Quality Improvement in Primary Care

SHARE Programme

“Our Practice, Our Problem, Our Solution” was a pilot funded programme offered to all GP practices in NI, and delivered by NIMDTA in 2018-19. It offered practices the opportunity to identify and share a problem, and consider ways to solve it. It was significantly oversubscribed and feedback was excellent. Several members of each GP team participated, and it allowed people to learn from each other about what worked for them. You can view a number of the presentations from the last SHARE programme at the link below

https://www.nimdta.gov.uk/general-practice/gp-cpd/gp-share-events/

New SHARE Taster sessions were advertised in March 2020 with a new programme to run in Spring and Autumn 2020, delivered by the Federation Support Unit. However due to Covid19 pandemic only one taster session took place.

We do hope that when the situation allows that this will happen. If you are interested in hearing more, please email [email protected]

 


Real QI Projects from GP surgeries across NI

The NIMDTA GP Specialty Trainee EQUIP (Experience in Quality Improvement) programme has attracted international recognition. A recent article on the RCGP website (at the link below) describes how a key goal of EQUIP, is to move from “Know-how” to “Do-how”

https://www.rcgp.org.uk/clinical-and-research/about/clinical-news/2020/february/how-do-we-equip-our-future-gps-to-be-leaders-in-improvement.aspx

You will find a wide range of poster examples of QI projects completed by GP Specialty trainees from across NI at the link below.

https://qi.hscni.net/equip/


Quality Improvement Glossary of Terms

The terminology and language used to describe quality improvement and the science of improvement eg methodologies and techniques can be confusing. This explains some of the commonly used terms.

Glossary of Terms Quality improvement


HSCQI (Health and Social Care Quality Improvement)

https://qi.hscni.net/

This is a ‘movement’ in health and social care services in Northern Ireland working together to focus on improving the quality of the services we provide/use, and sharing good practice so that we can all learn from each other and spread improvements. Anyone (service providers, service users, members of the public) interested in improving our health and social care services can become part of the HSCQI movement.

The annual HSCQI awards in NI took place in March 2020 just before lockdown.

The first primary care category winner was Aoibhin McGarrity for her “Crystal Clear” EQUIP project. 

It aimed to improve gout treatment so that 75% of patients with gout would have their preventative medication titrated appropriately to achieve a serum urate of < 300. Gout is the most prevalent inflammatory arthritis, affecting 2.5% of adults in the UK. Improving treatment leads to less pain and joint destruction which preserves function and limits time off work. The results demonstrated that now 80% of patients with gout in the practice are on a preventer titrated appropriately as per guidance.

https://qi.hscni.net/download/equip/Aoibhin-McGarrity-Removing-Gout.pdf

To read more about the award winners, click on the link below

https://qi.hscni.net/2020/03/26/quality-improvement-awards-2019-winners/


How can taking more time on a task, save time in future?

http://15s30m.co.uk/

15 seconds 30 minutes (or 15s30m for short) aims to help anyone identify how they could spend a few extra seconds on a task now which will save someone else 30 minutes or more later on. In doing so you will reduce frustration and increase joy.

Joy in work has been proven to help staff to do their best and deliver safe and effective patient care.

Improving joy is the key to retaining the workforce and reducing staff sickness.

15s30m is a change platform which you or your practice can use to release the value in every idea.

To get started you don’t need a formal plan: its just individuals being empowered to do what they know is right for staff and patients.

To find out more click on the videos below

Introduction to 15s30m

Creating joy in work is the only way to save the NHS (TEDxNHS)


How to “huddle” in GP?

Huddles are team-based meetings aimed at providing a forum for staff to flag up operational and patient safety concerns. They have also been shown to improve communication, patient safety and staff satisfaction in primary care. The huddles enable staff to coordinate and share information quickly, such as staff sickness or manager availability. Staff can also bring up more personal news such as birthdays, engagements, births, passing driving tests and sometimes sad news.

You can use a template Huddle checklist to get started  – Team-huddle-Checklist example GP

Below is an example from a GP practice who adopted a daily Huddle.

https://www.rcgp.org.uk/clinical-and-research/resources/bright-ideas/huddles-in-primary-care-promoting-healthy-team-dynamics.aspx


Other Online resource documents

What are we trying to accomplish? Setting out your QI project plan – Setting out your QI project plan

5 Whys: Finding the Root Cause

The key to solving a problem is to first truly understand it. Often, our focus shifts too quickly from the problem to the solution, and we try to solve a problem before comprehending its root cause. What we think is the cause, however, is sometimes just another symptom. One way to identify the root cause of a problem is to ask “Why?” five times.

When a problem presents itself, ask “Why did this happen?” Then, don’t stop at the answer to this first question.

Ask “Why?” again and again until you reach the root cause – Finding the Root cause of a problem 5-Whys-Tool IHI

The habits of an Improver

https://health.org.uk/publication/habits-improver

Change-Capable Leadership; The Real Power Propelling Successful Change

https://www.ccl.org/wp-content/uploads/2016/04/Change-Capable-Leadership.pdf

How to run a QI project? A SE Trust booklet

https://view.pagetiger.com/QIIC/How-to-Run-a-Quality-Improvement-Project

Creative Approaches to Problem Solving; A methods toolkit produced by Q Community

https://s20056.pcdn.co/wp-content/uploads/2017/08/Q-community-CAPS-toolkit-2017.pdf

RCGP Quality Improvement guide for General Practice (GPS and the whole practice team)

http://www.rcgp.org.uk/-/media/Files/CIRC/Quality-Improvement/RGCP-QI-Guide-260216.ashx?la=en

RCGP A guide to Process Mapping

http://www.rcgp.org.uk/-/media/Files/CIRC/Quality-Improvement/A-practical-guide-to-process-mapping.ashx?la=en

RCGP What is the Model for Improvement and PDSA approach

http://www.rcgp.org.uk/-/media/Files/CIRC/Quality-Improvement/A-practical-guide-to-Model-for-Improvement-and-PDSA.ashx?la=en

RCGP A guide to Run Charts

http://www.rcgp.org.uk/-/media/Files/CIRC/Quality-Improvement/A-practical-guide-on-how-to-build-a-run-chart.ashx?la=en

IHI’s QI Essentials Toolkit

This document includes the tools and templates you need to launch and manage a successful improvement project. Each of the nine tools in the toolkit includes a short description, instructions, an example, and a blank template. (attached to this email)

http://www.ihi.org/resources/Pages/Tools/RunChart.aspx

Institute for Healthcare Improvement Run Chart example Templates

http://www.ihi.org/resources/Pages/Tools/default.aspx

A checklist for Staff involved in QI;

http://engage.hscni.net/wp-content/uploads/2018/10/020204-HSC-HSCQI-Great-Leaflets-Staff.pdf

A checklist for engaging Service Users and Carers in QI

http://engage.hscni.net/wp-content/uploads/2018/10/020204-HSC-HSCQI-Great-Leaflets-Service-Users.pdf


BOOKS

The Memory Jogger 2: A desktop guide of tools for Continuous Improvement and Effective Planning  (Second Edition)

Spiral Paper Back – 30 Jan 2010

By Michael Brassard

The 7 Habits of Highly Effective People

Paperback – 4 Jan 1999

By Stephen R. Covey