Understanding quality improvement
“When you’re up to your neck in alligators, it is hard to think about draining the swamp”
–A/Prof John Litt, 'The Green Book'4
What is quality improvement?
In the busy environment of general practice, staff can sometimes identify areas that need improving, but may not have the time to fix the problem.
Quality improvement methods can help practices to find the balance between proactive and reactive care.4
Quality improvement is an evidence-based approach6 that helps practices to do the following:
Features of successful quality improvement
1. Data and systems provide a solid foundation
Good data and systems provide insight and understanding about your practice population. Understanding your practice population allows you to target preventative activities and supports staff to provide reliable care.
If you want a different result than you are currently achieving, then you need to adapt your system through a process of review, modification and documentation.
The foundation of improved cancer screening participation is a high quality recall and reminder system. A good recall and reminder system is dependent on good data management. This will allow your practice to:
- systematically remind all eligible patients about cancer screening (often reminders are only set for when a result comes in, overlooking patients who are not screening)
- identify and appropriately engage under-screened patients
- support clinicians to deliver better care to patients who are under-screened
- track your cancer screening participation rates (which is key to knowing whether what you are doing is working or not).
2. You have clear goals and measure progress
Change is often attempted without a clear discussion about what it is that you’re trying to achieve. Meaningful and measurable aims and goals are important.
This toolkit provides:
- process and outcome aims
- guidance on the recommended activities to reach these aims
- work plans for implementing the recommended activities.
If your practice team decides on additional goals that you would like to set for your cancer screening quality improvement work, it’s important that they are SMART goals: Specific, Measurable, Achievable, Realistic and Time-bound.
For example, “We will improve our reminder system” written as a SMART goal would look like:
“By the 10th of January, we will be sending breast screen SMS reminders to all eligible women aged 50–74.”
The work plans at the start of Modules 2 to 5 are the best place to document your goals and the steps you will take to reach your goals and track your progress.
3. Commitment to small, gradual changes
Large-scale change is difficult to achieve and has the potential for large unintended consequences. In the busy environment of general practice, it’s better to go for small changes, and checking the outcome at every step.
The work plans at the start of Modules 2 to 5 are broken down into a series of small, achievable changes. Large-scale change is the culmination of continual small steps.
“If you want to improve the quality of prevention in your practice, your whole practice needs to be involved. Think about the roles of the individual members of the practice team and what contribution they can make towards preventive care”
–Prof Mark Harris, 'The Green Book’ Editorial Committee4
Reception, administration and clinical staff all play an important role in improving cancer screening participation rates through data management, promotion of screening, and implementation of recall and reminders.
A systematic approach that shares workload and responsibility is the key to sustainable change.
Involve your team from the outset so that everyone understands the benefits of improved cancer screening, and has a chance to contribute their ideas on how to improve.
Importantly, once you have nominated team members to undertake work, agree as a team how you will provide them with protected time to complete their nominated tasks. While you will need to put time in at the beginning, the changes you make will pay off in terms of improved efficiency and patient outcomes in the future.
While it’s important to take a team-based approach to quality improvement, it is equally important to look outside your own practice to learn from the experiences of others.
Share your successes and challenges openly—we improve faster when we learn from one another.
Chances are that other practices in your area are working on cancer screening quality improvement. Speak to your primary health network representative about opportunities for networking with other practices.
Collaboration can be as simple as a social media group where you can post questions and ideas, or it can be a structured forum or workshop.
Effective prevention requires partnership and collaboration on multiple levels.4 That is, between:
- the patient and GP
- the patient and practice team
- the GP and practice team
- the GP and allied health care professionals
- the practice team and primary health networks and/or the broader community and health system.
Integrated patient care aims to improve patient care through better coordination of services. Planning an integrated approach to patient care can improve efficiency as well as your patients’ experience of care.7
Ideas for improved integration of cancer screening into routine patient care include the following:
- Incorporating cancer screening into the templates for existing practice services. For example, health assessments for 45 to 49-year-olds, 715 health assessment, antenatal and postnatal checks and General Practice Management Plans (GPMPs).
- Checking if patients are overdue for more than one type of cancer screening. If so, reminding and educating them about both programs at once.