Team Based Quality Reviews

Team Based Quality Reviews

This year's theme for the World Health Organization's World Patient Safety Day (17 September) is Engaging Patients For Patient Safety, in recognition of the crucial role patients, families and caregivers play in the safety of health care. Active patient involvement, both in their own personal care as well as at a strategic organisational level, is vital to help improve healthcare provision, and the RCSEd is delighted to support this year's WPSD theme. 

The RCSEd Patient Safety Group have produced a number of blogs as part of a campaign to mark World Patient Safety Day. In this blog, Manoj Kumar, Consultant Upper GI Surgeon, College Fellow and Lead of Healthcare Improvement Scotland Team based Quality Review (TBQR) team, shares his insights on how patients can contribute to significant event reviews.

Team Based Quality Reviews (TBQR) is a generic term for traditional multi-professional team learning activities such as mortality and morbidity forums (M&M), significant event analysis meetings or safety huddles, which typically take place routinely across health and care sectors. The terminology TBQR was coined to emphasise the point that there are significant learning to be gained from patient experience and feedback, good practice that takes place every day, near-misses, as well as from complications or mortality. The importance of seeking multiple perspectives and specifically actively engaging with patients or families and the teams involved in care, to better understand the strengths and weaknesses that exist within the systems, is prioritised in TBQR.

The principles of TBQR

The five foundational principles underpinning TBQR are:

  1. Acknowledging that teams outperform individual efforts in problem identification and problem solving.
  2. Exploring and understanding the relationship between work-as-imagined and work-as-done can provide a more meaningful context.
  3. Recognising the importance of applying Systems Thinking Principles and a Human Factors approach in analysis and design of work.
  4. Awareness that patients, families or service users, and the workforce or team delivering care/ the work, are likely to have the knowledge and understanding of the problem (and possibly solutions).
  5. Accepting that group problem identification, solving and reflection drives learning and improvement.

The TBQR programme is currently supported by NHS Education Scotland with the RCSEd as a key partner. Its goal is to improve the quality of safety reviews in healthcare through 1) supporting workforce and team development with training on updated safety science underpinned by an understanding of Human Factors and Ergonomics, 2) advice on design and development of IT systems to facilitate capturing and sharing of relevant data or intelligence, and 3) development of a shared learning platform to enhance learning experiences. Appropriate investment and development of these three key areas is essential if we are focussed on creating resilient systems or specifically systems that can respond, learn, monitor and ultimately anticipate challenges in advance. Understanding the role of effective teams, and their interactions with the relevant systems, task priorities and working environment to deliver safe and effective care is critical, and possible when a structured approach to team based reviews is applied.

A significant concern often raised by patients and their families are on receiving the relevant information in a timely manner regards care they or their family member received. This is especially relevant when outcomes are not what is expected. TBQR provide the opportunity for a more efficient and timely means of identifying and addressing the issues as they arise, and provide relevant response to those receiving care or their families. We have demonstrated that the introduction of a structured team based review process supported, by an informed workforce and delivered through the use of relevant technology, not only facilitated meaningful patient and family engagement but also improved the culture of reporting and speaking-up within the team, facilitated efficient review of cases, promoted Just-Culture and organisational learning, and effected timely improvement in care.

Whilst the TBQR programme does encompass health and social care sectors across Scotland, there is an opportunity to deliver a speciality specific educational and training package that is relevant to all practitioners across the globe. The RCSEd has been an active partner in the work on team based reviews and in the evolution of this TBQR programme. Currently, the RCSEd is working to develop and deliver a comprehensive training course on Team Based Quality Reviews for the surgical workforce. This training will include a practical workshop that will be addressing relevant subject matters, and an e-learning module.  It is our ambition to develop a virtual learning platform that will be open to anyone who has completed this training, whereby relevant learning from respective TBQRs (including M&M meetings) can be shared with other colleagues in their specialities or beyond, irrespective of where they work.

We would invite anyone who has an interest in learning more about the work on TBQR or the coming workshops being organised by the RCSEd to get in touch with us.

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