Evaluating the impact of junior doctors in quality improvement - a 10-year review

Objectives The importance of engaging junior doctors in quality improvement (QI) initiatives is well recognised. Junior doctors bring fresh perspectives and engage closely with patients, consumers, families and the healthcare team. They are well positioned to recognise inefficiencies in the system that may compromise safe, timely and effective care. To promote QI participation by our junior doctors our organisation created a specific role; the Improvement House Medical Officer (IHMO). The objective of this study is to describe and evaluate the IHMO rotation at the Royal Melbourne Hospital, a large tertiary hospital in Australia. Methods A mixed-methods study was performed that involved a survey of previous IHMOs since 2011, including a review of the major QI projects undertaken by IHMOs. Results Twenty-seven out of 40 IHMOs completed the survey. Doctors were attracted to the rotation to make an impact on the working conditions of junior doctors (selected by 20 respondents, 74%) and improve the quality of health care experienced by patients (18, 67%). Most respondents strongly agreed or agreed (22, 82%) that they used the skills gained in the rotation in their ongoing work. More than 40 QI projects have been led or co-led by IHMOs since 2011. Challenges of the role included the short timeframe of the rotation and the perceived slow pace of institutional change. Respondents found engaging other junior doctors with QI and understanding the hospital's organisational structure to be barriers. Conclusions The full engagement of junior doctors in QI upholds a healthcare culture that celebrates innovation and promotes patient safety. The IHMO rotation offers an immersive, experiential and impactful way to do so.