There are two main toolsets used in quality improvement.
- Tools to help explore the root cause of problems
- Tools to help you trial changes
1. Tools that help explore the root cause of problems
Before you get started, it’s important to establish a shared understanding of the changes your practice wants to make to improve cancer screening processes and participation rates.
This toolkit provides guidance on the steps your practice can take to improve cancer screening rates. However, by undertaking problem analysis, you may identify additional ideas for change.
Completing problem analysis as a team helps to ensure changes are supported, understood and sustainable.
This toolkit provides the following tools to support your problem analysis:
- The ‘Cancer screening quality improvement readiness tool'
- Information on how to undertake workflow mapping (which helps to identify workflow blockages and problems).
- A table of common challenges when seeking to improve participation in cancer screening, and potential solutions.
- Links to the Clinical Excellence Commission’s repository of tools for quality improvement. Each tool includes background information and instructions on how and when it should be used. Accompanying templates (Excel or Powerpoint) have been developed and are available for staff to download and use with their own data. Links to instructional videos have also been included for most tools, to further assist in the explanation of the resource.
Cancer screening quality improvement readiness tool
The ‘Cancer screening quality improvement readiness’ tool was adapted from a resource developed by the Hunter New England and Central Coast Primary Health Network. It is a useful tool to identify areas for improvement.
It is recommended that you keep a copy of your completed checklist as it is useful to check back on your progress throughout the cancer screening quality improvement journey.
Workflow mapping is a way of making the invisible “visible” to a practice to improve processes, increase efficiency, reduce errors and improve outcomes.8
Workflow mapping is the process of documenting the specific steps and actions that take place in completing a task.
Creating a workflow map allows a practice to see what is currently happening, identify opportunities for improvement/change, and design more effective processes.
It is helpful to consider workflows as being associated with the following processes:
- Perceived process (what we think is happening)
- Reality process (what the process actually is)
- Ideal process (what the process could be)
- Get visual: Workflow mapping can be a great, interactive way to build a shared view among a team of how a system is working; how you would like it to work; and what changes are needed to bridge the gap between the two. Use a whiteboard, or butcher’s paper and markers, to make the mapping an engaging and visual activity.
- Be realistic: Map what is happening now, and what is desired. Consider creating an example of a patient case history for breast, bowel and cervical screening. Map the patient’s journey in terms of how your practice would handle the patient’s data, patient care and communication. Map straightforward examples (e.g. screening results are negative), as well as examples where the workflow is more complicated (e.g. patient has a positive iFOBT and is sent for colonoscopy; the practice has not received results/follow-up information).
- Assign tasks: At each step in the workflow, map the person/s who is responsible for that step of the process.
- Communicate: Ensure everyone involved in the process has input and that it’s a safe and supportive space to discuss areas for improvement Successful change is often dependent on the strength of the relationships of those involved from the start to the finish.
2. Tools that help you trial changes
This toolkit provides work plan templates at the start of Modules 2 to 5. It’s important that your cancer screening quality improvement team gets together to complete the work plan at the start of each module. The work plans will help you to do the following:
- Plan the implementation: The who, what, when, where and how of:
- the activities suggested by the toolkit
- your own ideas for change.
- Assess how ‘the change’ went and what you want to do next to keep improving.
- Keep a record of what activities you have undertaken. This helps if you want to:
- share with others undertaking similar work (i.e. what worked or what went wrong)
- keep a record of activities for accreditation or quality improvement purposes.
Learn more about other tools that support implementing quality improvement changes from your primary health network, or refer to Appendix C (page 72) of the RACGP’s Green Book.