Making the difference

Is efficiency the enemy of innovation and improvement? Are efficiency programmes oppressive, leaving healthcare staff no time to be creative and piling on burdensome bureaucracy, or are efficiency, innovation and improvement positively correlated? These questions were debated at the International Forum on Quality and Safety in Healthcare, in Gothenburg in April, and here we dip into that debate and pick out the key arguments. Featuring contributions from: Jason Leitch, national clinical director, Healthcare Quality and Strategy, Scottish Government. Frank Federico, executive director, Institute of Healthcare Improvement. Mohsin Choudry, national medical director's clinical fellow, Royal College of Physicians. Robbert Huijsman, professor of management and organisation of elderly care, Erasmus University, Rotterdam. For more on the Forum, see http://internationalforum.bmj.com/. This episode is the last in the first series of the Making the difference podcast. We'll be back in a month with series two.

How can asking patient to tell us their story improve healthcare? Helen Morant, content lead at BMJ, talks us through her project getting healthcare professionals to sit down with patients and record their conversations, and what on earth this has to do with quality improvement. We also hear some of the recordings she has gathered through the project. Here are links to the other podcasts and projects Helen mentions: Story Corps - https://storycorps.org/ The Listening Project - http://goo.gl/3auSHX Beautiful stories from anonymous people - http://goo.gl/78QSjU

This week, we look at medication reconciliation. Joshua Pevnick, health services researcher and hospital physician at Cedars-Sinai Hospital, LA, US, talks us through what it is and why it can be so hard to get right. And Emma Iddles, a junior doctor in general surgery at Hairmyres Hospital, Lanarkshire, UK, explains how her project improved medicines reconciliation in the surgical admissions unit of the hospital. For more, read Joshua's full paper, http://goo.gl/O59BWo, and Emma's project write up http://goo.gl/znrNGQ.

Fiona Moss, dean at the Royal Society of Medicine, gives us an overview of quality improvement, and it's underpinnings. This interview was recorded at the International Forum on Quality and Safety in Healthcare, Gothenburg, April 2016. Find Fiona Moss on twitter, @FiMoss.

"Those who do not study the past are doomed to repeat it." At the International Forum on Quality and Safety in Healthcare, in Gothenburg in April, Don Berwick spoke on the scientific foundations of improvement. This is the full audio of his talk. Don Berwick is president emeritus and senior fellow, Institute for Healthcare Improvement. On twitter, he's @donberwick.

Or, the one where Fiona Moss and Don Berwick tells us what they think quality improvement is. Fiona Moss is dean, Royal Society of Medicine, and Don Berwick is president emeritus and senior fellow, Institute for Healthcare Improvement. Don's talk and the interview with Fiona were both recorded at the International Forum on Quality and Safety in Healthcare, Gothenburg, April 2016. Watch out for the extended versions of these recordings, up next Friday.

It's bad practice to prescribe a brand name drug when a cheaper, viable and approved generic is available. But, particularly in the US, this happens too much, at major cost to the health system. The team behind Michigan State University's paediatric clinics set out to increase their prescribing of generics, and found that much of the problem was that whilst brand names lodged in staff and patient's minds, generic names were easily forgotten. Sath Sudhanthar, paediatrician and assistant professor in paediatrics, and Kari Chandler, nurse manager, tell Harriet Vickers how they overcame this and tripled the team's generic medication prescription rate. Read their full report: http://qir.bmj.com/content/4/1/u209517.w3931.full

Plan, do, study, act cycles, or PDSA cycles, are the basis of many quality improvement projects, they're a model to trial changes and feed the lessons from each test into the next. Why are they a popular method, and how do you get the best out of them? And what on earth happens when they explode? Harriet Vickers asks Julie Reed, National Institute for Healthcare Research CLAHRC (Collaboration for Leadership in Applied Health Research and Care) for north west London. Read all of Julie's paper (for free): http://qualitysafety.bmj.com/content/25/3/147 Check out BMJ Quality: http://quality.bmj.com

The Francis report, the Berwick report, the Keogh review - all of these have highlighted how important learning from mistakes is in healthcare. Reporting incidents is key to this, and in this podcast Jen Perry, from BMJ Quality, tells Harriet Vickers the whats, hows and whys of incident reporting. And Emily Hotton, previously a foundation doctor at Royal United Hospital Bath, UK, talks about how her project helped junior doctors at the hospital become more confident at incident reporting, and bumped up the number of incidents they logged. Read Emily's full report: http://qir.bmj.com/content/3/1/u202381.w2481.full Check out BMJ Quality: http://quality.bmj.com