National Lung Cancer Audit


'25 by 25': National Lung Cancer Audit quality improvement workshop

Posted by Hannah Rodgers on Monday 23 October, 2017

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National Lung Cancer Audit (NLCA) project coordinator Hannah Rodgers looks back at the quality improvement (QI) workshop in Leeds.

On 20 September the NLCA hosted its second QI workshop of the year. The aim of these workshops is to introduce delegates to different QI techniques. The day began with three short presentations from:

  • Richard Steyn, chair, UK Lung Cancer Coalition
  • David Baldwin, chair of the clinical expert group (CEG) for lung cancer in NHS England
  • Neal Navani, NLCA co-clinical lead

Richard focused on the UK Lung Cancer Coalition , explaining their strategy for ‘25 by 25’, a goal to raise 5-year survival rates in lung cancer patients to 25% by 2025. Lung cancer survival rates are notoriously low with 35,900 people dying from the diseases in the UK in 2014. This is an ambitious target and the presentation aimed to give delegates the tools to help them reach it. This was followed by a talk on the key features of the National Optimal Lung Cancer Pathway by David, after which Neal gave a talk on earlier diagnosis and struck a chord with delegates with statements such as ‘millimetres matter’.

During the first break we were keen for delegates to network with each other and to share good things about their trust, so we asked them to post positive statements on the wall to encourage discussion. For example:

  • 'My one good thing is … our use of training and employment of an advanced nurse practitioner in lung cancer.'
  • 'My one good thing is… expanding the role of the lung cancer nurse specialist with nurse-led survivorship and diagnostic clinics.'

Delegates then participated in two QI exercises:

  • process mapping with post-it notes: delegates were asked to look at their patient pathway and see if there were aspects that caused delays such as bottlenecks in the system or steps that were repeated unnecessarily
  • root cause analysis also known as the ‘five whys’, this asks delegates to look at a key problem in their trust and then try to identify the root cause by asking ‘why’ each time a reason is given.

After lunch we jumped straight back in with three short and snappy QI examples from presenters, each representing different stages of the pathway:

  • Susan Harden, NLCA co-clinical lead, focused on her trust’s use of stereotactic ablative radiotherapy (SABR)
  • Richard Booton, clinical lead for lung cancer at University Hospital of South Manchester NHS Foundation Trust, explained his Rapid Access to Pulmonary Investigation Days (RAPID) programme
  • Michael Shackcloth, consultant thoracic surgeon at the Liverpool Heart and Chest Hospital, spoke about his experience of having his unit identified as an outlier in the clinical outcomes publication and the actions his team went on to take.

Mirek Skrypak from the Healthcare Quality Improvement Partnership (HQIP) gave a talk on the characteristics of successful improvement teams. This included a QI game that required a lot of tennis balls: delegates got into teams and had to reduce the amount of time that they held the ball in the correct sequence. Once teams had composed themselves our senior clinical lead, Paul Beckett, demonstrated a PDSA exercise. This is the plan, do, study, act cycle that encourages continuous improvement to patient care.

The day was a great success with all the delegates either agreeing or strongly agreeing that the programme was interesting and relevant to them and 91% agreeing that the structure of the day was effective. Many said it was thought-provoking and inspired them to reach the 25 by 25 goal.

Hannah Rodgers, NLCA project co-ordinator


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