Quality improvement
There is scope for improving the quality of medical care for residents through implementing
systems and tools over the short and medium term. Many RACFs use a continuous quality
improvement cycle to implement changes.260 The PDSA (plan, do, study, act) cycle is increasingly
used for quality improvement in general practice and health service organisations.261
The PDSA method encourages starting with small changes, which can build into larger
improvements in practice through successive quick cycles of change, as shown in Table 17.
Table 17. The Plan, Do, Study, Act cycle
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Step 1. Plan to test selected improvement or change
Once the actual change to be introduced has been agreed, consider the following questions:
What would we expect to see as a result of this change? What data do we need to collect to check the outcome of the change? How will we know whether the change has 'worked' or not? Who, what, where, when?
Step 2. Do the test and collect data for analysis
Keep the 'do' stage short and record any outcomes, unexpected events, problems and other observations.
Step 3. Study the results
Has there been an improvement? Did your expectations match the reality of what happened? What could be done
differently?
Step 4. Act on the result
Do an 'amended' version of what happened during the 'do' stage, measure and study any differences in results.
Once you have achieved success in a PDSA cycle, the change can be implemented as part of usual practice and
mechanisms established to sustain the improvement. These may include:
training and education of staff standardisation of systems and processes documentation of associated policies and guidelines measurement and review to ensure that the change is incorporated into routine practice.
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Over the long term, there are further challenges for enhancing the quality of medical care in the
residential setting. There is a need for:
inclusion of residents in clinical studies of the effectiveness of interventions systematic data collection to build an information base about the epidemiology and current
medical treatment of the residential aged care population processes to establish agreed and evidence based treatment guidelines specific to the needs
of this population.
General practitioners could help meet these challenges by working with other professional
groups (eg. nurses and geriatricians) to:
collect agreed objective data that can be used comparatively as a starting point for
quality enhancement examine and understand reasons for suboptimal care establish agreed clinical indicators that reflect good care establish agreed evidence based benchmarks develop agreed strategies for translating evidence into practice.
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