Quality improvement in the veterinary sector
Through interviews, surveys, focus groups, and other methods, researchers explored the current status of quality improvement initiatives in the veterinary sector and how to support the implementation of QI processes.
Although QI is not yet embedded into day-to-day work across the sector, the basic framework to support QI implementation is already in place, and those working in animal health care generally agree that it is desirable.
The world of animal health care is evolving rapidly – practices are being significantly changed by the arrival of new technologies, rising public expectations, new organisational structures, and limited resources. Some claim that these changes can be shaped by putting quality improvement (QI) at the heart of how services are delivered.
RCVS Knowledge (The Royal College of Veterinary Surgeons Charitable Trust), with the support of its Quality Improvement Advisory Board, commissioned RAND Europe to conduct an independent study into QI in the veterinary sector. The research explored the status of QI today and what could be done, and by whom, in the near future to support the embedding of QI in the sector.
The project addressed the following questions:
- What is the veterinary profession currently undertaking in their workplace to improve quality?
- What shapes/could shape the veterinary profession’s motivations for being engaged and involved with QI?
- What can RCVS, RCVS Knowledge and other stakeholders do to overcome the barriers and support the veterinary profession to engage with QI activities?
The project was designed to allow the research team to engage with as many people involved in animal care as possible to ensure the results were robust and reliable. The mixed-methods approach included:
- A document review of key QI documents from the sector;
- 18 semi-structured interviews with key stakeholders;
- A survey of members of the profession;
- 2 focus groups with PSS assessors; and
- A national summit event.
The current status of QI in the veterinary sector
- Among those working in animal health care there is a broadly positive view that QI is desirable, however there is much less clarity about what this might actually involve in practice. Although there is awareness of QI in general, there is also variation in the depth of people’s knowledge.
- Despite progression in QI within the veterinary profession in recent years, it is not yet embedded into day-to-day work across the sector. Current QI activities appear to be informal and are often not recorded. The amount of time spent on QI within the profession appears to increase with age and in large practice groups.
- QI activities used in practice are often developed in-house. Examples of current QI activities include: regular staff meetings; clinical audits and significant event audits; protocols, checklists and guidelines; continual professional development (CPD); and client and staff surveys.
How to support the implementation of QI processes in the veterinary sector
- A range of stakeholders are instrumental in supporting the effective implementation of QI practices across the animal care sector. They include RCVS, RCVS Knowledge, veterinary practices, professional bodies, universities, veterinary client mediation services, CPD providers and Practice Management System providers.
- It was felt by interviewees and summit attendees that available QI resources need to be made more visible to the profession, which would help to ensure RCVS Knowledge are the go-to organisation for QI support and guidance. Demonstrating the benefit of QI by sharing examples of its usage, as well as simplifying the language around QI, were also thought to be important.
- To achieve efficient, consistent, and focused QI across the veterinary sector, the implementation of QI tools need to be carefully tailored to the particular circumstances, and requires change management. The way in which activities are prioritised and timed must recognise and reflect the importance of time-constraints and busy lives.
- The study shows that embedding QI processes into the sector would be beneficial, but that evidence from human healthcare should be used with caution. Leadership will be needed to make sense of QI and tailor it to the needs of stakeholders.
- Much of the basic framework to support QI implementation is already in place within the sector and changes in QI should be consistent, prioritised and involve the efficient use of time. Past efforts to achieve change of this sort show how important it is to allow innovations time to become embedded and to operate for long enough to demonstrate whether or not to abandon, adapt or spread.