Driving quality in our echocardiography service

The importance of quality assurance in healthcare.

Quality assurance in healthcare involves the monitoring and evaluation of the services being provided to ensure that they meet defined quality standards. In echocardiography, the standards that we should all scan and report to, are developed by the British Society of Echocardiography in the form of published minimum datasets and guidelines. Accredited echocardiographers all have a responsibility to adhere to the latest guidelines to help ensure that best practices are being followed and high-quality scans and reports are being done every time to ensure that the best patient care possible is being provided, with the best outcomes. 

Meet Latoya Woolery

My name is Latoya Rebecca Woolery and I am a cardiac physiologist based in Birmingham. I have recently moved into the quality lead role in the North at Xyla and prior to this I was the regional lead in the West Midlands.

My previous experience includes a role as a consultant cardiac physiologist in echocardiography where I jointly managed the transthoracic echocardiography service. This involved helping to implement and develop new cardiac physiologist-led echocardiography services safely and innovatively. In that NHS role, I also contributed towards helping the service to achieve IQIPS (Improving Quality in Physiological Services) departmental accreditation, being only the third cardiology department in the UK to do so. The accreditation was a huge challenge and achievement and involved completely overhauling the way that we worked. We stopped doing things in a certain way just because that was how they had always been done and instead, we took the time to understand exactly what it was we were trying to achieve both locally and as part of the trust. I helped to set up various departmental audits and monitoring, setting up quality assurance for the echocardiography and cath lab services, ensuring adequate documentation for all that we do in our department including standard operating procedures, flow charts, process maps and contingency plans. 

I produced all the standard operating procedures for all echocardiographic and cath lab tests, as well as the departmental policies and documentation for triaging echo referrals and guidelines for requesting echo studies. Furthermore, I developed echo and cath lab training plans and competency assessments for both trainees and BSE-accredited cardiac physiologists which were successfully implemented. The SOPs helped to provide documented guidance which gave clarity in outlining everything that we did. Cardiac physiologists found it helpful to refer to the SOPs when they were unsure of anything. This reduced interruptions for senior members of staff. Training plans meant that there was a framework in place and trainees always knew where they were, and what was coming next in terms of their development. 

I saw how creating and implementing different ways of working and training transformed the department whilst going through the IQIPS accreditation process, and I now have a passion for quality improvement as I saw first-hand how much the department benefitted from it and was transformed in a positive way. I learnt a lot from going through the IQIPS process and it has shaped the way that I conducted my leadership when I stepped into more advanced roles.

Before rejoining the echo team at Xyla, I spent a year working at the United Kingdom Accreditation Service (UKAS) as an assessment manager in the IQIPS team. In this role I was able to use my previous knowledge and experience of achieving IQIPS accreditation at SWBH, to help me to lead and manage customers through their IQIPS departmental accreditation process. The role involved all aspects of planning assessments, managing the assessment team, managing onsite and remote assessments, coordinating feedback, producing assessment reports, reviewing improvement action evidence and deciding whether accreditation can be offered. I saw departments with high staff turnover, high DNA rates, poor DM01 compliance, poor patient satisfaction, low mandatory training compliance, high incident rates high staff and patient complaint rates completely turn things around to flourish as departments which retained staff, had good patient feedback, met local, trust and national targets and ensured that corrective and preventative actions which arose from incidents were effective.

I am a British Society of Echocardiography (BSE) assessor and help with the BSE level 2 Adult TTE accreditation. I am very proud of this and volunteer for as many practical assessments as possible, as well as logbook marking when I can. It is my way of giving something back and ensuring that I am playing my part in helping the next generation of echocardiographers achieve accreditation. I have mentored members of various departments through the BSE TTE accreditation process. 

Having always enjoyed sharing knowledge and teaching, I became a STEM (Science, Technology, Engineering and Maths) ambassador so that I could share some of the things that I love most about my career with the next generation who are yet to decide on their futures. In this voluntary role, I often go into schools and do careers-based activities to help promote STEM careers.

I am a guest lecturer at Birmingham City University, delivering an annual lecture on the basics of echocardiography on a Long Term Cardiac Conditions module on a Cardiac Care postgraduate nursing course.

Implementing effective strategies

In my previous roles I have developed and implemented new Quality Assurance programmes, at Xyla I have taken part in Quality Assurance Audits including reporting and providing feedback to services and individuals to help drive improvement and at IQIPS I have guided and assessed departments setting up their quality assurance activities ensuring that they are both effective and fit for purpose.

It would be unrealistic to expect 100% compliance to standards all of the time. There will always be nonconformities or noncompliance and there must be systems in place to identify them, review them, take corrective actions and then put preventative actions in place to reduce the risks of the same nonconformities happening again. This is an important part of the quality assurance process and something that we have begun implementing at Xyla and will continue to build on over the coming months. 

We plan to build on the fabulous processes already in place, and where required provide improvements, develop SOPs, guidelines and closed-loop processes to ensure that expectations and outcomes are clear for staff and people using our services and to give patients that assurance that the care that they receive from Xyla is of a high quality, safe and effective. 

Supporting our workforce through feedback

Supporting our workforce through feedback is not just about pointing out errors or areas of improvement; it’s about fostering a culture of continuous learning and growth. Feedback serves as a crucial mechanism for keeping our team members aligned with the latest standards and best practices in echocardiography.

We find in echo that people tend to do things the same way repeatedly and may not realise that the way that they are doing it is not adhering to the latest guidelines. Feedback allows us to inform staff of when standards are not being met, and changes that need to be made to meet them. Feedback acts as a corrective tool, helping individuals understand where they might be deviating from established guidelines or protocols. This is particularly important in a field like echocardiography, where even minor deviations can impact patient outcomes.

Additionally, feedback serves as a form of positive reinforcement. Recognising and acknowledging when staff members are meeting or exceeding standards can be incredibly motivating. In a fast-paced environment like healthcare, positive feedback can go a long way in keeping our team members engaged and motivated.

It also serves as a roadmap for professional development. By highlighting areas where improvement is needed, we can help staff members identify specific areas for growth and development. This, in turn, informs their CPD plans, ensuring that they are continually updating their skills and knowledge.

Feedback is instrumental in driving continuous improvement. When staff members receive feedback and subsequently make changes to align with standards, we often see tangible improvements in audit scores and outcomes.

By prioritising feedback as an integral part of our quality assurance efforts, we can ensure that our team members are equipped to deliver the highest quality of care to our patients consistently.