improving quality in primary care. leading with purpose and possibility

www.england.nhs.uk @robertvarnam @NHSEngland

Quality improvement

in general practice.

Leading through

purpose & possibility

Dr Robert Varnam MRCGP PhD MSc

Head of general practice development

@robertvarnam

[email protected]

28.04.15


How hard

can it be?


What do you want to achieve

for patients in your practice?


How do you feel?


Health & wellbeing-promoting care

Right access

Holistic, personalised, proactive

& coordinated care

Wider primary care at scale


How do others respond

when change is proposed?


Leading with purpose.

Lashing with compliance or unleashing

commitment.


How do you feel?


What stories do we tell?


Birth

Postnatal midwife

assesses risk

Midwife gives

Vitamin D

End


Birth

Postnatal midwife

assesses risk

Midwife writes

to GP

End


End

Discharge

Birth

Health visitor

assesses risk

Health visitor

gives Vitamin

D


End

Discharge

Birth

Health visitor

assesses risk

Health visitor

writes to GP

GP issues

prescription


End

Discharge

Birth

GP/PN assesses

risk in baby clinic

GP issues

prescription


End

Discharge

Birth

GP assesses risk

at postnatal check

GP issues

prescription


End

End

Discharge

Birth

Postnatal midwife

assesses risk

Midwife gives

Vitamin D

Midwife writes

to GP

GP assesses risk

at postnatal check

GP/PN assesses

risk in baby clinic

Health visitor

assesses risk

Health visitor

gives Vitamin

D

Health visitor

writes to GP

GP issues

prescription

End


How do you feel?


Vitamin D prophylaxis

Leading with purpose

vimeo.com/76794094


Leading with possibility.

The problem

of human performance.


How does good care happen?

Be a good person

Train well

Maintain good intentions

Work hard


Please pay attention…

Watch the video

There is a team wearing white shirts and a team wearing

dark shirts

Count all passes made by the white team


Remember …

Be a good person

Train well


Work hard


‘You can’t change the human condition,

but you can change the conditions

under which humans work’James Reason

Error is normal... what are you going to do

about it?


OU

TP

UT

S

HUMAN

FACTORS

HUMAN

FACTORS

INTERNAL PROCESSES & PROCECEDURES

INP

UT

S

Success = systems x people

Whether I like it or not, it’s not just about me.


Vincent, C. A. (2004). Analysis of clinical incidents: a window on the system not a search for root causes. Qual Saf Health Care, 13(4), 242–3.

What is ‘the system’?


What is ‘the system’?


New improvement design principles

Be a good person

Train well


Work hardMake it easier to do the right thing

Make it harder to do the wrong thing

Spot & stop inevitable errors


Leading with possibility.

The model for improvement.

VIDEO

Gever Tully, Tinker School

TED Talk

bit.ly/1Iia0vh


How do you feel?


5127


Prototyping

• anything that tests an idea and answers a question

• helps test boundaries and manage risk

• is less about the actual ‘product’ and more about the

interaction it provokes

Start small

A prototype needs only to

be as good as it needs to

be in order to learn more

about the idea.

Peter Van Manen, MD McLaren Electronic Systems.

• Easy to simulate. ‘You can’t move for laptops.’

• Reliance on data. ‘Measurement is cheaper than mistakes.’

• Easy to mock-up. ‘Don’t pontificate, prototype.’


Talk it or try it ?

This is my idea.

I’m right.

Do it!

We tried a couple of

ideas, and this

happened.

versus


What are we trying to accomplish?

How will we know that change is an improvement?

What change can we make that will result in improvement?

The Model for Improvement

Langley, G., Nolan, K., and Nolan, T., 1994. The Foundation of Improvement, Quality Progress, June 1994


PDSA Cycles

SOMETHING

BIG!

A P

DS

How can we achieve this?

A P

DS

A P

DS

A P

DS


This is not the same as audit !


Your turn ...

PlanDoStudyAct


PDSA vs audit?


What’s the big ambition?


How could we chunk it down?

How could we test it out?


Are you a leader?


Don Berwick myth-busting

livestream.com/IFQSH/ForumLIVE

What's wrong with audit?

bit.ly/WhatsWrongWithAudit1

Introduction to driver diagrams

bit.ly/DriverDiagramIntros1

The Productive General Practice

bit.ly/PGP2014

What next?


Leading with purpose

vimeo.com/76794094

Burning platform or burning ambition

youtu.be/Tfn6vD4yyC4

These slides

What next?


• Berwick, D.M., 1996. A primer on leading the improvement of

systems. BMJ : British Medical Journal, 312(7031), pp.619-622.

• Varnam, R.M., Dawda, P. & Jenkins, R., 2010. Quality

improvement in general practice. Discussion paper., London:

The King’s Fund.

www.kingsfund.org.uk/current_projects/gp_inquiry/dimensions_

of_care/quality_improvement.html

• Bendell, T., Penson, R. & Carr, S., 1995. The quality gurus –

their approaches described and considered. Managing Service

Quality, 5(6), pp.44-48.

www.emeraldinsight.com/10.1108/09604529510104383

• Langley, G. et al., 2009. The improvement guide : a practical

approach to enhancing organizational performance 2nd ed.,

San Francisco: Jossey-Bass. ISBN 978-0470192412

What next?

improving quality in primary care. leading with purpose and possibility

Health & Medicine

riskhealth visitor

vitamin dhealth visitor

baby clinichealth visitor

gpgp issues

vitamin dmidwife writesto

riskmidwife writesto

baby clinicgp issues

riskat postnatal checkgppn