Primary Care Quality Improvement Whakakotahi. Nelson Marlborough Health & Harley Street Medical Health Quality & Safety Commission

Transcription

1 Primary Care Quality Improvement Whakakotahi Nelson Marlborough Health & Harley Street Medical Health Quality & Safety Commission

2 Session description Overview of Whakakotahi Nelson improvement project: Overview of the project Key learnings, challenges and enablers Question time

3 The Health Quality & Safety Commission 'We are responsible for assisting providers across the whole health and disability sector private and public to improve service safety and quality and therefore outcomes for all who use these services in New Zealand.' Professor Alan Merry

4 Whakakotahi to be as one Partnering with primary care teams to work on small-scale improvement projects Projects chosen by providers Alignment with System Level Measures Framework and district improvement plans Accreditaton and MOPS requirements

5 Whakakotahi Focus on: equity integration consumer engagement

6 The story so far... December 2016 three projects selected: Papakura Marae Medical Clinic gout Nelson Marlborough Health & three general practices plus post-stent management Hutt Union & Community Services (HUCHS) diabetes 2017

7 2017 Papakura Marae Health Centre

8 2017 Hutt Union & Community Health Services

9 2018 Whakakotahi teams The Fono, Auckland - skin and soft tissue infections (SSTI) Turanga Health, Gisborne - Developing a mobile workplace wellness platform. Gonville Health, Whanganui - Targeting the new patient process Unichem Russell Street, Hawke s Bay - Respiratory disease in Māori and Pasifika. Linwood Medical Centre, Canterbury DHB Diabetes Service, Christchurch Diabetes West Coast PHO, Poutini Waiora & West Coast DHB, West Coast Diabetes/CVD

10 Central Law of Improvement Every system is perfectly designed to deliver the results it produces. Langley GJ, Moen RD, Nolan KM, et al The improvement guide: a practical approach to enhancing organizational performance. San Francisco: Jossey-Bass/Wiley.

11

12 Langley et al The Improvement Guide. San Francisco: Jossey-Bass.

13 Nelson Marlborough Health & Harley Street Medical Living better for longer after a heart attack.

14 The project: Altas of Variation: only 62% of post stent patients were taking their life-saving medications Aim: 100% adherence to medication for a year after stent for cardiovascular disease

15 Team introductions Consumer Community Care Primary Care Secondary Care Valerie Steel Averil West (Heart Foundation) Megan Peters (Community Pharmacist) Bee Williamson (Nelson Bays Primary Health Community Education Coord) Dr Elizabeth Wood (Mapua Health Centre) Dr Rachel Mackie (Harley St Medical) Dr Sue Stubbs (Tima Health Ltd) Annette Egan (Hospital Pharmacist) Jane Shadwick (Hospital Pharmacist) Dr Kerryanne Johnson (Cardiologist) Fran Mitchell (Quality Improvement)

16 Why Whakakotahi? Improving communication between and within primary secondary and community care

17 Cause and Effect Diagram

18 Process mapping - Inefficiencies

19 What have we done? Process Mapping Plan Do Study Act cycles (PDSAs) Patient Experience interviews Audit: GP post stent patient management Introduction of new processes in primary care

20 Progress to date 1. Patient experiences 2. Medication counselling 3. Discharge summaries 4. GP Practices managing discharge summaries

21 Percentage of referrals. Mean=55% Progress to date Patients counselled at discharge Cardiac Rehab attendance Baseline Sept 2015 to Jan 2018 PRE: mid 2017 POST: Nov 2017

22 New discharge summary GP Copy: GP info at the top Patient Copy: Patient info at the top

23 What we have learned? The power of primary, secondary and community care working together Model for Improvement skills Importance of aligning improvement work to requirements Awareness of the barriers to care

24 What have been the challenges? Working in a diverse team double edged sword How to measure to show an improvement Unable to adequately address equity The challenges of engaging the whole practice team

25 What are the benefits for our staff/team? Hearing the patient stories An integrated approach for the patient A Cornerstone project for quality improvement Discharge summary improvements Partnering with community pharmacies

26 What are the benefits for our patients? A patient-centric and integrated approach Improved understanding of medications

27 Summary of key points Awareness of barriers difficulties engaging general practice Improved appreciation between primary, secondary and community care Consumer input Learning new quality improvement skills

28 But... will it stick? Stuck in a back cupboard Lack of general practice interest and buy-in Youtube MinuteEarth

29 Capacity vs. Capability Capacity Ability Capability Facility

30 How can we attract practice teams and general practitioners to quality improvement?

31 Find out more at: and