Junior doctors leading hospital improvement

To the Editor: Clinical practice is constantly evolving, and while doctors are accomplished in recognising the need for continual personal development and improvement, they traditionally have been difficult to engage in health care system redesign.1,2 Quality improvement (QI) initiatives are often met with disengagement, owing to a perception that they provide little clinical benefit and that resources could be better spent elsewhere.1

While QI initiatives certainly require resources, they offer tangible benefits in the form of better patient outcomes and improved process efficiencies.2,3 They are increasingly being viewed as essential to quality patient care both locally and overseas, with junior doctor involvement often crucial to their success.4,5 Junior doctors provide a unique perspective in identifying issues with hospital processes, deficiencies in patient care and most importantly offering solutions for improvement.5 In the United States, QI skills are now a core competency for resident position accreditation, which has led to the integration of improvement training into medical curricula.4,5

As a means of engaging clinicians in QI, Melbourne Health recently implemented a hospital medical officer (HMO) improvement position, one of the first of its kind in Australia. This post is offered to residents and comprises 3-month rotations accredited with the Postgraduate Medical Council of Victoria. During the rotation, the HMO provides a junior clinician perspective on organisational committees and works collaboratively with doctors and allied health staff to lead redesign projects.

The program addresses the often perceived division between QI and clinicians by allowing junior doctors to become actively involved in improving ground-level processes.1 It also increases management knowledge and builds leadership skills among our next generation of clinical leaders. Completed projects have included creating clinical handover guidelines to enhance the transfer of patient care, developing procedure-specific consent forms and creating paging guidelines to improve communication between staff.

This program has provided many benefits to our organisation, our doctors and, most importantly, our patients. It has created a positive culture and empowered clinical staff to engage in the processes that affect them. As is already occurring, we believe similar programs could be instituted across other health services and allied health professions.