Quality care is desirable in all healthcare services, whether it be for people or animals; however, defining exactly what is meant by quality care is difficult. Terms such as “best practice”, “quality care” and “clinical excellence” are often used interchangeably although, strictly speaking, they are subtly different from each other. In veterinary practice, what constitutes quality care and best practice in individual cases is influenced by numerous factors in addition to the patient itself and its condition, including the wishes of the owner and financial constraints. Evidence-based medicine plays an important role, by enabling veterinary teams to deliver high-quality, thoroughly evaluated clinical care. However, in situations where there is a lack of high-quality evidence (not uncommon in equine medicine and surgery), then the use of weaker forms of evidence (including clinical experience and expert opinion) will be necessary.
Regardless of difficulties, providing the highest quality of clinical care to all of our patients is an objective that all veterinary surgeons and veterinary nurses aspire to. In order to achieve this, we must be prepared to critically appraise our clinical work, and look for ways that we can improve it.
Quality improvement can be defined as a systematic and formal evaluation of a programme or system of care, administration or experience that is carried out with the intention of improving the quality of the service provided to the client and/or patient. It’s all about working together, gathering real information from real teams and finding practical things that we can do to continuously improve as a whole.
Quality improvement aims to identify and address problems and deficiencies in the clinical care delivered to patients. In order to identify problems, data must be gathered to measure the quality of care currently being delivered. By identifying deficiencies, changes can be made to improve the quality of care and the process can subsequently be re-measured to assess efficacy. Some of the major objectives for practising quality improvement methods include the prevention of avoidable harm to patients, streamlining services, bringing your practice team together, establishing a learning culture, putting your patients first and improving staff satisfaction and retention.
Of course, many veterinary teams have been undertaking quality improvement initiatives for many years, but these have been largely unrecognised as such and not conducted formally. Members of the Royal College of Veterinary Surgeons are obliged to undertake clinical governance (defined as the continuing process of reflection, analysis and improvement in professional practice for the benefit of the animal patient and the client owner) as stated in the Guide to Professional Conduct; quality improvement is an essential component of this. Over the past five years, quality improvement methods have been officially recognised and further promoted through the Practice Standards Scheme. RCVS Knowledge has played a key role in promoting and supporting quality improvement in veterinary practice, and the RCVS Knowledge website contains useful information.
RCVS Knowledge, with support from BEVA, has also run two quality improvement roadshows in 2019 that have highlighted some quality improvement methods currently used in equine practice. National or international audits and benchmarking exercises, including audits of colic surgery, castration complications and antimicrobial resistance, are due to be launched imminently which will facilitate large-scale data collection that can be used by individual practices to compare and review their own data and implement changes to the way they work accordingly.
Whilst it is only common sense that practices will want to optimise clinical outcomes and provide high-quality veterinary care, there are barriers to incorporating quality improvement techniques into equine practices. Quality improvement is best practised as a team exercise, and this may be easier to introduce in equine hospitals than in ambulatory practices. The hurdles facing practices are currently being researched in a PhD project undertaken by Freya Rooke at the University of Nottingham. Initial results indicate that the biggest barriers perceived by veterinary teams to introduce quality improvement into their practices are lack of time and lack of knowledge. Lack of time in clinical practice is an issue that the profession and individual practices need to address – once the relevance and positive outcomes of implementing quality improvement become more widely recognised, hopefully dedicated time for undertaking such efforts will be made available. As far as gaining more knowledge and understanding of quality improvement methods relevant to equine practice is concerned, this will continue to be provided by organisations such as RCVS Knowledge and BEVA, and this will feature in the programme for BEVA Congress 2020.