Intended for healthcare professionals

CCBYNC Open access
Analysis Quality Improvement

Can we import improvements from industry to healthcare?

BMJ 2019; 364 doi: (Published 21 March 2019) Cite this as: BMJ 2019;364:l1039

Re: Can we import improvements from industry to healthcare?

Whilst we agree with the author that the 'plan-do-study-act' cycle is useful for quality improvement and training in the healthcare setting, we would like to suggest an additional approach. In cricket coaching, the 'play-study-plan-practise' cycle is often utilsed. Ie. After their 'play', they review and analyse areas for improvement; this informs the intensive training of specific skills, allowing teams to return to 'play' with a honed and precise skillset.

Clinically, time-pressures mean that our 'planning' and 'doing' stages often merge together. 'Studying' of our activities is often performed far in retrospect (for example, in audit), rather than contemporaneously honing our own performance. Similarly, 'action' is often in response to arising problems, rather than pre-emptive training. High-fidelity sim-scenarios go some way to cross this bridge, but are incorporated into training rarely.

Perhaps if we approached each new skill or process with a mechanism for detailed performance review, training and repetition - play-study-plan-practise - then this sporting industry technique could become a useful tool for enhancing clinician training and improving patient care.

Competing interests: No competing interests

28 March 2019
Claire C A Davies
ST4 anaesthesia
Mark Davies, consultant in anaesthesia & perioperative medicine
Royal Liverpool & Broadgreen University Hospitals NHS Trust
Liverpool L7 8XP