1. QUALITY IMPROVEMENT IN PRIMARY CARE
Dr. Olga Konwisorz GPST1
March 1st, 2011

2. Definign Quality Improvement
Continuous quality improvement (CQI) and related terms, such as total quality management, have come to describe a paradigm for systems change that, in UK health care, is now generally referred to simply as ‘quality improvement’ or ‘improvement’.
This comprises a set of values and tools for setting goals and planning, implementing and measuring change. The components that are most influential in health care stem from the work of quality gurus such as Deming and Juran who worked primarily withmanufacturing industries.

3. Principles Underlying QI
Culture
Aims
Collaboration
Training
Antiperfectionism
Measurement
Small steps
Standarisation

4. Some Tools for Improvement
Deming PDSA Model – framework for planning and implementing change. Changes are introduced in a controlled way, with frequent measurement and rapid feedback, in order to identify aspects of change ideas that need refining and improve them before they are rolled out across the organisation.
Six Sigma - uses a process or pathway-oriented approach to identify and minimise aspects of care that are unreliable, inefficient or ineffective. It places a strong emphasis on reducing inappropriate variation in how care is delivered, and places the needs of the patient above that of the system or staff.
Lean - seeks to improve the quality and efficiency of processes, and the satisfaction of staff and customers, through eliminating waste and unnecessary activity

5. The Deming PDSA Cycle
PLAN DO
STUDY
ACT

6. The Deming PDSA Cycle
Plan – recognize an opportunity for improvement and plan a change
Do-test the change
Study/Check- review the test, analyze the results and identify what you’ve learned
Act- take action based on your results
If it didn’t work go through the cycle again
If the change wassuccessful, incorporate what you learned from the test into wider changes. Use what you learned to plan new improvements, beginning the cycle again.

7. Six Sigma
DEFINE
MEASURE
ANALYZE
IMPROVE
CONTROL

8. SIX SIGMA DMAIC CYCLE
Define –defining the problem and setting project goals
Measure – measure key aspects of current process and collect data
Analyze – analyze data to try to find cause- and-effect relationship (Root cause analysis)
Improve – optimize current processes based on data analysis
Control – implement control systems to ensure future process does not deviate from the target

9. LEAN
Problem
Solving
People and Partners
Process
Philosphy

10. LEAN Philosophy- long term thinking Process – eliminate waste
People – respect, challenge and grow them
Problem solving – conscious improvement and learning

11. Barriers to adapting QI in Primary Care
Perceptions of QI
Attitudes of GPs
GP practices
NHS environment

12. Questions

13. Useful Resources http://www.ihi.org/ihi http://www.institute.nhs.uk/

14. References
Dawda, Jenkins & Varnam Quality Improvement in General Practice. London: King’s Fund. (Accessed at nts/SaferCare/PrimaryCare/QI%20in%20GP%2 0-%20KF.pdf )
planning-tools/overview/pdca-cycle.html
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