Improvement works best together
Quality improvement brings together the knowledge, experience and ideas of the whole acute medical team. Everyone has a part to play in understanding problems, developing solutions and delivering better care.
Learn how to involve colleagues, patients and carers meaningfully. Explore what quality improvement contributes to your own professional development, including relevant national standards, appraisal, revalidation and training pathways.
Bring the right people together
A good QI team reflects the pathway it wants to improve. Start with the people closest to the problem, not simply those who are easiest to invite to a meeting.
Patients and carers
Help identify what matters, where care is difficult to navigate and whether a proposed change improves the experience of receiving care. Involve them early enough to influence the decisions.
Frontline clinical colleagues
Nurses, doctors, advanced practitioners, pharmacy, AHPs, support workers and others understand how work actually happens across shifts, handovers and disciplines.
Operational and data colleagues
Bring knowledge of capacity, patient flow, digital systems, measurement, administration and the practical constraints affecting service delivery.
Leadership and wider partners
Help secure support, address risks and sustain changes. Include community teams or other organisations when the pathway extends beyond the AMU or hospital.
Co-design, not just consultation
Inviting people to endorse a solution after it has been designed is not the same as involving them in improvement. Ask patients and staff to help understand the problem, develop the changes and interpret what the results mean.
Not every project needs a large committee. The right team depends on the problem, the setting and the scale of the proposed change.
Include people who can explain its effect on care and daily work.
Map how decisions, tasks and handovers happen in practice.
Agree clinical oversight, operational support and responsibilities.
Revisit this question throughout the project, not only at the start.
QI and your professional development
Select your professional pathway to explore how improvement connects to national standards, professional development and evidence of your own contribution.
Resident doctors & specialty doctors
Quality improvement can contribute to professional development for both groups, but their formal requirements differ. Doctors on recognised training programmes should follow their curriculum and ARCP decision aid. Specialty doctors should follow the appraisal and revalidation requirements applicable to their role.
How QI can contribute
- Define and investigate an improvement problem.
- Participate in multidisciplinary testing and measurement.
- Reflect on learning and demonstrate personal contribution.
One project does not mean identical requirements
Colleagues can contribute to the same multidisciplinary QI project while demonstrating different capabilities and collecting different evidence. Regulatory standards, employment arrangements and curriculum expectations are not interchangeable.
One project. Different contributions. Shared improvement.
A multidisciplinary QI project creates opportunities for people to develop and demonstrate different skills. The team shares an improvement aim, but each member should be able to describe their own meaningful contribution.
Example: more reliable AMU handover
An acute medical team identifies inconsistencies in the communication of critical information at handover. Staff from different professions work together to understand the process and test improvements.
The project is not owned by one individual or profession. Its success depends on understanding the whole system and incorporating the perspectives of those involved.
Improve the reliability of agreed critical handover information within a locally defined timeframe.
Handover completeness, use of an agreed prompt and balancing measures such as handover duration.
Test changes, review feedback, understand variation and decide what to adapt before wider use.
Different roles in the same project
These are possible contributions, not fixed allocations of responsibility. People may take on several roles depending on experience, scope of practice and interest.
Resident doctors & specialty doctors
Contribute clinical assessment, patient safety expertise, improvement methodology and evaluation of the handover process.
Possible individual evidenceProject participation, PDSA cycles, analysis, presentations and reflection. Resident doctors on recognised training programmes should map evidence to their curriculum and ARCP requirements; specialty doctors should use their relevant appraisal and revalidation arrangements.
Consultants & specialist doctors
Provide clinical leadership, supervision, governance and support for implementing and sustaining improvement across the acute medical service.
Possible individual evidenceLeading or supporting QI projects, evaluating outcomes, coaching colleagues, improving services and reflecting on the impact of change for appraisal and GMC revalidation.
Nurses & nursing associates
Explore bedside information needs, continuity of care, handover workflow and the effect of changes across shifts.
Possible individual evidencePractice development, patient safety, collaboration, relevant CPD, feedback and reflective learning, as appropriate to NMC requirements.
Advanced practitioners
Link clinical practice with service development, education and leadership across professional boundaries.
Possible individual evidenceImprovement leadership, cross-professional working, education and evaluation of practice, mapped to relevant advanced practice and regulatory frameworks.
Pharmacy colleagues
Examine the reliability of medicines information and communication about time-critical or high-risk medicines.
Possible individual evidenceMedicines safety, service improvement, measurement and collaborative learning, with reflection consistent with the relevant pharmacy regulator.
AHPs & discharge teams
Explore functional assessment, onward care requirements and communication at transitions.
Possible individual evidencePathway improvement, patient-centred collaboration, outcomes evaluation and reflection for relevant professional development.
Operational, digital & data teams
Support process mapping, measurement, information flows and the practicality of implementation.
Possible individual evidenceImprovement methodology, data quality, implementation, operational leadership and service evaluation.
What evidence could I take from a team QI project?
Keep a proportionate record of your own role in the project and what you learnt. This is particularly useful when contributing to a larger team rather than leading an individual project.
Reflect on your decisions, the evidence you considered, what changed and how the experience will influence your future professional practice.
The evidence required depends on your professional role and pathway. In particular, ARCP evidence applies to relevant training programmes; it is not a universal requirement for specialty or specialist doctors.
- Your contribution to the problem definition, design or measurement.
- Meeting notes, project responsibilities or a project log.
- PDSA records, appropriately anonymised results and relevant feedback.
- Teaching, presentations or dissemination to which you contributed.
- A personal reflection on learning and future professional development.
The project is an illustrative teaching example, not a report of an actual clinical intervention. Professional evidence requirements differ by regulator, curriculum and role. Use approved local systems and follow information-governance requirements; do not place identifiable patient information in external portfolios or public QI tools.
Develop your improvement skills
Improvement capability grows through learning, practice and reflection. Whether you're beginning your first project or supporting others to improve care, there are different ways to build your confidence.
Build the foundations
Understand the purpose of QI, how systems influence care, what makes a useful improvement aim and how to measure change.
Useful next step: Read SAM's Five Steps Quick Guide and explore the interactive Learn QI page.
Apply and reflect
Contribute to a real project, observe care processes, participate in PDSA cycles and learn to interpret results with colleagues.
Useful next step: Join a local project or lead a manageable test with support from your organisation's QI team.
Lead and support improvement
Develop skills in facilitation, stakeholder engagement, improvement measurement, managing change and helping others sustain better practice.
Useful next step: Support a multidisciplinary improvement programme and share learning across services.
SAM improvement development programmes
SAM has developed learning programmes that support the practical application and leadership of improvement in acute medicine.
Acute Medics as Improvers
A programme supporting clinicians to understand QI approaches and develop the skills to participate in improving care and services.
Check SAM learning opportunitiesAcute Medics Leading Improvement
A programme focused on building improvement leadership capability, supporting teams and taking a more systematic approach to change.
Explore SAM eventsFind support for your improvement work
You don't need to navigate QI alone. Start with the improvement expertise available in your organisation, training programme or professional network.
Support arrangements differ across the four UK nations and between employers. Choose resources appropriate to your local setting and professional requirements.
Your organisation's QI or governance team
Can advise on project registration, clinical governance, measurement, information governance and practical improvement support.
Education, supervision and professional leads
Can help identify learning objectives, appropriate supervision and how improvement work contributes to professional development.
Regional improvement networks
May offer training, coaching, collaboratives and opportunities to share learning between services.
Q Community
A community connecting people working to improve health and care across the UK and Ireland.
Explore Q CommunityThese are development routes, not a compulsory progression framework. Professional, educational and regulatory requirements differ between roles and UK nations. Refer to the relevant professional pathway above for authoritative guidance.
Put your learning into practice
Whether you're starting a project, helping colleagues learn or finding a tool for your next test of change, SAM's Quality Improvement Hub can help you take the next step.
Better improvement begins with working together
Every member of the acute medical team can contribute to safer, more effective and more reliable care. Bring the right people together, make improvement a shared endeavour and use the experience to develop your professional practice.
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