advancing quality in primary care – what is quality improvement?
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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?. - PowerPoint PPT PresentationTRANSCRIPT
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