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How do you improve quality
If you want to raise the standards of personal and organisational
performance you should use the existing knowledge about improvement to make
changes and improve outcomes.
The culture needed for continuous quality improvement has 5 distinct
elements
- Improve all the time; improvement is a continuous process, it's never
complete.
- Define the problem rather than produce solutions; go to the source or
find the facts.
- Challenge others; problems create the need to improve.
- Share knowledge; teamwork makes improvement more efficient and
effective
- Respect other opinions; if two people always agree, one of them is
superfluous.
You want to make your organisation to provide higher quality at lower
cost and make the practice systems better and easier to operate.
How do you start Continuous Quality Improvement (CQI)?
This involves asking and answering 5 questions before you start any
change.
- What are you trying to achieve?
- What do you either know or need to know about this subject to plan
change?
- How will you know if the proposed change is an improvement?
- What changes can you make (with the available resources)?
- How will you continue the improvement in a cycle of feedback and
change?
The Different paths to High Quality Care
Top performing practices usually have one or more of three cultures
- The technophile – practices have quick adoption and consistent use of
electronic medical record tools. At the core of each practice is usually a
physician who is driven to achieve both good care and efficiency. This
physician finds new ways to use the EMR and tends to speak in terms of the
time it takes to get thing done. These physicians are innovators and can
modify the EMMR quickly and easily and stimulate practice wide improvement
as change champions
- The motivated team – practices put extra effort into motivating and
enabling staff to play important roles in improvement efforts. Motivation
may be enhanced by bonuses for a pay for performance programmed.
Strategies include a lead physician promoting importance of new activities
in conversations and behaviour, meetings to check feedback, progress and
make plans, work with practice staff to select indicators for improvement
and designed activities to achieve improvement, and quarterly half day
meetings when the practice was closed dedicated to making improvements.
These practices have more mixed feelings about EMR software than the
technophiles
- The Care enterprise – practices take a business approach that is
influenced by customer services and risk management. They organize special
service lines in the form of focused management clinics, hiring staff as
needed. The problem-focused clinic (e.g. diabetes, hypertension) are
designed to provide comprehensive, competitive, guideline-adherent care
convenient for the patient and ensure that the doctor has done everything
possible to manage care. Lead doctors delegate care management
responsibilities to staff and provide regular supervision, such as weekly
care coordination meetings between nurses and doctors. They redesign
delivery systems to support the special service lines. They conduct point
of care tests and use in house lab so that test are available for the
patient when they attend
Reference
http://www.annfammed.org/cgi/content/full/5/3/233
What is Improvement knowledge?
This is knowledge about how systems work. This includes the
- Psychology of team working - People are your most important asset. Its
people that make things happen, they get the results.
- Theory of knowledge- theory needs to be linked to practice. Planning
is not enough, projects need to get into action. It is only through
mistakes that learning and change can happen. Trying things out in audit
Plan/Do/Study/Act (PDSA) cycles should be the normal way of running a
practice.
- Understanding variation in systems –e.g. common causes of variation,
special causes of variation, and tampering
Resources
The Institute for Healthcare Improvement (IHI) is a not-for-profit
organization driving the improvement of health by advancing the quality and
value of health care.
How to Improve
http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/
The International Society for Quality in Health Care, is a non-profit,
independent organisation with members in over 70 countries. ISQua works to
provide services to guide health professionals, providers, researchers,
agencies, policy makers and consumers, to achieve excellence in healthcare
delivery to all people, and to continuously improve the quality and safety
of care. http://www.isqua.org.au/
Quality and Safety in Health Care: An international peer review journal
for health professionals in quality improvement and patient safety
http://qhc.bmjjournals.com/
If you have any suggestions about quality improvement email them to
contact@bristolgpsolutions.org.uk
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