Advancing Quality in Primary Care – What is Quality Improvement?

10 March 2011 Powys THB/IRH

Paul Myres- Chair Primary Care Quality Forum

3 basic questions

• How good is the clinical care received by your patient

• How do you know?• What are you doing to make it

better?

What is high-quality care?

• Relevant • Effective• Acceptable• Accessible

• Safe• Efficient• Equitable• Timely

• Measurable

What determines quality?• Personnel• Environment• Systems• Knowledge/ Clinical effectiveness• Culture• Monitoring• …………………………………….

Getting it right – checks and balances

Patient

Purchaser- LHB

Provider Eg Dentist/Trust

Resources

The Public,The Media

WAG

Evidence based care/ Skill

How do we ensure high quality?

ReviewAudit

ResearchKnowledge

Education/CPD

Planning Care Delivery

Implementation

Complaints/compliments

Risk management

Patients and public

Clinical Effectiveness

Research evidence

Clinical experience

Patient factors

Resources

How do we improve quality?

• Understand the problem – accurate interpretation of data

• Understand processes and systems• Analyse demand, capacity, and flows• Choose the right change tools –

leadership;staff and patient involvement• Evaluate impact of change

Processes for quality improvement

• evidence based practice and clinical effectiveness programmes

• risk management processes• clinical audit programmes• learning from incident reporting• learning from complaints/compliments• listening to the views of patients,

carers and the public

Quality & Use of information• Systems in place to store and share that

information• Capability to assess meaning and evaluate

information• Willingness and ability to respond to

information and evidence that something happens

• Accurate and reliable recording of appropriate information

Staff focus • Workforce planning and staff

management• Education, training, appraisal and

CPD• Induction and mandatory training• Multi-disciplinary team working• Monitoring individual/team

performance

Leadership, strategy and planning

• The team knows where it is going and why• There are clear processes and

expectations of performance• Teams and individuals understand their

roles and responsibilities• Planning involves all partners, internal

staff external staff as appropriate ?and patients/public

What can we use to assure quality? -Incident reporting - SEA

• Acknowledging something has occurred• Being prepared to tell others• Low blame culture• Analysing what happened• Identify what went wrong/right and why• Sharing the learning• Checking things have changed

What can we measure ?

• Outcomes – endpoints - markers• Processes• Patient Experience• Carer Experience• Staff Experience• Adverse events

What info is already collected?

• QOF• Audit+• Prescribing• Vacc & Imms• Hospital activity• OOHs activity• Critical incidents• Complaints

What can we use to measure it? - AUDIT

“a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change”

(Principles for Best Practice in Clinical Audit 2002)

The Audit CycleAgree/Review Standards

Implement change if needed

Collect data on current practice

Compare data with standards

The Improvement CyclePlan

Act Do

Study

• 26 Standards• Sit alongside professional and

quality standards• Key tool to help drive up clinical

quality and patient experience• Use them to plan, design, develop

and improve services • Stronger focus on embedding the

standards at team level

Doing Well, Doing Better :

Standards for Health Services in Wales

The key themes in the Standards• Running legally, efficiently and upholding public service values

• Promoting wellbeing and preventing ill health

• Emergency planning

• Engaging in a meaningful way with patients, service users and carers

• Providing safe and effective treatment, care and services in appropriate environments

• Communicating well internally, externally and with all stakeholders

• Dealing well with concerns, managing adverse incidents and learning from these

• Effective workforce planning, recruitment and development.

Teams and services should use standards to –

• Review their services – alongside professional standards as appropriate

• Assess where they are doing well and have good practice to share

• Assess where they could do better and have areas for improvement

• Develop improvement plans to address the weaker areas

• Engage with organisational management to escalate risks and actions that can’t be managed by the team itself

CGPSAT• Standardised model across Wales

• Linked to Standards for Health Services

• Developed by practitioners and other stakeholders

• Endorsed by GPC Wales & RCGP

• Designed to help practices review, monitor & improve systems within their practice

Quality Assurance Process

Primary Care Quality and Information Service

DATA(trends and patterns/

outcomes – avoid scoring

Analysis by LHB (MDT)

Focussed Visit

ActionPlan

Unacceptable

Investigation(More detail, diagnostic)

Trained Assessors eg LHB, Lay, PM,

GP

IMAsPMNurse assessor

Performance Procedures

Support• PCSS• IMA• CPD• Clinical

Director• AMD• ?Team Coach• ?Mentor• ?Hit Squad

4 basic questions • How good is the clinical care received by

your patient population? Clinical effectiveness, staff, systems & processes

• How do you know? Audit, incident reporting

• What are you doing to make it better? Leadership ,strategy, PPI, resources, risk management

• How can you share / prove it? Use of information, Openness