1. Health Needs Assessment and Quality Improvement Dr Luc Seuntjens

2. My presentation: 3 examples Significant event analysis European Practice Assessment Regional assessment of test-ordering and intervention using small quality groups DISCUSSION DISCUSSION

3. From needs to….quality issues

4. A large bouquet of Quality Improvement approaches Implementation of clinical guidelines Total Quality Management Accreditation and Certification Patient Empowerment and Partnership Organisational Development methods Indicators, accountability and transparancy Public reporting and physician profiling Business Process Reengineering and Business Innovation Breakthrough Collaboratives Clinical pathways, case management, managed care Balanced Score Cards Risk Management, Significant event analysis Knowledge management Leadership development Etc.

5. Quality assessment and quality improvement (Rhydderch,J Eval Clin Pract. 05 ) Externally-led quality assurance/assessment Internally-led quality improvement Primary Stakeholder: Accrediting agency GovernmentProfessional body Practice Purpose:commercialaccountability regulation self-regulation education service development Assessment by:external assessors (industry based) external assessors external assessors combined with internal (self) assessment internal (self) assessment Emphasis:accrediting agency-led primary care - led GP-ledpractice-led Values:summativesummative and formative formative End point:certificatelicensing contract payment certificationlocal criteria achieved

6. Significant event analysis: a little girl with high fever

7. Fish bone analysis & planning improvement Missed diagnosis of RSV infection people practiceexternal infrastructure Planning Improvement Laboratory does not provide test Not aware of RSV epidemic No test material No assistant present Gap of knowledge Friday night

8. Significant event analysis Describe the event in a detailed way Analyse What can be improved? Plan actions

9. Round table discussion 1 How do you deal with significant events in your practice? Discuss the strengths and weaknesses of significant event analysis in your specific situation.

10. Take home messages Needs/Quality problems should be analysed Needs are not isolated but refer to different causes of problems: interdependency of needs. Significant event analysis is a well-accepted and powerful tool to detect needs and initiate change.

11. European Practice Assessment (Engels,Grol 2005) Researchers from 6 European countries developed a set of European indicators for management of primary care 6 national panels rated the indicators and achieved a national consensus on a large set of indicators A pilot test in 9 countries; data collection in 30 practices / country

12. EPA domains 1. Infrastructure 2. Staff 3. Information 4. Finance 5. Quality and safety

13. EPA: the instrument Short self-administered questionnaires Principle GP or practice manager Individual GPs Staff members Patients Observer/facilitator visits the practice Structured interview with GP/PM Checklist

14. The urgency bag

15. The interview

16. Feedback (VISOTOOL 04)

17. Feedback (Visotool 04)

18. Prioritize and plan improving your practice

19. Rank priorities Develop strategies Plan intervention Deliver service Monitor & evaluate Identify needs NA Planning Cycle Start

20. Quality assessment and quality improvement (Rhydderch,J Eval Clin Pract. 05 ) Externally-led quality assurance/assessment Internally-led quality improvement Primary Stakeholder: Accrediting agency GovernmentProfessional body Practice Purpose:commercialaccountability regulation self-regulation education service development Assessment by:external assessors (industry based) external assessors external assessors combined with internal (self) assessment internal (self) assessment Emphasis:accrediting agency-led primary care - led GP-ledpractice-led Values:summativesummative and formative formative End point:certificatelicensing contract payment certificationlocal criteria achieved

21. Take home messages Needs assessment is a team activity Needs assessment is successful in a practice where improving quality is felt as an internal responsibility, as part of normal GP work, of identity, of professionalism (R.Grol)

22. Quality assessment and quality improvement (Rhydderch,J Eval Clin Pract. 05 ) Externally-led quality assurance/assessment Internally-led quality improvement Primary Stakeholder: Accrediting agency GovernmentProfessional body Practice Purpose:commercialaccountability regulation self-regulation education service development Assessment by:external assessors (industry based) external assessors external assessors combined with internal (self) assessment internal (self) assessment Emphasis:accrediting agency-led primary care - led GP-ledpractice-led Values:summativesummative and formative formative End point:certificatelicensing contract payment certificationlocal criteria achieved

23. Prescription rate of antihypertensive drugs in Belgium

24. Regional assessment of test- ordering Verstappen W, WOK, JAMA May 03 Involving peer interaction and social influence improves physician test-ordering behaviour.

25. Feedback on test ordering Verstappen W, 2004

26. The crucial importance of small group work Verstappen W, WOK, JAMA, 2003

27. Round table discussion 2 Government organisations put community priorities on the "needs" agenda. For example cost- efficiency related items. How are these priorities in your country/practice integrated in your personal or practice CPD agenda?

28. Take home messages Needs of the community/society are to be integrated in local improvement projects Quality groups can learn to analyse aggregated data and prioritize action plans The power of peers: needs assessment in touch with local attitudes