Quality Improvement/Share Programme

SHARE PROGRAMME INFORMATION

Online Resources

The habits of an Improver

https://health.org.uk/publication/habits-improver

Creating joy in work is the only way to save the NHS

https://blogs.bmj.com/bmj/2018/10/12/creating-joy-in-work-is-the-only-way-to-save-the-nhs/

Change-Capable Leadership; The Real Power Propelling Successful Change

https://www.ccl.org/wp-content/uploads/2016/04/Change-Capable-Leadership.pdf

How to run a QI project?

https://view.pagetiger.com/QIIC/How-to-Run-a-Quality-Improvement-Project

Creative Approaches to Problem Solving toolkit

https://q.health.org.uk/get-involved/creative-approaches-problem-solving-caps/

RCGP Quick Guides

https://qiready.rcgp.org.uk/format/quick-guide/#.W7yULe-Wy70

Quality Improvement guide for General Practice

http://www.rcgp.org.uk/-/media/Files/CIRC/Quality-Improvement/RGCP-QI-Guide-260216.ashx?la=en

Process Mapping

http://www.rcgp.org.uk/-/media/Files/CIRC/Quality-Improvement/A-practical-guide-to-process-mapping.ashx?la=en

PDSA approach

http://www.rcgp.org.uk/-/media/Files/CIRC/Quality-Improvement/A-practical-guide-to-Model-for-Improvement-and-PDSA.ashx?la=en

Run Charts

http://www.rcgp.org.uk/-/media/Files/CIRC/Quality-Improvement/A-practical-guide-on-how-to-build-a-run-chart.ashx?la=en

http://www.ihi.org/resources/Pages/Tools/RunChart.aspx

Institute for Healthcare Improvement

http://www.ihi.org/resources/Pages/Tools/default.aspx

Quality Improvement and Innovation (Sharing best practice across NI)

http://qi.hscni.net/

Staff Checklist for QI

http://engage.hscni.net/wp-content/uploads/2018/10/020204-HSC-HSCQI-Great-Leaflets-Staff.pdf

Service Users and Carers Checklist for QI

http://engage.hscni.net/wp-content/uploads/2018/10/020204-HSC-HSCQI-Great-Leaflets-Service-Users.pdf

Guides to involving service users and carers in QI

http://engage.hscni.net/get-involved/involving-people/guides-to-personal-and-public-involvement/quality-improvement/

How to huddle in GP and the subtitle be Huddles?

http://www.pulsetoday.co.uk/your-practice/regulation/how-our-morning-huddles-improved-practice-teamworking/20037047.article

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Books

The 7 Habits of Highly Effective People

Paperback – 4 Jan 1999

By Stephen R. Covey

The Health Care Data Guide: Learning from Data for Improvement

Paperback– 28 Oct 2011

By Lloyd Provost and Sandra Murray

The Improvement Guide: A Practical Approach to Enhancing Organizational Performance

Hardcover – 29 Apr 2009

by Gerald J. Langley and Ronald D. Moen

Memory jogger ll Healthcare Edition: A Pocket Guide of Tools for Continuous Improvement and Effective Planning

Spiral-bound – 1 Mar 2008

by Michael Brassard (Author), Diane Ritter (Author), Francine Oddo (Editor), Deborah Crovo (Illustrator)

“Our Practice, Our Problem, Our Solution” is a new funded programme being offered to all GP practices in NI, and delivered by NIMDTA. It offers your practice the opportunity to identify and share a problem, and consider ways to solve it. Have you ever thought…

“What if I had time to change one thing in the practice that would make things better for me, my colleagues, and my patients?”
Most agree that time does not currently exist. The constant reminders of the need to be more efficient and productive often result in us feeling worse about the job we do.

What if you did get that time?

Are you bombarded with a never-ending list of “repeats” to re-authorise, or with “missing script” requests? Do you struggle with the demand for house calls? Have you tried to free up phone access without success? Is your treatment room overwhelmed with demand? The list of clinical and administrative problems is endless.

This 6-session programme may be what you and your practice need.

We want to give you, and a member of your practice team, the help and support (and funded protected time), to talk about and plan a change that would make your surgery day just a little bit less demanding.

The good news is that you do not need to be certain of the practice problem you want to solve at the first session. There may be one burning issue creating a challenge for the practice, or there may be a long “to-do” list of choices. Perhaps the biggest challenge currently for the GPs is different to that of the practice manager, pharmacist, or staff. At the first session there will be plenty time to talk through how you can take that first step.

What we can provide?

1. FUNDED protected time for you to problem solve. (A claim form will be provided).
£250 per session GP
£92 per session Practice manager or Pharmacist.

2. Help and advice from GPs and practice managers working in NI who know exactly how hard it is to see beyond the huge workload. They also know how tough it can be to encourage weary colleagues and staff to get involved.

3. A mentor who can guide you through a range of Quality Improvement techniques and offer ideas about what has worked for them? You can contact them between sessions to help with the practicalities and challenges of making a change happen.

This course is currently oversubscribed; if you wish to hear about future courses email gpcpd.nimdta@hscni.net.

What we need from you:

 

• One GP, and either your practice manager, or practice pharmacist to participate in each session.
• To complete a single page report outlining the problem you have chosen to work on, and the progress you have made by session 6 (this information will be anonymised).
• To complete an anonymous survey at the beginning and end of the programme to allow us to assess the value of this course.

** Project ECHO® (Extension for Community Healthcare Outcomes) http://ECHO.unm.edu

With the use of video-conferencing technology, participants benefit by sharing evidence-based, best practice guidance and case-based learning. The hub (multidisciplinary team of experts) and spoke (primary care providers) model has been shown to be an effective way of improving access to specialist supported care and improving patient outcomes.

Quality Improvement and General Practice? Quality Improvement (QI) means different things to different people. Batalden and Davidoff propose that “everyone in healthcare really has two jobs….: to do their work and to improve it” But how do we improve? What approach should we take? In particular:

  • How do you find time to reflect on and improve quality of our care?
  • What should be prioritised?
  • How do you measure “quality”?
  • How do we effectively and efficiently improve our services?
  • What tools can we use?
  • Will our patients see the benefits of improved outcomes?

General Practitioners in the UK are already engaged in improvement work. They are required for appraisal and revalidation purposes to engage in quality and safety activities individually and collectively at a practice level within the framework of clinical governance. General Practice has a well-established track record in Clinical Audit and Significant Event Analyses. QI is the next logical step for improvement in healthcare. The techniques, tools and methods that are being used for improvement have come from and been taken from industry and adopted for healthcare. The IHI (Institute for Healthcare Improvement) based in USA has been one of the leaders in developing QI methodologies for healthcare. On the publication of the Francis Report in February 2013, the Prime Minister David Cameron asked Professor Don Berwick (former Chief Executive of IHI) to advise on the future direction for the NHS. One of the key recommendations in his report, “A promise to learn – a commitment to act”, was that the NHS “should become a learning organisation”. Quality Improvement is one of the ways for this to be achieved.

What is Quality?

In answer to the question ‘What is Quality in Healthcare’? – the Institute of Medicine in USA proposes six dimensions: qi1

  • Safe: Avoiding harm to patients from care that is intended to help them
  • Effective: Providing services based on evidence and which produce a clear benefit
  • Person-centred: Establishing a partnership between practitioners and patients to ensure care respects patients’ needs and preferences
  • Timely: Reducing waits and sometimes harmful delays
  • Efficient: Avoiding waste
  • Equitable: Providing care that does not vary in quality because of a person’s characteristics

The Institute for Healthcare Improvement (IHI) proposes the “Model for Improvement” within which the following questions are asked:

  • What are we trying to accomplish?
  • How do we know that a change is an improvement?
  • What changes can we make that will lead to improvement?

and the Plan-Do-Study-Act (PDSA) approach to change. The PDSA cycle is shorthand for testing a change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act). qi2 Many of the medical Royal Colleges have been developing their QI curricula and RCGP is no different. There are a range of resources available on the RCGP website. The RCGP QI guide ‘Quality Improvement for General Practice’ published last year is available there. You can access it directly by clicking on the image of the front cover below. Another UK organisation with a strong QI approach to healthcare improvement is The Health Foundation – their guide ‘Quality Improvement Made Simple’ is available by clicking on the image of the front cover below also. Finally if you prefer there is a popular short (11 minute) video on YouTube by Dr Mike Evans which you may find informative.

qi for gp qi made simple

If you would like more information related to Quality Improvement for General Practice please contact Dr Nigel Hart (Associate Director GP Training (QI)) on nigel.hart@hscni.net

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