Health Needs Assessment Health Needs Assessment and Quality Improvementand Quality Improvement

Dr Luc Seuntjens

My presentation: 3 examplesMy presentation: 3 examples

Significant event analysis

European Practice Assessment

Regional assessment of test-ordering and intervention using small quality groups

DISCUSSIONDISCUSSION

DISCUSSIONDISCUSSION

From needs to….quality issuesFrom needs to….quality issues

A large bouquet of Quality A large bouquet of Quality Improvement approachesImprovement approaches

Implementation of clinical guidelines Total Quality Management Accreditation and Certification Patient Empowerment and Partnership Organisational Development methods Indicators, accountability and transparancy Public reporting and physician profiling Business Process Reengineering and Business Innovation Breakthrough Collaboratives Clinical pathways, case management, managed care Balanced Score Cards Risk Management , Significant event analysis Knowledge management Leadership development Etc.

Quality assessment and quality Quality assessment and quality improvement improvement (Rhydderch,(Rhydderch,J Eval Clin Pract. 05J Eval Clin Pract. 05))

Externally-led quality assurance/assessment

Internally-led quality

improvement

Primary Stakeholder:

Accrediting agency

Government Professional body

Practice

Purpose: commercial accountabilityregulation

self-regulationeducation

service development

Assessment by: external assessors

(industry based)

external assessors

external assessors combined with internal (self) assessment

internal (self) assessment

Emphasis: accrediting agency-led

primary care -led

GP-led practice-led

Values: summative summative and formative

formative

End point: certificate licensingcontract

payment

certification local criteria achieved

Significant event analysis: Significant event analysis: a little girl with high fevera little girl with high fever

Fish bone analysis & planning Fish bone analysis & planning improvementimprovement

Missed diagnosis of RSV infection

people

practice external

infrastructure

Planning

Improvement

Laboratory does not provide test

Not aware of RSV epidemic

No test material

No assistant present

Gap of knowledge

Friday night

Significant event analysisSignificant event analysis

Describe the event in a detailed way

Analyse

What can be improved?

Plan actions

Round table discussion 1Round table discussion 1

How do you deal with significant events in your practice?

Discuss the strengths and weaknesses of significant event analysis in your specific situation.

Take home messages Take home messages

Needs/Quality problems should be analysedNeeds are not isolated but refer to different

causes of problems: interdependency of needs.

Significant event analysis is a well-accepted and powerful tool to detect needs and initiate change.

European Practice European Practice AssessmentAssessment

(Engels,Grol 2005)(Engels,Grol 2005)

• Researchers from 6 European countries developed a set of European indicators for management of primary care

• 6 national panels rated the indicators and achieved a national consensus on a large set of indicators

• A pilot test in 9 countries; data collection in 30 practices / country

EPA domainsEPA domains

1. Infrastructure

2. Staff

3. Information

4. Finance

5. Quality and safety

EPA: the instrumentEPA: the instrument

Short self-administered questionnaires Principle GP or practice manager Individual GPs Staff members Patients

Observer/facilitator visits the practice Structured interview with GP/PM Checklist

The urgency bagThe urgency bag

The interviewThe interview

Feedback Feedback (VISOTOOL 04)(VISOTOOL 04)

Feedback Feedback (Visotool 04)(Visotool 04)

Prioritize and plan improving Prioritize and plan improving your practice your practice

Identifyneeds

Developstrategies

Planintervention

Deliverservice

Monitor &evaluate

Rankpriorities

NA Planning CycleNA Planning Cycle

Start

Quality assessment and quality Quality assessment and quality improvement improvement (Rhydderch,(Rhydderch,J Eval Clin Pract. 05J Eval Clin Pract. 05))

Externally-led quality assurance/assessment

Internally-led quality

improvement

Primary Stakeholder:

Accrediting agency

Government Professional body

Practice

Purpose: commercial accountabilityregulation

self-regulationeducation

service development

Assessment by: external assessors

(industry based)

external assessors

external assessors combined with internal (self) assessment

internal (self) assessment

Emphasis: accrediting agency-led

primary care -led

GP-led practice-led

Values: summative summative and formative

formative

End point: certificate licensingcontract

payment

certification local criteria achieved

Take home messagesTake home messages

Needs assessment is a team activity

Needs assessment is successful in a practice where improving quality is felt as an internal responsibility, as part of normal GP work, of identity, of professionalism

(R.Grol)

Quality assessment and quality Quality assessment and quality improvement improvement (Rhydderch,(Rhydderch,J Eval Clin Pract. 05J Eval Clin Pract. 05))

Externally-led quality assurance/assessment

Internally-led quality

improvement

Primary Stakeholder:

Accrediting agency

Government Professional body

Practice

Purpose: commercial accountabilityregulation

self-regulationeducation

service development

Assessment by: external assessors

(industry based)

external assessors

external assessors combined with internal (self) assessment

internal (self) assessment

Emphasis: accrediting agency-led

primary care -led

GP-led practice-led

Values: summative summative and formative

formative

End point: certificate licensingcontract

payment

certification local criteria achieved

Prescription rate of Prescription rate of antihypertensive drugs in antihypertensive drugs in

BelgiumBelgium

0

200 000 000

400 000 000

600 000 000

800 000 000

1 000 000 0001999

2000

2001

2002

2003

DD

D

Misc

Sartanes

ACE inhibitors

Calcium antagonists

DIU+BET

Betablokkers (BET)

Diuretics

Regional assessment of Regional assessment of test- orderingtest- ordering

Verstappen W, WOK, JAMA May 03Verstappen W, WOK, JAMA May 03

Involving peer interaction and social influence improves physician test-ordering behaviour.

Feedback on test ordering Feedback on test ordering Verstappen W, 2004Verstappen W, 2004

The crucial importance of The crucial importance of small group work small group work

Verstappen W, WOK, JAMA, 2003 Verstappen W, WOK, JAMA, 2003

Round table discussion 2Round table discussion 2

Government organisations put community priorities on the "needs" agenda. For example cost- efficiency related items.

How are these priorities in your country/practice integrated in your personal or practice CPD agenda?

Take home messagesTake home messages

Needs of the community/society are to be integrated in local improvement projects

Quality groups can learn to analyse aggregated data and prioritize action plans

The power of peers: needs assessment in touch with local attitudes