Structured and systematic approaches to quality improvement are important in identifying areas of inefficiency or suboptimal performance within an organisation and take systematic actions to address them. These systems provide a structured framework for organisations to continuously learn, adapt and evolve in response to change.
Quality improvement activities may include:
- models of improvement (eg plan–do–study–act (PDSA) cycles, plans for continuous improvement)
- feedback from consumers/patients
- feedback from the general practice/RACF team
- audits of clinical data
- knowledge sharing and collaboration.
Models for improvement
The model for improvement entails three main concepts to consider when undertaking improvement:
- Aim: What are you trying to accomplish?
- Measures: How will you know that a change is an improvement?
- Changes: What changes can you test that will result in an improvement?1
Plan–do–study–act
Changes identified as part of the model of improvement can be tested using small-cycle testing called PDSA cycles. These small changes can build into larger improvements in practice through successive quick cycles of change, as shown in Table 1.
| Table 1. Plan–do–study–act cycle |
Step 1. Plan to test a 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, why?
|
Step 2. Do the test and collect the data for analysis
Keep the ‘do’ stage short and record any outcomes, unexpected events, problems and other observations. |
Step 3. Study the results/analysis of your data
- 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, and measure and study any differences in results.
- What changes do you need to make next?
- What will the change be?
|
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 mechanisms 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.
Over the long term, there are further challenges for enhancing the quality of medical care in the residential setting. There is a need for:
- the 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.
GPs could help meet these challenges by working with other professional groups (eg nurses, allied health, geriatricians and aged care facilities) 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.