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

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.

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

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

The Deming PDSA Cycle PLAN DO STUDY ACT

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.

Six Sigma DEFINE MEASURE ANALYZE IMPROVE CONTROL

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

LEAN Problem Solving People and Partners Process Philosphy

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

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

Questions

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

References Dawda, Jenkins & Varnam. 2010. Quality Improvement in General Practice. London: King’s Fund. (Accessed at http://www.institute.nhs.uk/images/docume nts/SaferCare/PrimaryCare/QI%20in%20GP%2 0-%20KF.pdf ) http://asq.org/learn-about-quality/project- planning-tools/overview/pdca-cycle.html http://en.wikipedia.org/wiki/Six_Sigma http://en.wikipedia.org/wiki/Lean_manufactu ring