Creative approaches to Quality Improvement

Dr Richard Genever, on behalf of the UTI Quality Improvement Team:

At Chesterfield Royal Hospital we have been working to improve the accuracy of diagnosis of urinary tract infection. Audits had shown that the majority of inpatients treated for UTI did not have symptoms to support that diagnosis.We recognised that there was a cultural element in this. Changing culture in a large workforce with rapid turnover can be difficult. We decided to use techniques based on behavioural sciences, also known as ‘Nudge Theory’. The Behavioural Insights Team is a social purpose company, jointly owned by the UK government, an innovation charity and its employees. Its role is to improve public services and expenditure through the application of behavioural science.The Behavioural Insights Team have designed a framework to facilitate change called EAST. To implement change the actions should be:

• Easy
• Attractive
• Social
• Timely

We have been using this approach locally and through social media. One initiative was to widely disseminate guidance on diagnosing UTI, accompanied by a cartoon strip that was colourful and mildly irreverent. The percentage of patients diagnosed with UTI without any symptoms reduced from 30.7% to 16% after the intervention. Further actions based on behavioural science are planned.Click here for full size pdf