Quality improvement activity for appraisal and revalidation

Quality improvement activity (QIA) is one of the six types of supporting information the GMC expects. Doctors often find it the hardest to pin down. This guide sets out what the GMC says.

The GMC gives three purposes for collecting and reflecting on QIA:

• to review and evaluate the quality of your work;
• to identify what works well and where you can make changes; and
• to reflect on whether changes you’ve made have improved your practice, or what further action you need to take.

The GMC says it can take many forms depending on your roles and the nature of your practice. You should think about activity that has focused on improving the quality of your practice. Examples the GMC gives:

• reviewing your practice against local, regional or national benchmarking data, where it is robust, attributable and validated, such as morbidity and mortality statistics or complication rates;
• case review or discussion: a documented account of interesting or challenging cases discussed with a peer, another specialist or a multidisciplinary team;
• learning event analysis;
• evaluating the impact and effectiveness of a piece of health policy or management practice;
• audit, including review of prescribing activity, clinical audit, local audit of compliance with key safety alerts, audit and monitoring of a teaching programme, and audit of outcomes from clinical guidelines, devices and innovations recently introduced.

The GMC says you must actively take part in QIA relevant to your scope of practice at least once in your revalidation cycle. The amount and frequency depend on the scale and nature of the activity. Some activities need more time and resource than others, which affects how often you’re expected to do them.

Your responsible officer, suitable person (or PA/AA recommender) must agree the type, amount and frequency that is appropriate for your scope of practice. Your discussion with your appraiser may inform that decision.

The GMC also says you must take part in regular reviews and audits of your work and your team’s work. That includes any national audit or outcome review being conducted in your area of practice, and you must reflect on its outcomes even if you can’t take part directly.

The medical royal colleges and faculties give advice on how different types of QIA can be done in their specialties, and many have validated quality measures such as national specialty databases. If you are in specialist practice, the GMC says to consult your college or faculty advice.

The GMC says you should collect, reflect on and discuss your QIA at your appraisal, in the same cycle the evidence was collected in. Your reflection should focus on:

1. how the activity is relevant to your work;
2. how you evaluated and reflected on the results, for example through reflective notes, peer supervision or team meetings;
3. what action you’ve taken or plan to take in response; and
4. whether an improvement has occurred, or the activity showed that good practice has been maintained, ideally through a repeat of the activity or a re-audit after a period.

If you couldn’t evaluate the result of changes you made or plan to make, discuss with your appraiser how to include that in your personal development plan (PDP).

Bring your QIA and your reflection. Our revalidation checklist lists all six types, and online doctor appraisal explains the meeting. Next, see significant events and complaints, and writing reflections.

You still need QIA. Ask your RO or suitable person what is appropriate. If you have neither, discuss with your appraiser what is appropriate. See locum doctor appraisal.

GMC, Guidance on supporting information for revalidation: Quality improvement activity.