Quality Improvement often takes the shape of project-based initiatives, unfolding within defined timeframes. The oversight and planning that project management offers are crucial but frequently underestimated. Remember, effective project management isn't just an added luxury; it's an essential ingredient for successful QI initiatives.
If your project is fortunate enough to have funding, investing in a dedicated project manager could be a game-changer. While clinical leads may be the heart and soul driving the improvements, they may not possess the requisite project management skills or time to devote to get things done.
Leading a QI initiative is also about ushering in change—a task easier said than done. Change can be unsettling because it's often viewed through the lens of loss. Maybe it's the loss of familiar routines or the added cost of learning new skills. By understanding that resistance to change is really a resistance to loss, you can start crafting strategies that make change not just tolerable but welcome.
Leading Change to Implement Ovarian Cancer Prehabilitation in Wales:
Strong leadership and project management were key to implementing prehabilitation for ovarian cancer across 3 cancer centers in Wales. The project was led by Sadie Jones, a clinical academic surgeon. Sadie provided oversight through regular meetings to track progress, identified and addressed challenges and maintained momentum. This helped ensure the project stay on track and on budget. Comprehensive collaboration between multi-disciplinary teams standardised the prehabilitation framework. Engaging stakeholders early on definitely helped drive change.
Cleverly presenting and reframing prehabilitation as an essential (rather than an optional) part of patient care helped change the perception from 'extra' to necessary for quality of care. This reframing overcame initial resistance. Actively engaging stakeholders at all levels was vital to successful implementation.
Tools used within the project:
Patient representatives were involved throughout to provide input from the patient perspective on the acceptability of changes being made. This helped show the benefits to patients which facilitated uptake. When patient engagement with parts of the prehabilitation program lagged, the team adapted by modifying the program based on direct feedback from patients. Their adaptability and responsiveness to patient feedback was key. When patient engagement with the initial NERS exercise program was lacking, the team made changes based on patient feedback to improve uptake. Being adaptable to overcome resistance was key.
Excellent communication at all levels was required to implement changes across different sites, maintain motivation, and quickly address any confusion or problems. This included regular all-Wales meetings.
Project management and leadership highlights:
- The project lead developed clear criteria to identify high-risk patients who would benefit from personalised interventions from the MDT. This helped ensure efficient and effective use of resources.
- When it became evident that one of the three sites were lagging in patient recruitment due to staffing issues, the project lead tried to explore reasons and find solutions. Knowing when further efforts wouldn't resolve the situation and accepting limitations was an important leadership lesson.
- The project lead involved trainees at each site to take responsibility for contributing to data collection and analysis. Delegating tasks helped drive project execution.
- The lead scheduled all Wales fortnightly meetings to discuss progress and challenges in more detail. This two-tiered communication approach kept both broad alignment, kept up the tempo of activity and handled site-specific issues.
West of England AHSN Project Management Guide
NHS England – The Change Model Guide