Quality Improvement

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QI Tools

QI Activities

What is Quality Improvement?

Quality Improvement (QI) is an evidence-based approach that helps primary care free up time to deliver and evaluate initiatives, and embed new approaches more effectively and efficiently into practice. QI helps us to make the most of our systems, organisations, talents and expertise to deliver better outcomes for patients.   

Why Quality Improvement? We're already overstretched?

Up until recently, quality improvement in General Practice has been hard work.  Doing big projects and big clinical audits on top of QoF, LES’s, DES’s, Appraisal, GP Training and so on, has made it feel overwhelming and quite frankly HARD WORK!!!   This is because for far too long, the NHS has been too concerned with QUALITY ASSURANCE rather than QUALITY IMPROVEMENT.   Quality Assurance is proving to others that we’re doing a good enough job – and that’s why it feels horrible – we’re proving to others that we are meeting criteria and there’s not much in it for us!   And it’s far too focused on meeting a set of standards defined by someone else rather than just trying to move to a better place than we currently are.   Quality Improvement is more focused on this movement to a better place.  It’s about accepting that we’re not always great, not beating ourselves up about it but actually working towards this better place.  And unlike Quality Assurance, it is a process that doesn’t just happen every now and then, but something that happens in small incremental steps continuously.   As a result, it feels far less overwhelming, far more achievable, far more likely to improve the quality of care we provide as time goes by and far ultimately far more satisfying. 

Isn’t that what you’d like to be a part of?

If you’re still feeling a tad overwhelmed at this stage, it’s probably because all you have ever know is the Quality Assurance model and all the bits and bobs that go with it that cause us all headache.    So, these Bradford VTS pages and the RCGP’s QI Ready Online Toolkit (see below) are provided to help you understand the Knowledge, the Skills and the Attitudes necessary for Quality Improvement.   And when you have that under your belt, you will feel well-equipped to engage!  And if we train GP trainees up for it during their training, then it will them in a positive position to want to continue to engage when they qualify.   Well – we hope so!

The 3 fundamental questions for Quality Improvement

1. What are we trying to achieve?

Understand the problem. Know what you are trying to achieve. Have clear and desirable aims and objectives

2. How will we know that a change is an improvement?

Measure processes and outcomes

3. What changes can we make that will result in an improvement?

What have others done? What hunches do we have? What can we learn as we go along and how?

= USE PLANNING & PREPARATION TOOLS

There are tools that will help you define your question, aims and objectives clearly.

= USE QI TOOLS & ACTIVITIES

There's lots of tools to help you measure processes and outcomes.

= EVALUATE, PRESENT & IMPLEMENT TOOLS

Then there are tools to help you evaluate, present your data, & even help implement actions.

The QI Wheel

I love this diagram of the QI Wheel (found the on the RCGP’s QI Ready Online Toolkit).  Why?

  1. Because it illustrates all the components of good QI work.
  2. And then it brings all of it together as a cohesive whole
  3. And it’s based on evidence.

To go into more detail…. it’s not just about doing lots of PDSAs, Significant Events or mini-audits!  None of that works if…

  • You don’t belong to a working organisation whose has a good learning culture in place.
  • You don’t involve or listen to patients when they complain something is not delivering good quality of care.
  • You don’t engage the other stakeholders in a meaningful way (i.e. for example, if you force someone to do a task because your their boss, you are likely to get less quality results than someone who is as near passionate about it as you are). 
  • You don’t base it on what the evidence and research says that makes a difference.  If you just do stuff by trial and error, you get hit and miss results (more miss actually).  

The RCGP's Amazing QI Ready Online Toolkit

This is an amazing online tool developed by RCGP to help make implementing and engaging quality improvement activities that are meaningful and contextual.    Sign up to their website to access things like

  1. Knowledge bites: to help you understand more about Quality Improvement, including some e-modules
  2. Resources and tools: to help you with your quality improvement in practice
  3. Case studies: which you can duplicate, thus preventing you from ‘re-inventing the wheel’
  4. A network to link with others to help you and give advice.  

All of this should help you engage in Quality Improvement in a way that is

  • easy to do and not overwhelming
  • making it an enjoyable activity to get involved in
  • and making a difference to the way you and others currently deliver health care.

 

The RCGP’s QI Ready Toolkit: 
You’ve nothing to lose and everything to gain.
Designed for GP’s, GP Trainers and GP Trainees.   

Access it here: 

And if you end up doing a good QIA project you're proud of...

Please share it with others through the RCGP’s QI Ready Online Toolkit.   Help others to improve the quality of their work like you have done by sharing your work.    Give them inspiration, give them ideas, and see your work published.

Go to the RCGP’s QI Ready Online Toolkit and “Submit a Case”

Please leave a comment if you have a tip, spot an error, spot something missing or have a suggestion for a web resource.
And of course, if you have developed a resource of your own, please email it to me to share with others.

'Make GP Training Better Together'

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