A ground-breaking intervention to improve junior doctors’ performance – designed in Leicester and developed in Lincolnshire – is attracting global interest and has been shortlisted for a prestigious award.

“EPIFFANY” (Effective Performance Insight for the Future) is shortlisted in the Education Team of the Year category at the British Medical Journal (BMJ) awards, to be announced today, (Thursday 5 May). The innovation was developed by the EPIFFANY team, led by Dr Rakesh Patel (University of Nottingham) and Dr William Green (University of Leicester). It was piloted at Leicester General Hospital and subsequently pioneered at Pilgrim Hospital in Boston, Lincolnshire.

The project is now attracting interest from other areas of the UK - and also globally from academics and clinicians in the USA and New Zealand.

EPIFFANY was developed in response to a General Medical Council (GMC) study confirming newly qualified junior doctors struggle with complex clinical decision-making, and make prescribing errors at up to twice the rate of other health professionals.

It uses the principle of small gains to improve junior doctor performance around key patient safety tasks such as note-taking, handover, acting on results and timely escalation to senior doctors.

The structured educational programme uses a blend of learning approaches to increase competence, performance and safety behaviours. It recognises that a one-size fits all approach is not appropriate for addressing individual learning needs and targets specific educational opportunities - so learning is personalised to the individual.

EPIFFANY also uses the experience and expertise of healthcare professionals such as pharmacists and nurses alongside medical educators to enable junior doctors to improve their clinical practice.

Dr Patel said: “Training of junior doctors in their foundation years is highly pressured. We know that for young professionals working alongside highly qualified consultants, this can lead to a lack of confidence and an intimidating environment in which people don’t feel able to ask questions.

“This can impact on their wellbeing and enthusiasm and I felt strongly it was not the best way to develop and nurture our young health professionals in their first few days on a new ward.”

EPIFFANY was developed with support from partners including the East Midlands Academic Health Science Network, Health Education England East Midlands, the BMJ, UpToDate and Pfizer.

Following the success of the pilot at Leicester General Hospital, EPIFFANY was rolled out at Pilgrim Hospital in 2015.The implementation was led by an EPIFFANY team from United Lincolnshire Hospitals NHS Trust comprising pharmacists, nurses, hospital management and doctors.

The impacts at Leicester and Boston have been significant:

• Since August 2015, it has helped drive a 60% reduction in junior doctor prescribing errors in Boston. Earlier this month the project team received a quality and safety award from United Lincolnshire Hospitals NHS Trust.
• During the original eight month pilot in Leicester, the potential cost saving from avoiding medication errors was £300,000 and the junior doctors reported they were more confident and enthusiastic throughout their work.

In 2014 the pilot initiative won the Frontline Staff award at EMAHSN’s Innovation in Healthcare Awards.

EMAHSN Managing Director Professor Rachel Munton said: “We are keen to identify healthcare innovation and support its rapid spread, improving services for patients. Our region has a growing reputation for innovation and Dr Patel’s inspirational project is an excellent example of the transformational work developed by frontline staff.”

As well as improved training, the project aims to increase junior doctors’ wellbeing, ensuring they stay in the East Midlands and see it as a great place to build a career.

NOTES TO EDITORS

For a video introduction to EPIFFANY please see: https://vimeo.com/145646356

EPIFFANY was identified as an example by the ‘Commission on Education and Training for Patient Safety’ report “Improving Safety through Education”: follow this link for more information.

Testimonials about EPIFFANY from junior doctors are shared here

About the partners:

• One of 15 Academic Health Science Networks in England, The East Midlands Academic Science Network (EMAHSN) brings together the NHS, universities, industry and social care to transform the health of the region’s 4.6M residents and stimulate wealth. Priorities focus on innovations that address health challenges including obesity, diabetes, mental health and cancer.

• Health Education England: East Midlands (HEE EM) develops a quality, safe & sustainable workforce with the best possible education and training for students, trainees and staff. It brings together the NHS, social care and third sector, working on large scale change. For information visit www.em.hee.nhs.uk or @HEE_EMids

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