Where to begin on your quality improvement journey in practice

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Are you eager to do some quality improvements but find the sheer number of potential improvement opportunities overwhelming?

In this blog article, we’ll identify six key areas to begin your improvement project, complete with practical examples. By the end, you’ll feel confident and ready to embark on your journey.

Aligning with Strategy 

When diving into your improvement project, remember that quality goes beyond the shop floor. Companies that value quality also have big-picture strategies that dictate where staff should be prioritising their time. If you want to get noticed by ‘higher-up’, align your project with your practice or company’s plan.

For instance, let’s take the practice’s goal to increase high-value procedure sales. Karen, a new nursing team leader, noticed her new employer isn’t doing as many dental X-rays as her previous practice, despite having all the equipment and a similar caseload. Karen teamed up with the practice manager to test a new pricing model that bundles together dental procedures and X-rays. She closely watched how this impacted sales.

Profit and Loss

Most organisations, including charities, are concerned with understanding their costs and how well they cover them with sales. So, any improvement project that targets these areas is a smart choice and is easy to demonstrate results. Don’t let financial metrics intimidate you; it’s all about finding ways to cut costs or sell more in the same time.

Consider Sally, the surgery nurse. She noticed that the practice was using costly 1ml syringes when the larger cheaper variety would do. She added clear signage to the drawers, encouraging her team to ‘think twice’ when grabbing a syringe. She monitors the number of syringes ordered and compares it to previous months.

Reducing Defects 

In the veterinary world, “defects” can be seen as things that didn’t go as planned. A common example includes significant events, animal mortality, avoidable morbidity, and resulting client complaints. When these occur, the impact can be significant. A quality-driven team seizes this opportunity to investigate what went wrong in a blame-free environment and works on improvements to prevent such incidents from happening again.

For instance, consider Martin, the in-patient nurse. He takes over a shift and notices that a cat with an indwelling urinary catheter is in pain and the bladder isn’t draining properly. After the team resolve the situation, Martin conducts a root cause analysis with the team. Together, they develop a new standard operating procedure (SOP) for managing blocked cats, which involves doing an additional check on the bladder every 4hours.

Listening to the Voice of the Customer (VoC)

Maintaining a strong relationship with our customers is crucial in making sure our patients get the treatment we reccomend at home and also supporting the practice financially. Customers interpret quality in different ways so its important to research and understand what your customer value.

In the example above, Karen introduced a new pricing model, bundling all dental X-rays into dental procedures as a value-added package. After conducting a client survey, she found that some customers didn’t fully appreciate this change. In response, she piloted a new way of work in which the team sends the dental X-rays to the customer after the procedures in order for them to see what was done. She repeated the survey 6 months later. 

Listening to the Voice of the Employee (VoE)

The practice team are close to the action and can provide valuable “bottom-up” perspectives on opportunities for improvement. But listening to all their suggestions and effectively managing their ideas is a skill in itself. It’s important to develop this skill to develop a culture of ‘continuous improvement’ amongst the team.

Consider Chloe, the practice manager. She regularly receives improvement requests from her staff but finds it challenging to handle them all. In a quality improvement effort, she created a closed suggestion box and provided template cards for her team to submit suggestions. On a monthly basis, she shortlisted the ideas that aligned with the practice’s strategy and presented them to the team for voting on the “quickest win.”

Pareto Principle (80/20 Rule)

The Pareto Principle, often referred to as the 80/20 rule, suggests that 80% of the effects come from 20% of causes. This principle is a valuable tool in quality management as even small or margin improvements in the 20% will result in substantial results.

Sandy, the receptionist, realises the team leaves the desk on average every 15 minutes. Half of the time they are going to the printer. She does an improvement project which moves the printer within safe reach of the desk. She compares the number of time the team leave the desk before and after. 

Deciding the right opportunities to work on when you have so little time can be tough, but by using the above themes you can rationalise your decisions and get your project off to a confident start. These themes can also be used to help facilitate a meeting where you collect idea’s within the team. 

If you need any support in making quality improvements, Contact VetQI—we’re here to help.

Preparing for a successful RCVS Practice Standards Scheme assessment

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Your inbox pings, and there it is – the email from your RCVS assessor with the all-important assessment date. As you stare at it, the initial feeling of unease creeps in, and you wonder how to kick off this journey. If this scenario sounds familiar, fear not! We’ve got your back. In this blog, we’re here to guide you with some valuable tips to help you make a confident start and pave the way for a successful assessment day.

Tip 1: Set the right expectations

The assessment process isn’t just about ticking off boxes; it serves multiple important purposes. First and foremost, it’s a means to acknowledge and celebrate all the excellent work carried out within your veterinary practice. Additionally, it’s a way to ensure compliance with the necessary legislation concerning medicines. However, it’s essential to emphasise that this assessment isn’t a simple pass-or-fail exercise. It’s a valuable opportunity to invite a fresh perspective into your practice, uncover any blind spots, and continually improve the way you operate. Once the assessment day is complete, you’ll receive a report detailing your areas of improvement and a timeline to address them.

Tip 2: Start with the end in mind

Adopt a project-like mindset with three months of preparation. Break this time into monthly segments and list specific activities you want to accomplish in these time periods. Maintain a visible progress tracker, like a whiteboard, which everyone can see in order to generate some “creative tension” within the team. Utilise numbers to tell the story e.g. “We have 1 month left to go”, or “we’ve internally audited 80% of modules”.

Tip 3: Work Smart 

Practice Standards is composed of 19 modules, but not all areas should be treated with equal attention. Some modules, such as Diagnostic Imaging, Medicines, and Practice Team, deserve particular focus due to the number of regulatory requirements they contain. If you’re short on time, Medicines (Module 10) should take priority, because the assessor’s core aim is to check you’re complying with the Veterinary Medicines Regulations (VMRs). If you have deficits in this area, the assessor will give you a short timescale to address them (1 month). Therefore, its a good idea to start early and invest time on the Medicines module before the assessment day.

Tip 4: Create Champions

To make the preparation process more manageable, consider creating champions within your team. Assign specific modules to team members based on their expertise and roles. For instance, an experienced receptionist and vet can handle the Client Experience and Clinical Governance modules respectively. Members of the nursing team can take on Dentistry, Surgery, Anaesthesia, Nursing, and Lab modules. Your RPS should lead the Diagnostic Imaging module, and if you have a Practice Manager, they might be best placed to focus on the Practice Team module. Where possible, try to ensure these team members are in on the day of the assessment and communicate with your assessor when they will be free for questions. 

this assessment isn’t a simple pass-or-fail exercise. It’s a valuable opportunity to invite a fresh perspective into your practice

In summary, preparing for your RCVS assessment doesn’t need to be stressful. Start early with your planning, break it down into chunks, and get the whole team involved. Should you have any questions or need additional support along the way, don’t hesitate to Contact VetQI. Best of luck with your RCVS assessment preparations!

Essential temperature monitoring solutions for your medicines

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This article will cover the importance of monitoring your medicine’s temperatures, especially for your upcoming RCVS Practice Standards Scheme (PSS) or Veterinary Medicines Directorate (VMD) assessment.

Why is temperature monitoring for medicines so important? 

To keep your medicines working effectively, you’ll need to store them at the right temperature as described in their specific product characteristics (SPC). Monitoring the temperature of all the medicines you store on-site can be a big challenge especially as they can be stored away in different rooms and draws across the practice.

What’s required for the RCVS Practice Standards Scheme (PSS)?

For those participating in the scheme, it’s a core requirement to monitor the ambient temperature of your medicines and quickly respond if it deviates outside of the reference range. It’s also important to record and store the temperatures you monitor for auditing purposes. Prior to the assessment day, your inspector will ask you to upload your standard operating procedure (SOP) for monitoring and responding to temperature changes. On the day of the assessment, your inspector will also want to see all the areas you store medicines and check you have the right systems in place.

What solutions are out there to help?

There are various solutions to help you manage and record the ambient temperature of your medicines. These include min-max thermometers, data loggers, and cloud-based temperature monitoring. Some of the key characteristics of these are summarised below. 

  1. Min-max thermometers
  • The manual approach for temperature monitoring involves daily readings from a specific thermometer which stores the minimum and maximum temperature within a given period. Staff record this down once daily e.g. in a paper book or laminated table and then reset the device
  • Pros: It’s low cost and quick to set up
  • Cons: dependency on staff, difficulty in analysing data, and environmental impact of paper and laminating

2. Data loggers

  • These USB stick devices are used to monitor temperatures in specific areas, store data on themselves, and notify using an alarm or flashing light if it deviates from a set range 
  • Pros: They save staff time and provide a rich amount of data for analysis
  • Cons: Upfront investment cost in the technology and dependency on staff to collect and download the data weekly

3. Cloud-based monitoring

  • Small devices are placed in different locations and sync temperature data via the internet to a cloud-based storage system, triggering notifications such as an email or push notification if temperatures deviate from a set range
  • Pros: A further saving on staff time and often built-in analytics for the stored data
  • Cons: The highest upfront investment costs and reliance on a reliable internet connection

When it comes to considering which system to go with, it’s not only important to consider the direct staffing cost if manual checks are involved but also the opportunity cost, which is the potential of using them elsewhere.

5 Top tips for monitoring and recording medicine temperature 

  1. Take care of storing medicines near heat sources like radiators, printers, and lab equipment
  2. Place fridge thermometers inside a Tupperware to limit the impact of opening and closing the fridge door
  3. Assigning temperature monitoring responsibility to a specific shift or role can improve compliance
  4. Centralise the storage of medicines when possible to minimise the effort of monitoring and recording
  5. Don’t forget to monitor the meds stored in the controlled drugs cabinet, reception, and crash kit!

In summary, monitoring medicine’s temperatures correctly at your practices is key to essential to keep them working effectively. There are different solutions out there that can help you depending on the level of investment you want to make. Keep in mind that investing upfront in a more automated solution will improve compliance and free your team up to do more rewarding work.

VetQI can provide expert support in choosing the right system for a practice’s needs, especially when it comes to upcoming PSS assessments. Contact VetQI for more information

Setting the standard for excellence: crafting effective policies for your veterinary practice

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As a veterinary practice, you are responsible for providing high-quality care to your patients and clients. But with the many complex and challenging situations that can arise in the course of daily operations, it can be tough. That’s where policies come in. By providing clear guidelines and parameters for behaviour and actions, policies help to support decision-making, maintain quality of care, and promote a culture of excellence in your practice.

What is a policy?

A policy is a statement that conveys the values, culture, philosophies, goals, and limits of your organization. It helps in decision-making and serves as a link between your organization’s vision, values, and daily operations. Procedures, also known as standard operating procedures (SOPs), are detailed instructions that provide specific steps to execute a policy. They are a part of policies but are more specific and detailed.

Why are policies useful for vet practices?

Key benefits of having policies in place include:

  • Set guidelines and parameters for employees to successfully reach their goals with confidence
  • Increase compliance with regulatory and professional standards
  • Improve the quality of the care being delivered to patients and clients
  • Support decision-making during difficult or complex situations to avoid a crisis

What policies should a vet practice have?

As a veterinary practice, there are specific policies that you should have in place. These policies include:

  • Health and Safety Policy
  • Code of Conduct Policy
  • Complaints Policy
  • Data Protection Policy
  • Waste Management Policy
  • Biosecurity Policy
  • Staff Training and Development Policy

Who should be involved in making policies?

Responsibility for policy-making can vary depending on the type of policy and the size or structure of the company. In a small company, it might be the business owner, while in a corporation, it could be the head office. For specialist services or offerings, it might be the departments themselves. It’s important to involve subject matter experts and conduct research to reflect the latest regulations and standards. 

How should policies be structured?

A policy document should include the following:

  • Document control: Who created and approved the document, who edited last and what version is it?
  • Purpose: What is the policy about?
  • Statement: This is the core of the document. What is the policy statement of your organization specific to the topic? 
  • Procedures: What procedures might sit within this policy?

In the statement, consider the what, why, when, who, and basic how (this will be elaborated on in each procedure that comes out of it). It may be important to lay out the responsibilities for certain roles in this area in some detail. Further useful reading on writing a specific sustainability policy can be found here by the BVA.

Top tips for creating policies

  • To make it easier to read, use simple, easy to understand language and have a set structure to each policy
  • Think about what you want to achieve with your policy and ask yourself ‘what if’ to see if it covers the most common eventualities 
  • Learn about what needs changing by piloting it as quickly as possible with operational teams 

When should policies be reviewed?

Policies are not changed very often (unlike procedures), and when they are, will involve many stakeholders from across the company. Policies should be reviewed periodically to ensure that they remain current and relevant. Examples of when you might want to review and update policies include:

  • Existing policies are not robust enough.
  • Outdated policies with new technologies, systems or services offered.
  • Changes in regulations and professional standards.

In conclusion, having policies in place is essential for the success of your veterinary practice. They provide clarity around how to run the practice within the context of the organisation (e.g., values, mission), regulatory requirements (e.g., health and safety), and professional standards (e.g., code of conduct). For more help withe reviewing or crafting your own policies, Contact VetQI.