Implementation of the system in practice involves a representative team of practitioners working with a trained facilitator for around an hour every two to four weeks to work on improving a specific topic of their choice, for example, post- operative pain management for surgical patients, pressure area care for elderly patients, information giving and education for newly diagnosed diabetic patients. The facilitator is an individual with skills and experiences of working with groups and their main role is to enable the group to work as effectively and efficiently as possible towards their goal of achieving quality improvement in practice.
Depending on the specific topic being addressed and the client group to whom it refers, the group agree the overall standard they are aiming for (the standard statement) and then identify the essential elements or criteria required to achieve the standard. These are arranged according to Donabedian's structure-process-outcome framework (Donabedian, 1966).
This can be illustrated with an example from a nursing home caring for older people. Nursing staff working in the unit were concerned about the nutritional status of the residents in their care. Nutrition of older people in hospital or community care is a major area of concern in the UK generally. Meals are often produced that are unsuitable for patients' needs, there is no accurate assessment of nutritional status and nutritional intake is not accurately monitored. Aware of these problems and the subsequent complications associated with poor nutritional status, the staff decided to set up a quality improvement team, with representatives from the key groups involved (for example, nurses, care assistants, catering staff and a community dietician), to work on improving this area of their practice.
