1. The Context Dr Brian Robson Medical Director NHS QIS
Institute for Healthcare Improvement Fellow

2. The Plan... A little bit of national context
Reflections on Primary Care’s experience
Using a tool - PDSA

3. Less money ... much less money
IFS predictions – Dec 2009
Reflects current use of EYF

4. The only show in town caring and compassionate health services
collaborating with patients and everyone working for and with NHSScotland
providing a clean and safe care environment
improved access and continuity of care
confidence and trust in healthcare services
delivering clinical excellence
May 2010

5. Primary care is front and centre
National actions
Patient access / Patient experience
SPSP in Primary Care
Care pathways – LTCs
Quality measurement framework
Anticipatory care
Dialogue around
independent contractor contracts
Multi-professional partnerships
Aug 2010

6. What the high heid yins are saying .....
Primary Care is at the heart of the NHS in Scotland and will be central to delivering these quality improvements

7. What the high heid yins are saying .....
All practice staff…GPs, nurses, receptionists and other professionals …should be very proud of what has been achieved.
Aug 2010

8. You are the ones! Self selected bunch Leading the way
Lessons from SPSP in hospitals
GTT – Harm is out there

9. General practice – the advantages
Small
Change happens
Change can be rapid
Structure
History of commitment to quality

10. SPSP – the lessons so far
Energy and will
“It has reminded me of why I do what I do”
Clinical + Managerial + Political Patients
Power of the narrative – patient and professional
Assumption that care is safe and reliable
Measurement is key
Collaboration is energising
Change is hard work – sustaining it is harder still

11. Repeated Use of the PDSA Cycle
Changes That Result in Improvement A P S D
DATA D S P A
Implementation of Change A P S D
Wide-Scale Tests of Change A P S D
Not always rapid cycle – e.g.
Follow-up Tests
Hunches Theories Ideas
Very Small Scale Test

12. Improvement works 81 PDSAs over 24 months
Reception staff signposting training
Change in nursing skill mix
HCA role
GP 3rd AA
4 to 0.59 days !
Dr Campbell & Partners
Clarkston
Aug 2010

13. Improvement works
Practice redeveloped its CHD service over 24 months using multiple PDSAs
Flow charts / action cards / protocols
HCA / skill mix
% aspirin 68% 100%
% statin %  93%
% Beta-blockers 20%  100%
Kilcreggan Practice
Argyle
Aug 2010

14. Collaboration helps !
Aug 2010

15. It speaks for itself...
“We have completely turned around our repeat prescription system which suits our staff and patients love it”
Practice Manager,
Dalry Medical Practice
Aug 2010

16. Using the Model for Improvement
New book – spread, work with IHI, considered improvement teams …what were the CSFs ?

17. Model for Improvement Act Plan Study Do What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Act
Plan
Study Do
Page 7

18. Successful Cycles to Test and Adapt the Care Model Changes
Plan multiple cycles to test and adapt change
Scale down size of test (# of products, locations) – keep it small
Test with volunteers
Do not try to get buy-in or consensus for the test
Collect useful data during each test
Eventually, test over a wide range of conditions

19. PDSA Table Exercise

20. PDSA Exercise

21. How did you get on ?

22. Important
Primary care is central
You are leading the way
Building on work to date

23. Thank You

24. Health Foundation Safety Improvement in Primary Care SIPC