03 December 2025
Quality improvement can sometimes feel daunting, but as many clinicians across the specialty will testify, QI is often one of the most rewarding parts of their work. The NEIAA (National Early Inflammatory Autoimmune Diseases Audit) aims to improve the quality of care for people living with inflammatory arthritis and autoimmune diseases, collecting information on all new patients over the age of 16 in specialist rheumatology departments in England, Wales and Jersey. National audits such as the NEIAA help illuminate where to begin, giving visibility of strengths and clarity on where targeted improvement could make a real difference.
The Getting It Right First Time (GIRFT) programme is a national NHS England programme that aims to improve the service and care of patients through extensive evaluation of services, benchmarking, and also showcasing a strong evidence to support change.
Dr Gavin Cleary, GIRFT Clinical Lead and Paediatric Rheumatologist, reflects,
“Working on QI projects can provide colleagues involved with healthcare with some of the most rewarding professional experiences.”
Dr Charlotte Sharp, Consultant Rheumatologist and Health Services Researcher believes “Quality improvement supports all members of the MDT to work with patients to improve the services they work in.”
Their experiences, combined with NEIAA insights, form the foundation of the five practical tips for how you can improve the service in your clinical practice.
Tip 1: Start with targeted, small-scale interventions
QI progress doesn’t start with a grand redesign - it starts with one thoughtfully chosen area highlighted by your NEIAA data. Teams benefit enormously from beginning small.
As Gavin emphasises, “Start small – design and conduct small-scale tests of change using PDSA cycle.”
Small tests allow teams to learn quickly, reduce risk, and build momentum. And importantly, as Gavin reminds us, “data for improvement projects does not need to be ‘research quality’.
Tip 2: Use NEIAA findings to facilitate structured team discussion
NEIAA results can act as prompts for honest reflection within teams. For example, significant delays in referral and assessment may prompt teams to review their pathways and introduce earlier assessments, reducing long-term disability and improving patient outcomes. Likewise, variation in quality measures across trusts or regions can highlight system-level issues and trigger discussions about how to improve consistency and address potential health inequities.
Reviewing the data together supports shared understanding and highlights where experiences diverge.
Charlotte notes how vital it is to understand the people and system behind the data: “Working together with everyone who might be affected by potential changes can be hugely rewarding as it builds longer term relationships and helps you to see things you might not ever have considered as being important.”
In her triage improvement project, the power of structured and transparent collaboration was clear. Her team introduced a number of interventions - including feeding back individual consultant practice with a fully agreed-upon “league table” - which led to meaningful change. The results speak for themselves: variation in triage acceptance dropped from 61% to 39%, and out-of-area referrals reduced from 40% to 17%.
Tip 3: Integrate patient perspectives early
While NEIAA gives vital population-level data, patients offer insight into lived experience - and both are essential to effective QI.
Gavin from GIRFT highlights this:
“A simple way of expressing this is: 1. Have we asked our patients and families for their ideas? 2. Have we road tested our ideas with our patients?”
Feedback methods can be simple: short surveys, informal conversations, or even patient shadowing. In paediatrics, involving families is especially important.
One example from Gavin illustrates the impact: after surveying families newly diagnosed with juvenile idiopathic arthritis, “They told us they would value meeting others with the condition and spending more time discussing their diagnosis with the clinical team.” The team responded by arranging patient events, which received very positive feedback.
Tip 4: Incorporate QI into routine clinical practice
Embedding QI into daily routines keeps it manageable. This might mean a brief discussion at the end of clinic, a QI item on MDT agendas, or maintaining a shared bank of ideas.
As Gavin notes, “Use well established QI tools… to provide structure and help design and deliver QI projects.”
The most important factor, Charlotte reminds us, is understanding the everyday context:
“Quality improvement works best when the people undertaking a project understand the context and people involved in the service.”
Tip 5: Communicate progress and share learning
Celebrating progress - especially improvements linked to NEIAA data - keeps teams energised and builds shared purpose. Sharing learning across services encourages others to think, we can do this too.
And sometimes the best way to sustain momentum is surprisingly simple. As Gavin puts it: “Find friends and get started!”
Through tools such as NEIAA insights, QI becomes not only achievable but transformative of daily practice. It is about improving outcomes, strengthening teamwork, and most importantly, working with patients to shape services that reflect what matters to them. The NEIAA acts as a vital starting point in reviewing QI within rheumatology, and encourages Trusts to actively monitor and enhance their support to deliver great patient care.