Quality improvement: improving things that are important to us and our patients

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06 September 2019

Dr Joanna Bircher, GP and Clinical Director of Greater Manchester GP Excellence Programme 

Over recent years, the RCGP has been developing expertise and resources on quality improvement (QI) to help GPs and their teams embed new approaches more effectively and efficiently into practice. When it seems like there’s no time available to address some of our biggest frustrations, this system can help practices make small changes, step by step.

We all have a sense of what the ‘perfect day’ at work looks like. On our perfect day, there is enough capacity to meet the needs of our patients, and enough time to spend developing our team and our processes. We have time for breaks, the work is challenging enough to be interesting and rewarding, and we're not presented with unsolvable problems.

On a perfect day, the repeat prescribing system runs smoothly, nothing gets lost, all surgeries run to time and there are no IT failures. The practice team is relaxed, and all patients seem happy with the care they receive. We get home in good time for dinner and to spend time with family and friends. If every day were like this, we possibly wouldn’t need to learn anything about quality improvement (QI).

'Our days become so full that we only have time for reactive stuff'

But these days are rare for most of us. In fact, systems often don’t run smoothly; things get lost, we see patients who don’t really need us, and we don't get the time to see those who really do. The phone can ring constantly, and our world is full of re-work as we make up for failings somewhere else in the system.

Our days become so full that we only have time for reactive stuff. We end up with no capacity to step back to look at improving the things that are important to us and our patients, for example, prescribing safety, end of life care, care and support planning. This can develop into a routine that can go on so long that it becomes what we expect every day and it’s hard to believe it could ever be different.

'Quality improvement can improve a whole range of processes'

The resources developed by the College have been well received by those who have used them, and this approach has also been welcomed by the health services across the four nations. In England, GPs will now be incentivised for learning about and implementing QI in their practices via QOF.

QI can improve a whole range of processes from streamlining document management to improving the number of patients with diabetes achieving their HBA1c and lipid targets. And every project follows the same pattern –so after a while, it becomes second nature.

The pattern seems logical. First, do some ‘diagnosis’ and look at information and data to see what you need to improve. This might mean reviewing some records or mapping a practice process using post-it notes. It might mean comparing your performance against national benchmarks. This all depends on the area you are interested in.

The better your team gets on and works together, the better your QI outcomes will be

Once you have worked out your improvement need, then plan and test out a few changes in sequence to see if you can work out what change generates improvement. Make sure you measure what it is you are trying to improve to see if your changes have worked. Start small and build on what you have achieved. If something you try doesn’t work, then stop doing it.

Remember QI is a team sport, so the better your team gets on and works together, the better your QI outcomes will be. So, don’t learn the skills on your own; practice managers, nurses, and pharmacists can be brilliant at QI and are often keen to make things better in their area of work, but don’t know how to start.

QI resources

If this sounds intriguing and you want to know more, QI Ready is your starting place for all QI resources and guidance the College has and is developing.

The RCGP has produced a webinar which provides an overview of QI and the different QI tools and processes. This is a great starting point if you want to familiarise yourself with quality improvement and find out how you can start your quality improvement journey! The webinar can be accessed on QI Ready.  

The team at Lockside Medical Centre, Greater Manchester, shared their experience of undertaking a quality improvement project to reduce the number of incoming phone calls to their practice in a short case study video. The practice team showed how they identified this area of improvement, how the QI process started, the interventions they tested as well as their successes and challenges.

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