Advancing Quality in Primary Care – What is Quality Improvement? 10 March 2011 Powys THB/IRH Paul Myres- Chair Primary Care Quality Forum

3 basic questions How good is the clinical care received by your patient How do you know? What are you doing to make it better?

What is high-quality care? Relevant Effective Acceptable Accessible Safe Efficient Equitable Timely Measurable

What determines quality? Personnel Environment Systems Knowledge/ Clinical effectiveness Culture Monitoring …………………………………….

Getting it right – checks and balances Patient Purchaser - LHB Provider Eg Dentist/Trust Resourc es The Public,The Media WAG Evidence based care/ Skill

How do we ensure high quality? Review Audit Research Knowledge Education/ CPD Planning Care Delivery Implementation Complaints/ compliments Risk management Patients and public

Clinical Effectiveness Research evidence Clinical experience Patient factors Resources

How do we improve quality? Understand the problem – accurate interpretation of data Understand processes and systems Analyse demand, capacity, and flows Choose the right change tools – leadership;staff and patient involvement Evaluate impact of change

Processes for quality improvement evidence based practice and clinical effectiveness programmes risk management processes clinical audit programmes learning from incident reporting learning from complaints/compliments listening to the views of patients, carers and the public

Quality & Use of information Systems in place to store and share that information Capability to assess meaning and evaluate information Willingness and ability to respond to information and evidence that something happens Accurate and reliable recording of appropriate information

Staff focus Workforce planning and staff management Education, training, appraisal and CPD Induction and mandatory training Multi-disciplinary team working Monitoring individual/team performance

Leadership, strategy and planning The team knows where it is going and why There are clear processes and expectations of performance Teams and individuals understand their roles and responsibilities Planning involves all partners, internal staff external staff as appropriate ?and patients/public

What can we use to assure quality? - Incident reporting - SEA Acknowledging something has occurred Being prepared to tell others Low blame culture Analysing what happened Identify what went wrong/right and why Sharing the learning Checking things have changed

What can we measure ? Outcomes – endpoints - markers Processes Patient Experience Carer Experience Staff Experience Adverse events

What info is already collected? QOF Audit+ Prescribing Vacc & Imms Hospital activity OOHs activity Critical incidents Complaints

What can we use to measure it? - AUDIT “a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change” (Principles for Best Practice in Clinical Audit 2002)

The Audit Cycle Agree/Review Standards Implement change if needed Collect data on current practice Compare data with standards

The Improvement Cycle Plan Act Do Study

26 Standards Sit alongside professional and quality standards Key tool to help drive up clinical quality and patient experience Use them to plan, design, develop and improve services Stronger focus on embedding the standards at team level Doing Well, Doing Better : Standards for Health Services in Wales

The key themes in the Standards Running legally, efficiently and upholding public service values Promoting wellbeing and preventing ill health Emergency planning Engaging in a meaningful way with patients, service users and carers Providing safe and effective treatment, care and services in appropriate environments Communicating well internally, externally and with all stakeholders Dealing well with concerns, managing adverse incidents and learning from these Effective workforce planning, recruitment and development.

Teams and services should use standards to – Review their services – alongside professional standards as appropriate Assess where they are doing well and have good practice to share Assess where they could do better and have areas for improvement Develop improvement plans to address the weaker areas Engage with organisational management to escalate risks and actions that can’t be managed by the team itself

CGPSAT Standardised model across Wales Linked to Standards for Health Services Developed by practitioners and other stakeholders Endorsed by GPC Wales & RCGP Designed to help practices review, monitor & improve systems within their practice

Quality Assurance Process Primary Care Quality and Information Service DATA (trends and patterns/ outcomes – avoid scoring Analysis by LHB (MDT) Focussed Visit Action Plan Unacceptable Investigation ( More detail, diagnostic) Trained Assessors eg LHB, Lay, PM, GP IMAs PM Nurse assessor Performance Procedures Support PCSS IMA CPD Clinical Director AMD ?Team Coach ?Mentor ?Hit Squad

4 basic questions How good is the clinical care received by your patient population? Clinical effectiveness, staff, systems & processes How do you know? Audit, incident reporting What are you doing to make it better? Leadership,strategy, PPI, resources, risk management How can you share / prove it? Use of information, Openness