Profile: Sally Welham, Deputy CEO, British Thoracic Society

17 May 2011

Formed in 1982 through the merger of the Thoracic Society and the British Tuberculosis Association, the British Thoracic Society (BTS) has grown into an organisation of over 2,700 members, comprising medical consultants and specialty trainees, respiratory nurses, physiotherapists, and respiratory technicians.  With a wide ranging and growing clinical audit programme, the society's commitment to the quality improvement agenda is clear. HQIP met BTS Deputy Chief Executive Sally Welham to find out more.

HQIP: The society has established a key role for itself in supporting its growing membership base and to the wider medical and patient community. Tell us more about BTS and its mission

SW: Respiratory medicine encompasses a range of over 50 conditions, including those that pose among the largest burden on the NHS: chronic obstructive pulmonary disease (COPD), asthma, lung cancer, as well as others including TB, bronchiectasis, and pneumonia.

BTS is a charity, and our main charitable objective is to improve standards of care for people with respiratory disease. We do this in three ways: through the production of guidelines and audit tools; by promoting and advancing knowledge about the causes, prevention and treatment of respiratory diseases through our comprehensive educational activities such as conferences, short courses and e-learning; and by promoting and disseminating research, which is showcased through the society's annual Winter Meeting.

This is a society for respiratory medicine as a whole, and our members look to BTS for help and support in their working lives.  The recent re-development of the BTS audit tools provides those working in respiratory medicine with tools to help them audit and improve their practice.

How would you summarise your role at BTS and what recent developments have there been?

I joined the society in 2007, having worked previously in an academic department at University College London and at the Department of Health in the early days of the NHS research and development programme.

Sheila Edwards, BTS Chief Executive, has led the development of the Society over the past 10 years, and the last two or three years in particular have seen a significant expansion in the society's work programme.  Our work in setting, maintaining and improving standards of care lies at the heart of the organisation, and so great emphasis has been recently been placed on ensuring that we have robust systems in place for the production of evidence-based guidelines, leading through to the development of educational resources for the dissemination of guideline recommendations, and on into a sound system for audit to allow those working in respiratory medicine to review and improve their practice.

BTS has an impressive clinical audit programme. How has that developed?

The society has a long tradition of clinical audit, and the BTS audits of asthma and COPD date back over the past 15-20 years.  In 2009 the society's Trustees, on the advice of our Professional and Organisational Standards Committee, made the decision to invest in a redevelopment of the audit programme.  Up until that time, BTS audit tools had been administered through colleagues at the University of Glasgow, but in 2009, the society launched a new web-based audit system.

We now offer eight audit tools: adult and Paediatric Asthma, Adult and Paediatric Pneumonia, Emergency Oxygen Use, Non-Invasive Ventilation in Adults, Bronchiectasis, and finally Pleural Procedures.  Each audit involves a national audit period - a one, two or three-month period for focused national data collection, followed by additional time for entry of data onto the online system.  This provides a national dataset for the audit each year, and participating centres can generate reports which compare their centre's data against the national picture.  The audit tools are available outside the national audit period so that centres can also audit their practice at other times if required.

Back to top >>

The 2009 re-launch saw you add three new audits. Why were these chosen?

The Pleural Procedures audit was developed specifically to audit the insertion of chest drains in line with the new BTS Pleural Disease Guidelines, and followed on from the National Patient Safety Agency Rapid Response report in May 2008 which highlighted problems associated with the insertion of chest drains.  We worked with the NPSA to offer a pilot audit in 2009 involving a small number of organisations.  The audit was rolled out on a national basis in 2010, and will run again in 2011. The society has also developed a range of educational tools in this area to ensure that those involved in pleural procedures have the guidelines, complemented by appropriate education and training, and supported by audit tools to allow practice to be monitored and improved.

The national Emergency Oxygen audit is another good example, in that the audit has been run annually since 2008 when the guideline was published, and has allowed the society and those involved in participating centres to monitor the improvement in the prescription of emergency oxygen over the past three years.  This work has just been recognised through the National Patient Safety Award for Patient Safety in Clinical Practice 2011, given jointly to BTS, Southend University Hospital Trust and Salford Royal Hospital Trust.

In your opinion, has the extended audit programme been deemed a success?

Since the new audit system was launched in June 2009, we have seen a rapid expansion in the number of individuals and centres that participate in our audits - and feedback from those who use the system has been positive.  The production of reports which compare a centre's practice against the national dataset has been particularly appreciated.  We are also pleased that the inclusion of our audits on the list of those recommended for inclusion in Quality Accounts in England has provided an incentive for centres to become involved on a regular basis.

Those working in respiratory medicine in this country are well aware of the value of audit data, as part of the quality improvement cycle.  As an example, the results of the 2008 national COPD audit have been invaluable in providing evidence for the recent work on the national clinical strategy for COPD, which aims to improve care for those with COPD across the country.

And BTS is now working internationally as well?

In 2010/11 the Society participated in the European COPD audit, a Europe-wide audit of the management of acute exacerbations of COPD.  There have been regular national audits of COPD in this country for some time now, but in other European countries, audit is not a common feature of clinical practice.  The European Respiratory Society (ERS) COPD audit, led by Professor Mike Roberts from London, working with colleagues from Spain and Austria has developed an ambitious audit project which involves 13 countries including all four nations in the UK.  Over 100 institutions from the UK are involved contributing over 5000 cases to the total audit dataset.

BTS takes a holistic approach, with a comprehensive educational programme on offer too. What is the overall vision educationally?

The society's aim is to produce educational resources, including e-learning modules, where appropriate to accompany each guideline and facilitate the widespread dissemination of guideline recommendations in key areas.

We also offer short courses, usually run for one or two days, depending on the subject area.  We run about 12-14 courses per year, in topics ranging from radiology for chest physicians, to cystic fibrosis, lung transplantation and non-invasive ventilation, which are intended to map on to the respiratory training curriculum. The BTS Education and Training Committee oversees the programme of short courses and other educational activities and resources, and receives proposals for new courses from a number of sources, including the society's network of Specialist Advisory Groups.  Each proposal for a new short course is considered by the Education and Training Committee to ensure it is appropriate for the needs of healthcare professionals involved in respiratory care, has defined learning outcomes and meets the high standards of the society.

Are there any particular challenges you face with your audit programme?

The BTS head office team is small, and we are fortunate to be able to rely on an enthusiastic membership for their input and advice in a number of important areas - not least for the audit programme.  Each audit has a clinical lead, often a member of the relevant guideline group, and our programme is overseen by Dr Christine Bucknall, a respiratory physician in Glasgow who has been instrumental in driving the audit programme forward over a number of years.  We review each audit annually to ensure that the content remains appropriate and additional questions can be added when required, or if guideline recommendations have changed.

The contribution of the membership to the work of the society is immensely impressive and head office staff has huge regard for the time and energy that members give to their society, bearing in mind their clinical and other commitments.

We are also conscious that as a specialist society we need to ensure that the public, patients, and those working in other healthcare disciplines, understand what the specialty involves and how the specialty can contribute to improved patient care.

Finally then, where would you like to see things in four or five years time? Do you think there's still major work that the wider world of audit or the BTS to take on?

There are a number of challenges for the future - one of the most important being to provide the appropriate support via our audit system to allow participating centres to complete the audit cycle so that our audit programme is used to best effect in improving the quality of care.  We are also giving more thought to wider dissemination of the results of our audits and we are delighted that Thorax will soon be publishing a series on national audits in respiratory medicine.

In everything we do, we need to make sure that we come back to our main objective which is improving standards of care for people with respiratory disease. 

BTS homepage: http://www.brit-thoracic.org.uk/home.aspx

BTS clinical audit programme: http://www.brit-thoracic.org.uk/audit.aspx

Back to top >>