LAUSR

VET professionals are signed up to the concept of quality improvement (QI) to drive up standards of care, but lack of time is the chief reason they don’t implement or use systematic QI approaches. These are among the main findings drawn from an analysis of the QI landscape across the veterinary sector, conducted last year by consultancy Rand Europe. It found that, unlike in human healthcare, QI is not embedded into day-to-day veterinary practice and, where it does exist, it is a more informal arrangement. QI is about reviewing an existing task or process and using a formal and explicit approach to improve it. While lack of know-how and organisational support are significant barriers to vet professionals undertaking QI activity, time pressures are seen as the most significant, the consultants found. ‘The concern is that teams are already working at, or even over, capacity and that there is no room to add further tasks to the daily routine,’ they say in their review, published last month. While there is no need or appetite for the profession to roll out a whole new ‘improvement architecture’ to support QI, the consultants argue that a more structured approach to advancing quality of care is needed across the veterinary profession due to animal owners being better informed than ever and potentially more willing to make complaints. These factors make it increasingly important to have some formal system to demonstrate how quality issues are addressed, they warn. ‘The time is now for the professions to embrace the opportunities presented by a culture of quality improvement and to translate these opportunities into safer, more efficient and improved clinical outcomes for patients,’ their report says. Last year RCVS Knowledge commissioned the research to establish the level of QI activity across veterinary practice and to find out how relevant it was considered by vet professionals to their work. Rand Europe was also tasked with finding out how the profession measures the quality of work it provides, as well as exploring barriers and possible incentives for embedding QI work in veterinary practice. Based on the views of 314 vets and 194 veterinary nurses from across small and large animal practice, the consultants found vet professionals generally positive about QI – some 96 per cent thought it would improve veterinary care. However, they also found some uncertainty about what QI is and what it involves (74 per cent said they lacked know-how about QI). Their research also found that those new to the concept of QI are unclear about the best ways to get involved, and some 81 per cent would appreciate some training in QI. Tom Ling, senior research leader and head of evaluation at Rand Europe, said QI was rising up the veterinary agenda, following the introduction of the Practice Standards Scheme by the RCVS in 2005. Commenting on the vet sector analysis at last month’s Society of Practising Veterinary Surgeons/ Veterinary Management Group conference, he said: ‘There is no hostility to the basic idea of QI – there is in fact strong support for it. ‘Awareness of it varies, however. They [professionals] are generally aware of it as a concept, but the depth of knowledge is quite variable. ‘The top reason for not engaging with QI is time,’ he said. ‘This comes out time and time again in quality improvement work – we see this in human health care too. The way to overcome that is to connect QI to the system priorities.’ Recommendations by the Rand consultants are set out in a ‘roadmap’ that suggests practices can kick off their QI work by focusing on a small number of specific projects linked to work – they suggest clinical audits, benchmarking, significant event audits, guidelines or checklists as suitable improvement activities. The consultants have also drawn up 28 recommendations, shortto long-term, to drive progress. As a priority, they suggest the vet professions should consider establishing an ‘improvement community’ to drive up quality via webinars and site visits (and suggests this work be led by the RCVS and RCVS Knowledge). Commenting on the launch of the Rand review, Chris Gush, executive director of RCVS Knowledge, said: ‘The time is now to embrace the opportunities QI presents for safer, more efficient and improved outcomes for patients – aims that we know drive veterinary professionals in their work every day.’ ●