Quality Improvement (QI)

What is quality improvement (QI)?

Improving quality is about making healthcare safe, effective, patient-centred, timely, efficient and equitable. In the history of the NHS, there has never been such a focus on improving the quality of health services.

Our QI Aim

Our QI aim is one of our 5 key priorities as a Federation - To improve health outcomes, reduce health inequalities & ensure effective use of resource to the residents of Camden. It has three key objectives:

• To develop a population health model to understand the local health needs and unwarranted variation thereof for our population
• To establish & deploy solutions where the population health model identifies opportunities for improvement
• To embed a Quality Improvement approach across all our staff so that these skills provide continuous improvement to the care our residents receive

Our QI Methodology

We follow a ‘Model for improvement’ approach to Quality Improvement. This is an approach to continuous improvement where changes are tested in small cycles that involves planning, doing, studying, acting (PDSA), before returning to planning, and so on. These cycles are linked with three key questions

• ‘What are we trying to accomplish?’
• ‘How will we know that a change is an improvement?’
• 'What changes can we make that will result in improvement?’

Quality Improvement Support Team

This work is led by a Quality Improvement Support Team (QIST). The team have access to and draw on a range of local knowledge, clinical expertise, and information systems expertise. The team are multi-skilled groups capable of interrogating practice data and developing bespoke interventions to improve wellbeing at an individual patient level. They support our member practices by:

• Holding joint meetings & running Learning Together Events across the area
• Meeting with the leadership of individual practices regularly to provide tailored advice and jointly address any areas of concern
• Keeping all practices up-to-date with the latest tools, knowledge and skills
• Aiding practices in following a best practice common approach to systems and processes (e.g. managing call & recall)

Quality Improvement In Diabetes Mellitus & Atrial Fibrillation

Aims

• Improve diabetes prevalence
• Reduce unwarranted variation in diabetes good control measures.
• Raise rate of anticoagulation therapy in appropriate patients.
• Improve patient outcomes

Implementation

Dedicated qist team – 3x clinicians & 1x QI facilitator who delivered:

• Tailored action plans
• Regular GP Practice visits
• Internally developed IT tools
• Weekly focuses
• Learning together events

Diabetes outcomes

Qist team founded

• Increment of 552 diabetic patients: 4339 → 4891
• 12.8% increase: 39.1% → 51.9%

Atrial fibrillation outcomes

AF + CHA2DS2–vasc >=2 on anticoagulation

Qist team founded

• April 2016: 71%
• April 2017: 77%
• April 2018: 83%
• April 2019: 86%

Key learning

• Meetings need to be with all members of the GP Practice team, not just clinicians
• Each GP Practice is unique & requires a tailored action plan
• GP Practices who implement clear systems & processes have higher outcomes

Next steps

• Improve opportunistic call/recall processes in all GP Practices
• More regular & targeted GP Practice visits & learning together events
• Considering alternative solutions to ensure improvements in outcomes are sustained