause analysis, benchmarking).

    • Application to Practice: Explain how you applied or plan to apply what you learned to your clinical work or a specific QI project.

    • Skills Gained: Discuss any new skills you gained from the training (e.g. data analysis, process mapping) and how they enhance your ability to lead or contribute to QI projects.

    • Further Development: If you’ve undertaken further QI training (e.g. more advanced courses, online modules), mention this and how it has deepened your understanding of QI methods.


5. Reflective Practice on QI Projects


Title Example: "Reflecting on My Role in the ED's Patient Handover Improvement Initiative to reduce time and increase efficiency"


  • What to Include:

    • Project Reflection: Reflect on your personal role in a QI project and the impact it had. What was successful? What challenges did you face?

    • Learning from Feedback: Share any feedback you received from colleagues, mentors, or patients about your involvement in QI projects.

    • Challenges and Problem-Solving: Reflect on any obstacles you faced during the project (e.g. resistance to change, logistical issues) and how you overcame them.

    • Personal Development: Discuss how working on QI projects has influenced your professional growth, particularly in terms of leadership, teamwork, and problem-solving skills.

    • Future QI Projects: Describe how you would approach future QI projects differently based on your reflections and what you would improve.


6. Collaborative Work in Multidisciplinary QI Teams


Title Example: "Collaboration with Multidisciplinary Teams to Reduce ED Waiting Times"


  • What to Include:

    • Team Collaboration: Describe the multidisciplinary team you worked with (e.g. doctors, nurses, physiotherapists, administrators) and your role within that team.

    • Shared Goals and Outcomes: Discuss the common goal of improving patient care (e.g. reducing waiting times, improving discharge processes) and how the team worked together toward that goal.

    • Communication and Coordination: Highlight how communication and coordination within the team were managed (e.g. regular meetings, shared resources).

    • Outcome Evaluation: Share any outcomes that were tracked (e.g., wait times before and after interventions) and whether the collaborative effort led to measurable improvements.

    • Team Dynamics: Reflect on the importance of working within a team and how your ability to collaborate improved over the course of the project.


7. Data Analysis in QI Projects


Title Suggestion: "Using Data to Drive Improvements in Prescribing Paracetamol Before referring to the Pain Team on Ward 12 between June- September 2024"


  • What to Include:

    • Data Collection: Describe the type of data collected for the QI project (e.g. pain team referrals, surverys to nursing team, clinical outcomes) and the methodology used (e.g. retrospective analysis, prospective data collection).

    • Data Analysis: Explain how you analysed the data (e.g. statistical software, manual calculations) and what trends or issues were identified.

    • Impact on Practice: Discuss how the data informed changes in practice (e.g., changing patient communication strategies based on satisfaction scores).

    • Monitoring Improvements: If you’ve conducted follow-up data collection, mention any improvements tracked (e.g. improvement in paracetamol prescribing before referral).

    • Challenges with Data: Reflect on any challenges encountered during data collection or analysis (e.g., data gaps, small sample size) and how these were overcome.


8. Reflecting on a Quality Improvement Guide


Title Suggestion: "Reflecting on the TIPSQI Guide for Effective Quality Improvement"



9. Running a Session for Medical Students on QI and Audit


Title Suggestion: "Teaching Quality Improvement and Audit to Medical Students"


  • What to Include:

    • Session Overview: Describe the session you ran for medical students on QI and/or audit, including the objectives and the content covered.

    • Teaching Methods: Discuss the methods you used to engage students, such as interactive discussions, case studies, or real-world examples.

    • Feedback from Students: Share any feedback you received from students, particularly about what they learned or found useful.

    • Personal Reflection: Reflect on how teaching the session has enhanced your own understanding of QI and audit, and how it has influenced your teaching style.

    • Future Plans: If you plan to run more sessions, explain what changes you would make based on your experiences and feedback.

    • Top tip: Remember to get a DCT for this this too!

 
 
 

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