Incremental gains within an assisted conception service – utilizing evidenced based quality improvement strategies in a novel setting

Woodland, Emma (2023) Incremental gains within an assisted conception service – utilizing evidenced based quality improvement strategies in a novel setting. Doctoral thesis (DClinSci), Manchester Metropolitan University.

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Abstract

Background Quality Improvement (QI) principles conceived from the manufacturing industry were evaluated within a fertility clinic. Model for improvement (MFI) and Lean can accelerate performance improvement within an organisation making it faster, better, and more affordable. There are examples of successful application of these approaches within healthcare (Silvester, 2015; Graban, 2016; Mazzocato et al., 2010). Little has been published regarding application of MFI or lean within assisted conception. Aims This study aimed to assess the usefulness of these QI principles within a fertility clinic. To continuously improve through an aggregation of marginal gains in clinic performance, patient support and testing a novel self-administered psychological intervention. Methods The MFI and lean were applied to identify areas for improvement within the clinic processes. Areas of focus included optimisation of culture conditions and exceptional patient support. Changes for improvement were explored. Application of QI principles were also used to troubleshoot a reduction in one of the clinic’s key performance indicators (KPI). This quality improvement project is a time series study analysed with statistical process control methodology. Results Staff engaged with the project which emphasised the importance of QI within the clinic. This work resulted in improvement in the workflow of the embryo culture system through refining processes without impacting on clinical results, maintaining good patients support despite the Covid-19 pandemic, and successful troubleshooting of a drop in a KPI value back to benchmark. The study demonstrated application of PDSA cycles and behaviour charts to evaluate improvement interventions, and provides a novel report of Quality of Life (QoL) assessment and use of an innovative self-administered psychological intervention during routine clinical practice. Conclusion The exploration of QI principles is a valuable learning experience encouraging a mindset of continuous QI and accelerated performance improvement within the fertility clinic. Application of this approach to a larger clinic might bring greater rewards but further research is needed and more publications to SQUIRE standards.