Intended for healthcare professionals

Letters Is quality of care improving?

Improvement efforts need to be targeted at junior doctors

BMJ 2011; 342 doi: (Published 01 March 2011) Cite this as: BMJ 2011;342:d1323
  1. Rob Bethune, surgical registrar, Severn Deanery, and clinical adviser, Health Foundation1,
  2. Alice Roueché, clinical leadership fellow2,
  3. Toby Hilman, board member3
  1. 1Severn Deanery, Deanery House, Bristol BS16 1GW, UK
  2. 2London Deanery, Stewart House, London WC1B 5DN, UK
  3. 3The Network,
  1. rob.bethune{at}

Pronovost and colleagues and the linked evaluations of the Safer Patient Initiative (SPI) comment on the successes and failures of the patient safety and quality improvement movement in the UK.1 2 3

Crucially, the initiatives were not targeted at junior doctors, who are most concerned with safety at work and best placed to drive quality improvement because most (80%) ward based activity is led by trainees.4 The SPI learning sets mostly called on trusts to supply teams of managers, consultants, and senior nurses, which is one of the main reasons why penetration to ward level was poor.2 Few junior doctors in training are aware of the various national safety projects, even at the SPI sites. To improve safety, efforts will need to be directed to this group first in all NHS improvement initiatives.

The people who can make a difference are largely not being adequately equipped or informed. However, in the south west of England 150 foundation year one doctors run quality improvement projects, and in London the Beyond Audit Programme is changing the way junior doctors think about influencing the standard of care they give to their patients.


Cite this as: BMJ 2011;342:d1323


  • Competing interests: None declared.


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