Question 1

Why do you want to work in quality improvement?

Accepted Answer

Honestly, it started with frustration. I was working on a busy medical ward and every few weeks we'd have the same conversation about patients waiting too long for their discharge medicines. Someone would send an email, things would improve for a fortnight, and then we'd be back where we started. Nobody was lazy or uncaring. We just had no way of understanding why it kept happening or of testing whether anything we tried actually worked. Then our matron got us onto a small project with the trust's improvement team. The facilitator didn't arrive with answers. She sat with us, mapped the process on brown paper in the staff room, and asked questions that made us see things we'd stopped noticing, like how many times one prescription chart travelled between the ward and pharmacy. We tested one small change on a Tuesday, looked at the data the next week, and adjusted. Over a few months the waits came down and, more importantly, they stayed down. What stayed with me was how differently the healthcare assistants and junior nurses talked about their work. They'd gone from feeling done to, to feeling like they owned it. That's what I want to do. I want to be the person who helps a team find their own answers and gives them a method and the confidence to keep going after I've stepped back. I've since completed an improvement practitioner course, supported two projects and coached a team through their first PDSA cycles. I'm realistic about it. Change is slow, some projects don't work,…

Question 2

How would you explain the Model for Improvement to a ward team who have never done QI before?

Accepted Answer

I'd keep it short, because a team in their first session usually has twenty minutes and one eye on the call bells. I'd say the Model for Improvement is just a structured way of answering three questions before you start changing things. The first is, what are we trying to accomplish? That's our aim, and I'd help the team make it specific: who it's for, by how much and by when. "Improve falls" isn't an aim. "Reduce falls on our ward by a set amount by the end of March" is something we can work towards. The second question is, how will we know that a change is an improvement? That's about measurement, so we agree a small number of things we'll track over time, often on a simple chart on the staff room wall. The third is, what changes can we make that will result in improvement? That's where the team's own ideas come in, because they know the work better than anyone. Then I'd introduce PDSA, which stands for Plan, Do, Study, Act. I'd describe it as testing an idea on a small scale before rolling it out. So rather than changing the whole ward's handover tomorrow, we might try a new safety huddle with one nurse, on one bay, for one morning. We plan what we'll do and what we predict will happen, we do it, we study what actually happened, and then we act: adopt it, adapt it or abandon it. Then we go again, a little bigger. I'd stress that failing a small test is fine and actually useful, because we've learnt something cheaply and safely. I'd finish by asking the team what's…

Question 3

What is the difference between measurement for improvement, measurement for judgement and measurement for research?

Accepted Answer

The main difference is purpose, and that shapes everything else about how you collect and use the data. Measurement for research is about producing new, generalisable knowledge. It needs a fixed protocol, large samples, careful control of variables and usually ethics approval, and you wait until the end to find out the answer. Measurement for judgement is what we see in performance management, league tables and some audits. It compares a team against a target or against other teams, usually at a single point in time, and the question is essentially, are you good enough? Measurement for improvement is about learning. It asks, is the change we're testing helping, here, in our setting? So it uses small samples, collected little and often, plotted over time so you can see what happens as changes are introduced. It's "just enough" data to learn, not perfect data. That distinction matters a lot in practice. I supported a community nursing team who were nervous about tracking how often their care plans were updated, because a previous audit had been fed back to them as a red rating at a governance meeting. They assumed our data would be used the same way. I explained that we'd sample a handful of records each week, they'd own the chart, and it would stay with them to learn from rather than going up the line as a score. Once they saw a run chart start to move after their second PDSA cycle, it became a source of pride rather than fear. I'd also say that the three don't compete.…

Question 4

Tell us about a time you engaged a sceptical clinician in an improvement project.

Accepted Answer

On a project to improve the timeliness of senior reviews for patients admitted overnight, one of the consultants was openly sceptical. In the first meeting he said, quite reasonably, that he'd seen three initiatives like this come and go and none of them had changed anything except adding forms. My first instinct was to defend the project, and I'm glad I didn't. Instead I asked if I could meet him for fifteen minutes after his ward round. I asked what had gone wrong before and what he thought the real problem was. It turned out he had a lot of insight. He felt the issue wasn't consultant attitudes at all but that the list of patients needing review was handed over verbally and things got lost. He also felt projects were designed by people who'd never worked a post-take ward round. So I took his point seriously. I asked whether he'd be willing to test his idea, a simple shared list at the morning board round, for one week on one ward. I made it clear there'd be no new form, and that if it didn't help we'd drop it. I collected the data myself for that first week so it didn't land on his team, and I shared a simple run chart with him before anyone else saw it. The reviews weren't transformed overnight, but there was a clear improvement in the first fortnight, and he started presenting the chart at the directorate meeting himself. That was the turning point, because his colleagues listened to him in a way they'd never have listened to me. What I learnt is that scepticism is…

Question 5

How do you coach a frontline team to lead their own improvement rather than doing it for them?

Accepted Answer

I think the hardest part of this job is not doing it yourself. When a team is short-staffed and stressed, it's tempting to make the chart, write the aim and run the meeting for them. It feels helpful, but the moment you leave the project stops. So I work on the idea that I'm there to build their skills and confidence, and I plan my own exit from the start. With a recent outpatient team working on reducing missed appointments, I agreed at the first meeting who the project lead would be, which was a Band 4 administrator who knew the booking process inside out. I asked questions rather than giving answers: what do you think is happening, what would you try first, how would we know if it helped? When they came up with an idea I thought might not work, I let them test it on a small scale, because finding that out themselves taught them more than me telling them. Early on I sat beside the administrator while she built the run chart in a spreadsheet, rather than building it for her. By the third cycle she was doing it alone and I was just reviewing it with her. I also helped her practise presenting to the service manager, because standing up in that meeting was what really scared her. I check in at agreed points rather than hovering, and I'm honest when I see the project drifting. I'll say something like, I've noticed we haven't run a test in three weeks, what's getting in the way? Sometimes the answer is that the team needs protected time, and then my job is to raise that with…

Question 6

Tell us about an improvement project that failed. What did you learn?

Accepted Answer

I supported a project to reduce the time patients on a surgical ward waited for pain relief after returning from theatre. On paper it had everything: a keen ward manager, a clear aim and a good change idea, which was a standard prompt on the post-op handover sheet. Six months later the data hadn't moved, and when I visited the ward most staff didn't know the project existed. Looking back honestly, there were a few reasons. The ward manager had chosen the problem, but the nurses on the floor didn't see it as their biggest issue. When I finally asked them, they said the real delay was getting a prescriber to review analgesia, which our change didn't touch at all. We'd also jumped straight to rolling out the new handover sheet across the whole ward instead of testing it with one or two nurses first. When it didn't fit how the evening shift worked, people quietly stopped using it, and we didn't notice for weeks because our data was only being collected monthly. I'll be honest, it knocked my confidence. But it changed how I work. Now I spend much more time at the start understanding the problem with the people who do the work, through process mapping or simply standing on the ward and watching. I insist on small tests before spread, even when a manager is impatient. I push for data collected weekly so we spot problems early. And I check engagement by asking frontline staff directly, not just the project lead. We did eventually reshape the project with the anaesthetic and…

Question 7

While observing on a ward for a process-mapping exercise, you notice something that worries you about a patient's safety or welfare. What would you do?

Accepted Answer

The first thing I'd say is that the project would immediately become secondary. Whatever my reason for being on the ward, if I see something that worries me about a patient, I have the same responsibility as anyone else in the trust to act. Say I was observing the morning medicines round on an older people's ward and I noticed a patient who seemed frightened when a particular visitor arrived, and I overheard the visitor speaking to them in a controlling, threatening way. As a QI facilitator I'm not there to assess or investigate, and it wouldn't be right for me to question the patient or confront the visitor. But I also wouldn't keep quiet because it wasn't my area. If I thought the patient was at immediate risk, I'd alert the nurse in charge straight away and, if needed, ask for security or police in line with trust procedure. If it wasn't immediate, I'd still speak to the nurse in charge at the earliest opportunity, privately, and describe exactly what I saw and heard, without adding my own interpretations. I'd check what they were going to do and make sure the concern was being taken forward under the trust's adult safeguarding procedures, which usually means the ward raising it with the safeguarding team. If I wasn't satisfied it was being acted on, I'd contact the trust safeguarding team myself for advice. I'd write down what I observed, factually, with the time and date, and keep it secure. I'd also be careful about my project notes. Anything about that patient…

Question 8

How would you make sure an improvement project reduces, rather than widens, health inequalities?

Accepted Answer

I've learnt that improvement work can easily make inequalities worse without anyone meaning it to. If you improve the average, the people who were already doing well often benefit most, and the people who struggle to access care can be left further behind. So I try to build equity in from the start. When we scope a project I ask, who isn't getting a good experience or outcome here, and would our aim help them? A good example was a project to cut missed outpatient appointments. The obvious change idea was text message reminders. But when we broke the existing data down by things like postcode deprivation, age and whether an interpreter was needed, the picture was different. People who needed interpreters and people from the most deprived areas were much more likely to miss appointments, and many of them weren't reached by text reminders at all, either because of language or because they didn't have a reliable phone. So we added different change ideas, like phone calls in the patient's preferred language and checking contact details at every visit, and we kept tracking the gap between groups, not just the overall rate. That made sure our success wasn't hiding a group being left behind. I also make sure the people we involve in co-design reflect the people who use the service, which sometimes means going out to community groups rather than waiting for people to come to a meeting at the hospital. And I link projects to the trust's work on health inequalities, such as the…

Quality Improvement Interview Questions & Answers

About this NHS interview question bank

Free NHS interview questions and model answers

Question 1: Why do you want to work in quality improvement?

Question 2: How would you explain the Model for Improvement to a ward team who have never done QI before?

Question 3: What is the difference between measurement for improvement, measurement for judgement and measurement for research?

Question 4: Tell us about a time you engaged a sceptical clinician in an improvement project.

Question 5: How do you coach a frontline team to lead their own improvement rather than doing it for them?

Question 6: Tell us about an improvement project that failed. What did you learn?

Question 7: While observing on a ward for a process-mapping exercise, you notice something that worries you about a patient's safety or welfare. What would you do?

Question 8: How would you make sure an improvement project reduces, rather than widens, health inequalities?

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