Title: Reflective Template: Quality Improvement Activity
Author: WilliamL
Last saved by: NHSLAdmin
Company: NES

Reflective Template:  Quality Improvement Activity (QIA)

This reflective template has been designed to use with the SOAR Database (Scottish Online Appraisal Resource).  When you have completed this reflection, please upload it to SOAR / Form 3 and submit it to your interview to share with your Appraiser.

3-step guide to completing this form:

1)	Save this form (using “Save As”) to your computer (e.g. My Documents, Desk top), and customise the file name (e.g. QIA Reflection 2012)
2)	Proceed to filling out the form - when finished, Save and Close the document.
3)	Login to SOAR and Upload this file from where you had saved it (from step 1), either to the Documents Library, or directly to Form 3.

This reflection template form should be used for Domain 2: Safety and Quality.

The boxes will expand automatically as you type into them.
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What supporting information have you provided for your QIA?
Paper discussing Metastatic Cancer of Unknown Primary (mCUP), the challenges surrounding management of this particular cancer, and service developments implemented to improve the patients’ pathway.

What strengths or achievements does it demonstrate?
The establishment of a clinical team of medical and clinical oncologists, and clinical nurse specialist; devising a site policy, diagnostic pathway, and guidance for referral to a cancer MDM; weekly mCUP MDM; establishment of database; development of treatment protocols; improvement in patient information and education of other medical personnel within the hospital.

Did you encounter any difficulties in this process?
The complex pathway referrals of these patients has meant that for many, diagnostic work-up has been lengthy resulting in considerable uncertainty and anxiety for patients and their family members. For many patients the uncertainty surrounding a diagnosis of CUP can be very difficult.

Have you been able to make any changes as a result of undertaking this activity?

An audit of patient pathways before and after establishing the service suggests that it has led to a significant reduction in the time spent by patients in hospital, has reduced the number of non-essential investigations and has helped ensure the more rapid review of patients by the specialist oncology team and palliative care services. This has led to substantial efficiency saving for the organisation, and has improved the cancer journey for many of these patients.
The development of a more efficient diagnostic pathway and early specialist review has led to an estimated cost saving of £3169 per person.

What have you learned from undertaking this activity?

There was an unmet need for patients with mCUP and establishing this service has significantly improved a number of areas in the patient pathway. 
It has been a very valuable and enjoyable experience to be part of a team where there are obvious and measurable improvements in quality of care for these patients by establishing solid multi-disciplinary working, pathways and protocols, and audit.

Is there anything else that you would like to/ need to do to follow it up?

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