This article reflects the conversations in the breakout group on this topic at the Recently Appointed Consultants symposium on Friday 13 March 2015. Last reviewed July 2021.


All consultants have a duty to continually try to make improvements within their daily routine of clinical service. The first challenge is to find time to stand back and observe the system they work in. Further challenges include how to find the time, resources or support to then implement improvements. These potential barriers can demotivate, but even small changes can make a big difference, including improved outcome, shortened length of stay and more person-centred goals like quality of life. Gaining support from others is very important. In order to build enthusiasm for changes, highlight things that are already done well within a system, identify your aims and then try to suggest changes that make it easy to ‘do the right thing.’ Data collection is key, for if you cannot measure it, you cannot improve it. Try to build your data collection into your daily practice so that it is not too onerous.

It is important to prove that the new ideas work and that any change or improvement is sustained over time. Process, outcome and balancing measures (unintended consequences) are all vital to your improvement journey. You may not get your expected outcome, so it is safer to test out all changes in a small scale way initially. Small-scale change can also help to demonstrate the benefits of improvement to others and gain further support.

The model for improvement, or ‘plan/do/study/act’ (PDSA) model, can be used to test change. Pinpoint a measurable outcome, take regular measurements and plot results over time on a run chart. If possible, try to gather measurements prior to testing and implementation in order to produce a baseline for comparison. Reduce the likelihood of unnecessary variation by standardising the new methods and training any other members of staff involved. This will help to improve the fidelity, reliability and consistency of the impact of the change.

Web resources/further reading:

The Scottish Patient Safety Programme has successfully implemented a lot of quality improvement initiatives:

1000 Lives Improvement is the national improvement programme supporting organisations and individuals to deliver the highest quality and safest healthcare for the people of Wales.

In England, try the Patient Safety First Campaign:

For free resources relating to quality improvement try: or

Breakout group leader: Professor Kevin Rooney, Professor of Care Improvement, Royal Alexandra Hospital, Paisley

Reviewed April 2018