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Clinical Supervisor
Departmental QIP Lead
Your first QIP in eight steps
Never done a quality improvement project? This page is the whole method on one screen: what each step is for, how much is enough, and what a weak and a strong version look like. Each step links to the page in the app that does it.
Audit or QIP? Decide first
Both are worthwhile and both count towards your EM QIAT. The difference is what you do after the first measurement.
Clinical audit
- Measures practice against a standard, usually once
- Output: a compliance rate and a report
- Re-audit after an intervention, often months later
- Cannot tell whether a change caused the difference
Quality improvement project
- Aim with a number and a date
- The same measure collected weekly, before and after changes
- Small changes tested in PDSA cycles; keep what works
- A run chart shows whether each change made a difference
An audit you have already done is a good start: its result is baseline evidence and its standard becomes your target. The next step is to measure the same thing every week rather than once.
Choose a problem that fits one rotation
One process, in one area, that the EPR already records, that happens often enough to measure weekly, and that a consultant and the nurses who do the work care about. Narrow beats ambitious: a project you finish is worth more than one you start.
Weak
"Improve sepsis care in the ED." Too big to measure, no single process, no end.
Strong
"Adults with red-flag sepsis at triage do not reliably receive IV antibiotics within 60 minutes." One step, one group, one place, one number.
In the app: the setup wizard checks feasibility and offers fifteen starter projects that pass these tests.
Register it and find a sponsor
Before you open a single patient record, register the project with your Trust audit or clinical governance department: that is the usual permission to use patient data for improvement. Agree a consultant sponsor who will keep the project alive after you rotate. Both take a week or two, so do them first.
In the app: wizard step 3, then the Ethics & Governance section of Define & Measure (the HRA decision tool tells you it is not research).
Draft the aim, then finalise it once you have a baseline
One sentence: direction, the measure, from the baseline to a target, by a date, in a place. You will not know the baseline yet, so write "[to be measured]" and come back once you have about ten weekly points. Avoid 100%: it is rarely achievable and makes a real improvement look like a failure.
Weak
"To improve antibiotic timing for septic patients." No number, no date, no place, and "improve" cannot be measured.
Strong
"To increase the percentage of adults with red-flag sepsis who receive IV antibiotics within 60 minutes of triage from 42% to 90% by 31 May 2027 in the Emergency Department."
In the app: the aim coach on Define & Measure reads your aim and says what is missing.
Choose three measures and define them exactly
The outcome measure is what patients care about. The process measure shows the steps are happening. The balancing measure checks nothing else got worse. Then write the operational definition: numerator, denominator, who is excluded, where the data come from, so anyone would collect it the same way.
Weak
Outcome: "sepsis compliance". Who counts? Compliance with what? Measured how?
Strong
"Numerator: adults with a red-flag criterion at triage given a first IV antibiotic within 60 minutes of the triage time stamp. Denominator: all such adults that week, excluding end-of-life pathway and transfers already treated. Source: EPR sepsis flag and drug record, extracted each Monday."
In the app: choose the kind of number (percentage, time or count) on Define & Measure and the operational definition template appears with the gaps to fill.
Collect the baseline before you change anything
A little, often. One point a week, each from a small sample of 10 to 20 consecutive eligible patients (or every eligible patient if the EPR gives it for free). Aim for 10 to 12 weekly points before the first change: that is about three months, which is why registration and the data plan come first. Below ten points the run chart cannot separate a real change from noise.
Weak
200 sets of notes reviewed once, giving a single figure of 42%. You cannot see whether 42% is typical, improving or getting worse.
Strong
The first 20 eligible patients each week for 12 weeks: twelve points between 36% and 48%, median 42%. Now a change that lifts the line is visible.
In the app: the data collection plan and baseline progress bar on Define & Measure and Data & SPC; the dashboard counts your baseline points for you.
Work out why it happens
With the team, build a driver diagram: what has to be true for the aim to be met (primary drivers), the specific factors under each (secondary drivers) and the change ideas that address them. If the causes are not obvious, brainstorm with a fishbone, walk the process map, or ask "why?" five times. Causes you can act on become change ideas; the rest are context.
In the app: the Diagnosis Tools page, each with a one-line explainer and a worked example from the demo project.
Test small changes in PDSA cycles
Pick one change idea and test it small: one shift, one desk, five patients. Write a prediction first (a number and a reason), do it, study the result against the prediction, then decide: adopt, adapt or abandon. Adopted? The next cycle tests the same change bigger. Keep the weekly measure running throughout so the run chart shows the effect. Most first projects need around three cycles to show a sustained shift; there is no set number.
Weak
Plan: "Teach everyone about sepsis." Prediction: "It will improve." Nothing to test, nothing to compare.
Strong
Plan: "Sepsis grab bag in resus for two weeks, day shifts." Prediction: "Time to antibiotics on those shifts will fall below 60 minutes for at least 7 of 10 patients, because the equipment hunt is the biggest delay in the Pareto chart."
In the app: PDSA Cycles, where the prediction is required and an adopted cycle prompts you to scale up.
Read the chart, hand it over, sign it off
A run chart with the baseline median tells you whether anything changed: a shift is 6 or more points in a row on one side of the median, a trend is 5 or more rising or falling. "No change yet" is a valid finding; say why and what you will test next. Before your rotation ends, write who owns each change, how the measure keeps being collected and who will see the chart, then give your successor and sponsor the handover note. Finally complete the EM QIAT with your supervisor before ARCP.
Weak
"Compliance went from 42% to 61%." Two numbers, no chart, no idea whether the 61% was one good week.
Strong
"From the week the PGD started there are 9 consecutive points above the baseline median of 42%, a shift, with the new level about 70%. The balancing measure (inappropriate antibiotic starts) did not rise."
In the app: interpretation templates on Data & SPC, the handover note under Learning & Sustainability, and the EM QIAT on SLO 11 Sign-off.
How much data is enough?
Per point
10 to 20 consecutive eligible patients, or every eligible patient if the EPR gives it for free. Same sample rule every week.
Before the first change
10 to 12 weekly points. Fewer and the run chart rules do not work; more is rarely needed.
To call it a change
A shift of 6 or more points on one side of the median, or a trend of 5 or more, that lines up with a change you made. SPC limits need about 15 points.
If the event is rare (a few a week), use fortnightly points or widen the definition rather than waiting months for one number.
RCEM, SLO 11 and the EM QIAT
The Royal College of Emergency Medicine requires you to participate in quality improvement throughout your training. Specialty Learning Outcome 11 covers your skills in patient safety and service improvement.
The Quality Improvement Assessment Tool (EM QIAT)
You complete an EM QIAT form annually on the risr/advance ePortfolio. Your Educational Supervisor reviews and signs this off before your Annual Review of Competence Progression. The form itself says it is not mandatory to lead a QI project in every year of training: audit and re-audit, service evaluation, process improvement, guideline development and patient safety work all count as engagement. What matters is that you can show what you did, what you learned and where it sits on the QI Journey.
The Model for Improvement
The RCEM recommends the Model for Improvement, which asks three questions.
- What are we trying to accomplish? This is your SMART aim.
- How will we know that a change is an improvement? These are your outcome, process and balancing measures.
- What change can we make that will result in improvement? These are your change ideas.
What each stage of training expects
- ACCS: participate effectively in a departmental project and understand basic improvement principles.
- Intermediate: progress to independent data analysis, evaluate changes and reflect on your project outcomes.
- Higher: provide clinical leadership, drive effective change and support a culture of good clinical governance within the department.
Project Aim
Portfolio Readiness
Quick Chart
Quick Add Data Point
ARCP Countdown
Recent Activity
Clinical Standard References
Ground your project in current evidence to justify your problem analysis.
Data & SPC Charts
Track your measurements over time.
Add Data
Press Enter to add — the date and phase stay filled in for the next one.
Copy the columns from Excel or Google Sheets — Date, Value, and optionally Phase and Note — and paste them here. A header row is fine.
Data collection plan
Operational Definition
Precisely define what you are measuring and how — so any team member could collect the same data identically.
Results Interpretation
Your Data
Results & Measurements
A clean, per-measure summary of what your data shows — pulled together from the Data & SPC page.
Operational Definition
Results Interpretation
Measures
PDSA Cycles
Plan, Do, Study, Act. Test your changes.
Timeline (Gantt)
Publication
AI Review Centre
Powered by Google Gemini. Analyses every section of your QIP and provides examiner-level feedback and recommendations.
Your project text is sent to Google's servers to run this — don't include patient names, dates of birth, or NHS numbers anywhere in your project before using it.
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Full Project Assessment
Gemini will review all 10 domains: problem, aim, methodology, evidence, PDSA, data, team, sustainability, dissemination, and QIAT readiness.