The problem with most QIPs
Most QIPs identify a problem, write an SOP, and never measure again. NHS quality improvement works differently — it is iterative, measured, and embedded in team culture. If your project would still count as complete whether or not practice changed, it is not a QIP. It is an audit with good intentions.
The PDSA cycle in practice
Plan-Do-Study-Act is a framework for learning under uncertainty. Your aim must be SMART: specific, measurable, achievable, relevant, and time-bound. If your aim is not measurable, you cannot study. 'Reduce time to nerve block as measured by NRS ≥2 reduction within 30 minutes in 80% of eligible cases by December 2026' is a SMART aim.
Baseline data and honest measurement
The Phase 1 nerve block QIP at Conquest Hospital ED began with a baseline staff questionnaire. The data showed significant variation in confidence, no standardised proforma, and no systematic post-block monitoring. These three gaps became the three intervention targets.
The governance layer
No NHS QIP survives without governance support. Identify your clinical lead and get their name on the proforma. Present at a governance meeting before changing anything. Register with the Trust audit department. These steps protect your project, your colleagues, and your practice.
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