Recently we published a paper¹ that discussed how all aspects of national clinical audits should be designed with a focus on the desired changes in behaviour by recipients to achieve better outcomes. Hence the purpose of the Epilepsy 12 audit, which we commission, is not measurement alone but using data to inform quality improvement (QI). I was therefore delighted that the Epilepsy 12 team were able to also deliver an epilepsy quality improvement programme (EQIP) to understand existing barriers to desired change and have a plan for how feedback helps to tackle those barriers using QI methodology. I was also thrilled to help shape EQIP along with the Epilepsy 12 team, by being a member of the faculty with some esteemed faculty colleagues, where we too were on a journey of learning, sharing and improvement.

Without functioning local networks and systems, the Epilepsy 12 audit will struggle if local QI is based on repeated, unconnected, and inappropriately delegated projects conducted in isolation from the improvement goals across the pathway. Particularly if teams are also isolated and struggle with data review, collection and entry thereby impacting on using data for measurement and using data for QI. Epilepsy 12 teams should ask questions about their organisational performance in response to Epilepsy 12 data and feedback such as:

• Do we know how good we are?
• Do we know where we stand relative to the best?
• Over time, where are the gaps in our practice that indicate a need for change (i.e. improvement)?
• In our efforts to improve, what’s working?
• Do we know/understand where variation exists in our organisation?

They should then be empowered locally to set clear goals, mobilise resources, and promote continuous improvement. The Epilesy12 team and the data they produce themselves cannot solve ingrained deficiencies but can emphasise priorities for change, inform focused actions, and evaluate progress. What I saw and experienced throughout the EQIP collaborative was the 12 participating teams discussing messy and complex problems. They then got the time to sit down, for some of them the first time as a team, to approach solutions together in a variety of safe spaces including the residential weekend, online webinars, telephone calls, emails etc. The energy, laughter, difficult discussions resulting in support and a way forward for the teams was great to see, hear and experience including virtually, once the pandemic started.

I think the EQIP work will support Epilepsy 12 to accelerate data guided improvement and reduce unwarranted variations across the pathway. It’s a match made in heaven from a continuous improvement point of view and helps teams to learn from the children and young people (CYP) of yesterday, test improvement with the CYP of today, and improve the quality of care that CYP with epilepsy will get tomorrow.

Mirek Skrypak, Associate Director for Quality and Development 

Healthcare Quality Improvement Partnership (HQIP)

Find out more about Epilepsy12 and EQIP in our spotlight here and watch presentations by EQIP teams from the 2020 OPEN UK National Conference below: