Primary Care Safety In Practice / Planned Proactive Care Quality Improvement

Problem Statement

All general practices were encouraged to engage in a newly designed Quality Improvement Framework, which included appointing quality improvement champions and carrying out regular audits against agreed care bundles.

The Quality Improvement Framework is based on continuous quality improvement, and subsequent improvements to the model of care, resulting in an enhanced capability and capacity to deliver quality care across the primary care sector. The aim is to develop a network of practices capable of delivering high-quality care. The practices will have robust quality improvement approaches and achieve minimum standards of care for patients with long-term conditions.

Within the past five years, greater emphasis has been placed on developing the model of care, with significant investment made in quality improvement initiatives to build capability and capacity in primary care.

What are we trying to achieve?

Our goals are to:

• improve the model of care of practices, to make them more effective for their patient populations
• enhance primary care’s ability to use quality improvement methods and processes
• improve efficiency and deliver savings
• improve practice systems and processes, to ensure reliable, safe quality care
• promote a culture of improvement.

What have we done?

• Developed care bundles for patient cohorts, specifying the interventions and timeframes, then monitored adherence to the bundles and the outcomes being delivered.
• As part of a planned proactive care quality initiative, encouraged general practices to complete team building exercises. For example, practices have been encouraged to use team climate tools to build awareness and desire for change in how they work collaboratively within the practice, as well as with disciplines outside.
• Provided advice on implementing quality improvement in general practices, and on spreading and sustaining those improvements.
• Supported training for quality improvement champions within practices.

What did we find?

Implementing quality improvement is time consuming and challenging for general practices. Various factors account for this, including a lack of:

• resources (financial and non-financial)
• expertise around change management and project management
• the agenda to change and improve.

We have been working to address these issues. By asking practices to complete care bundles, practices are able to see their performance through an audit of a small, targeted cohort in their enrolled population. This then raises a list of issues for the practice, which is intended to generate discussions around areas for improvement.

The team climate tools help practices recognise the importance of working collaboratively in order to achieve quality improvements, and to identify how the practice can improve this. Providing advice around understanding capacity and how to grow it, and building awareness and desire for change is another key activity we use to facilitate improvements in practices.

How did we make a difference?

Feedback from general practices, gathered through surveys and interviews, has been very positive and have emphasised that the framework is a necessity.

However more analysis and research needs to be done to better understand the effects that it will have around health outcomes and financial savings for the DHB.

Where to from here?

Continue fostering quality improvement initiatives in practices.