Intended for healthcare professionals


Is quality of care improving in the UK?

BMJ 2011; 342 doi: (Published 03 February 2011) Cite this as: BMJ 2011;342:c6646

Patient Safety and Quality Improvement efforts need to be targeted at junior doctors.

The editorial (Pronovost, Berenholtz et al. 2011) and the linked
evaluations (Benning, Dixon-Woods et al. 2011; Benning, Ghaleb et al.
2011) of the Safer Patient Initiative (SPI) make many good points about
the successes and failures the patient safety and quality improvement
movement in the UK.

One additional, and crucial, point is that these initiatives were not
targeted at the staff who are most involved in safety work and who are
best placed to drive quality improvement - the junior doctors. 80% of
ward based activity is de facto lead by trainees (Tooke 2008). The SPI
Learning Sets mostly called on trusts to supply teams of; managers,
consultants and senior nurses. This is one of the main reasons why there
was so little penetration to ward level (Benning, Ghaleb et al. 2011).
Very few training junior doctors are aware of the various national safety
projects even at the SPI sites. If we really want to improve safety we
will have to direct our efforts to this group first. This is a key issue
in all NHS 'improvement' initiatives. The people that can make a
difference are not being adequately equipped nor informed.

This situation may be beginning to improve. In the South West there
are now 150 Foundation Year one doctors running 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.

Rob Bethune
Surgical Registrar, Severn Deanery
Clinical Advisor, The Health Foundation
The Network

Alice Roueche
Paediatric Registrar, London Deanery
Clinical Leadership Fellow, London Deanery

Toby Hillman
Respiratory Registrar, London Deanery
Clinical Leadership Fellow, London Deanery
The Network

Benning, A., M. Dixon-Woods, et al. (2011). "Multiple component
patient safety intervention in English hospitals: controlled evaluation of
second phase." BMJ 342: d199.

Benning, A., M. Ghaleb, et al. (2011). "Large scale organisational
intervention to improve patient safety in four UK hospitals: mixed method
evaluation." BMJ 342: d195.

Pronovost, P. J., S. M. Berenholtz, et al. (2011). "Is quality of
care improving in the UK?" BMJ 342: c6646.

Tooke, P. S. J. (2008). Aspiring To Excellence, Independent Inquiry
Into Modernising Medical Careers, MMC Inquiry.

Competing interests: No competing interests

15 February 2011
Robert M. Bethune
Surgical Registrar
Alice Roueche, Toby Hillman
Severn and London Deanery