Safety and quality
Our practice is committed to quality improvement.
Quality improvement activities
Our practice participates in quality improvement activities.
► A. Our practice team can describe aspects of our practice that we have improved in the past three years.
► B. Our practice uses relevant patient and practice data for quality improvement (eg. patient access, chronic disease management, preventive health).
- Practices need to engage in quality improvement activities to improve quality and safety for patients in areas such as practice structures, systems and clinical care
- Decisions on changes should be based on practice data
- Achieving improvements requires the collaborative effort of the practice team and all members of the team should feel empowered to contribute
- This criterion cross references to Criterion 2.1.2 Patient feedback and Criterion 1.3.1 Health promotion and preventive care.
Quality improvement is an essential business activity
Improvement in general practice can involve examining practice structures, systems and clinical care. Improvement needs to be based on evidence produced by the practice’s own data. This data can be gathered from patient or staff feedback, an audit of clinical databases, or the analysis of near misses and mistakes.
Examples of quality improvement
It is important that standards for general practices encourage quality improvement and identify opportunities to make changes that will increase quality and safety for patients.
It is critical the practice has a plan for carrying out any improvements it has identified as being necessary. Quality improvement activities can encompass changes to the day-to-day operations of the practice (eg. scheduling appointments, normal opening hours, improving patient health record keeping, changing the way patient complaints are handled, or altering systems in response to ‘near misses’). Quality improvement can also encompass activities specifically designed to improve clinical care or the health of the entire practice population (eg. improving rates of immunisation, improving the care of patients with diabetes or hypertension or altering the systems used to identify risk factors for illnesses that are particularly prevalent in the practice’s local community such as cardiovascular disease). For example, practices could undertake an internal assessment of their clinical handover processes by checking with randomly selected referral recipients whether the practice’s clinical handover processes are consistently satisfactory.
Patient experience feedback
Patient feedback is an essential component of quality improvement activities in both clinical and system domains (see Criterion 2.1.2 Patient feedback).
Practice accreditation as a driver of quality improvement
One of the most effective quality improvement activities is formal accreditation using these Standards; peer surveyors can provide extremely useful ideas about how a practice can improve in a range of areas.
Quality improvement activities are underpinned by effective information management techniques that allow practices to collect and analyse practice data and make decisions for service changes based on that data. Innovative use of information technology can assist practices in performing quality improvement activities to improve the health of their practice population. Ideally, practices need to review their own practice data for quality improvement purposes. Where such data is not easily accessible (eg. in non-computerised practices) national recall and reminder registers such as the Australian Childhood Immunisation Register can provide practice specific data for practices to use in quality improvement activities.
Consistent data coding systems drive meaningful quality improvement activities. Coding is an effective means to address issues of having consistent clinical terminology. This can be readily addressed by means of a software system that uses ‘drop down box’ functionality in defining medical diagnoses. Coding can form the basis of chronic disease registers and avoids the confusion that can result from ‘free text’ style descriptions in the medical history.
It is preferable for the practice to use nationally recognised coding systems rather than a system which is idiosyncratic to the practice.
Quality improvement is a team activity
Engaging in quality improvement activities is an opportunity for the practice’s GPs and other staff members to come together as a team to consider quality improvement. Quality improvement can relate to many areas of a practice and achieving improvements will require the collaborative effort of the practice team as a whole.
Quality improvement tools and other resources
The National Prescribing Service offers free quality improvement activities that help GPs review their prescribing habits at www.nps.org.au/health_professionals/activities/ clinical_audits_for_gps/clinical_e-audits_for_gps.
Australian Primary Care Collaboratives offer subsidised learning workshops on a model for improvement at www.apcc.org.au.
The RACGP Quality Framework included in the January/February 2007 issue of Australian Family Physician discussed the theory of quality improvement in general practice and included an examination of the RACGP Quality Framework at www.racgp.org.au/afp/200701).
RACGP QI&PD services offer a wealth of quality improvement tools and guides including clinical audit mechanisms. Visit http://qicpd.racgp.org.au.
The RACGP has produced and endorsed a wide range of guidelines to assist GPs and practice teams in their work. These resources are available at www.racgp.org.au/guidelines.
The Measurement for improvement toolkit is a tool produced by the Australian Commission on Safety and Quality in Healthcare and is available at www.safetyandquality.gov.au/internet/safety/publishing.nsf/content/publications-M.
Safety and quality
Our practice is committed to quality improvement.
Overview of Standard 3.1
This Standard is about your health service’s capacity to deliver and maintain a high standard of clinical care by ensuring and improving quality and safety for patients. Having sound, clear policies and guidelines for your service and its staff helps you to maintain and improve safe and high-quality clinical care. You may achieve this by focusing on four aspects of clinical health management:
- quality improvement – regularly reviewing and improving your service’s clinical structures, systems and clinical care
- clinical risk management – putting in place clinical systems and protocols that minimise the level of risk to patients
- clinical governance – actively promoting and encouraging safe and high-quality clinical care through clear policies, guidelines and accountability
- patient identification – putting in place a process of patient identification that minimises the risk of adverse events associated with misidentification and maintains confidentiality and accuracy in patient health record keeping.