Kidney Matters - Issue 9 Summer 2020

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20KQuIP meetingsHave you ever wondered what mechanisms we have in place to identify potential qualityimprovements and trigger change in the delivery of our treatment and care? The KidneyQuality Improvement Partnership (KQuIP) is a partnership of professionals and patientsworking together to achieve this goal.What is Quality Improvement and why is itimportant?Healthcare professionals across the country areconstantly trying to improve things for patients –whether working out a new rota to offer tailoredappointments, or introducing better wastemanagement to reduce the environmental impact.Individuals are working above and beyond their dayjob, in an effort to improve patient outcomes, thesystem, and the care environment.What is the difference then, between all of this activityand ‘quality improvement’? Why do we need skillsin quality improvement (QI), if people are alreadyworking to improve things - should we not all just get onand join in?The answer to this can be summed up by a famousquote from W Edwards Deming – one of the foundersand pioneers of QI:“Without data, you’re just another person with anopinion.”What Deming is trying to get across is that oftenwe – as humans - have a tendency to think we havethe answer. The trouble is, a problem doesn’talways have a single answer. And often, if we try andmake something better on our own without fullyunderstanding things, involving the right people, ormeasuring the outcomes, we can get things wrong- there can be missed opportunities for sustainedimprovement (at best) or unintended negativeconsequences (at worst).Healthcare is a complicated system, within whichsit many processes, people and cultures. What a QIapproach gives us, are the tools to deconstruct andtruly understand a problem, plan and test ideas forimprovement, and measure – in real time – the actualimpact of that change.What does this mean for kidney care?With Kidney Care UK’s support, KQuIP is using this QIapproach to tackle some of the key issues identifiedby the kidney community during co-design eventsheld back in 2015/16. These were: transplantation,dialysis at home, and managing vascular access.Quality Improvement skills are taught alongsidedelivering these important projects in the hope thatthe same skills can be used in further improvementprojects in the future.KQuIP meetingsAlongside quality improvement, KQuIP brings twoother elements to improvement work that theprogramme sees as key to success: collaboration andleadership. Bringing renal teams and kidney patientstogether through regional meetings has meant thework has broken out of the usual hospital or trustboundaries, and teams have been able to sharechallenges, ideas and experiences, learning from eachother and pooling their combined expertise.Highlights:• A re-designed living-donor and donorrecipienttransplantation pathway in the SouthWest reducing the number of visits for patientsfrom over seven, to a maximum of three• Piloting a standardised electronic transplantreferral form to reduce delays caused bypaper and posted referrals• The introduction of home haemodialysistraining at satellite units• The introduction of week-long home therapyevents across the regions including radiobroadcasts, roadshows and education sessions• Revamping of staff and patient educationto encourage a culture of ‘home first’ fordialysis across participating units.• The production of an e-learning course,based on the national cannulationrecommendations - so far over 88 nursesfrom four units in Yorkshire and Humber and108 nurses from five units in the North Westhave enrolled on the course.kidneycareuk.org
21Through these three elements – quality improvement,leadership and collaboration – KQuIP is bringing abouttangible, sustainable improvements to outcomesfor people living with kidney disease, and kidney careservice delivery. All of the projects aim to reduceunwarranted variation across the country and embeda sustained approach to QI that can be adapted to anyprojects moving forward.Impact of the KQuIP improvement projectsFour regions are taking part in the project TransplantFirst aiming to improve access to kidney transplantation;two regions have selected the Home Therapiesproject DAYLife with the overall aim of increasing thenumber of people receiving dialysis at home; and fourregions, including Wales, have chosen to participatein the national MAGIC project (Managing Access byGenerating Improvements in Cannulation), aiming toimprove rates of definitive access, improve patientexperience, and reduce complications of needling(cannulation).The success of KQuIP relies on kidney patients sharingtheir experiences. Many of us already participate in ourlocal meetings. If you would like to participate in a KQuIPmeeting in your area please get in touch with CatherineStannard at catherine.stannard@renalregistry.nhs.uk“One of the major challengesfor clinical services is to takethe best evidence and developservices to make sure that allpatients who would benefit fromthe evidence do so. There is nowincreasing evidence that KQuIPis helping units overcome thischallenge and improving care forpatients with kidney disease.”Paul Cockwell, Professor of Nephrology (Hon), UniversityHospital, BirminghamFeedback from healthcare professionals and patients participating in theKQuIP Programme“The course has empowered me to be bold in pushing through the changes that arenecessary”“A great course for self-awareness and insight”“Excellent team building as well as sharing ideas with other teams”“Patient involvement was brilliant, enjoyed this”“Best QI training day I’ve attended”“Thank you for coming to the unit, you help us to keep focused on our project”Quotes from patient participants - key to the programme’s success:“I’ve learnt more on this table than I’ve learnt in 30 years of being a patient”“You have loads of time to think when you’re on dialysis. Why not think about how tomake things better for yourself?”“I plan my dialysis around my life now, whereas before it was planning my life aroundmy dialysis. If I want to go somewhere or do something, I can with little thought. I canchange when I do my dialysis to suit plans. I can take it where ever I want to go.”Article by Rachel Gair,KQuIP LeadIssue 9 | Summer 2020
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