RNZCGP Aiming for Excellence (CORNERSTONE ) and Annual Program PMAANZ Conference, Rotorua 6 th September 2014 Rosemary Gordon
What I will cover today Entry Level Reaccreditation Annual Cycle Viewpoint from an Assessor Foundation Standard
What is Aiming for Excellence Aiming for Excellence is the Royal New Zealand College of General Practitioners standard for general practice. It contains indicators and criteria that identify minimum legal and safety standards and those that pose significant risk as defined by the College. Each indicator has been designed to consider patients first. There are four sections in Aiming for Excellence Patient experience and equity Practice environment and safety Clinical effectiveness processes Professional development
The history of Aiming for Excellence the Standard 1996- The Goodfellow Unit, University of Auckland, reviewed the literature to identify indicators that identified the scope of good quality general practice. A range of provider groups and consumer organisations then reviewed them for relevance. 1998 - International and stakeholder leadership response to a need for increased accountability in general practice. Other consultation and investigation. RNZCGP Practice Standards Committee was established to develop standards for general New Zealand practice. 1999- The RNZCGP agreed to develop a standard specifically for New Zealand General Practice. Indicators were developed by a Goodfellow Unit project and released by RNZCGP Practice Standards Working Party in 1999 as Aiming for Excellence.
The history of Aiming for Excellence the Standard 2000- Aiming for Excellence in General Practice Standards for General Practice (1st edition) was tested. Six assessors were trained. A pretest and pilot study of 20 practices was undertaken to determine its usefulness for general practice. 2001-2002- RNZCGP Practice Standards Validation Field Trial. Indicators and criteria in the first edition of Aiming for Excellence were subjected to a rigorous evaluation in a field trial of 81 practices during 2000-2001 and found to be reliable, valid and feasible for use in measuring the quality of care provided by a general practice. Aiming for Excellence An assessment tool for General Practice (2nd edition published) Sixty-one GP, practice nurse, practice manager assessors trained in practice assessment.
The history of Aiming for Excellence the Standard 2004- RNZCGP establishes Cornerstone General Practice Accreditation Programme. 2005 - The CORNERSTONE General Practice Accreditation Programme is established as a formal RNZCGP Programme for practice teams. (Te Puea Marae Clinic in Auckland was the first general practice in New Zealand to become Cornerstone accredited) 2009 - A4E 3 rd Edition released 2009/2010 Consultation and review processes 2011-4 th Edition released 2014- Review underway
The history of CORNERSTONE CORNERSTONE is an accreditation programme specifically designed by the College for general practices in New Zealand. The accreditation process assesses a practice s level of performance in relation to a defined standard entitled Aiming for Excellence (2011-2014). The accreditation process combines quality assurance with CQI. At its introduction in 2004, CORNERSTONE had a three year renewal cycle. In order to remain accredited the practice was required to complete the CORNERSTONE accreditation process, including an external visit from an assessment team every three years. Between accreditation cycles there was no requirement for practices to interact with the CORNERSTONE programme.
The history of CORNERSTONE cont The annual programme was introduced in April 2012 and introduced three main changes: the accreditation period increased to four years; a requirement to submit annual self-assessment data and documentation was introduced the introduction of an annualised fee payment schedule. The intent of the annual programme is to develop a culture of CQI within general practices. Its objective is to promote continuous updating of processes and systems within a general practice.
NZ Figures Total North Island practices Cycle 0 Cycle 1 Cycle2 Cycle 3 316 5 66 162 83 Total South Cycle 0 Cycle 1 Cycle2 Cycle 3 Island practices 106 2 28 43 33
Up front- the Benefits Vs the Barriers Benefits Improved teamwork Improved Systems and Processes Policies Sense of feeling part of the team Pride in your practice Risk management Leadership by GP - ownership Development of skills of staff
Benefits Teamwork working together for a combined purpose Systems and Processes- complaint management, H & S, Infection control, improved records, HR*** Policies repeat prescribing, test results and medical information, incident reporting Sense of belonging particularly admin staff Pride- on achievement e.g. ownership of an area Risk management test results/ incident management/ H & S Development of staff- particularly admin staff and can I also say GPs and nurses
Up front- the Benefits Vs the Barriers Barriers Cost Time Lack of commitment buy in from some staff Demand on individuals Tick box exercise Lack of understanding of value
Barriers Cost real and perceived BUT Cost vs Standard and Risk Time need to be organised, spread the work and be efficient Buy-in- an issue but work with the committed- all staff are received to complete some area Tick box exercise- if it is do not do it Value come with time
CORNERSTONE made easy.or easier Team approach Designated tasks and roles Plan the process Team meetings to check progress- share the successes Make Cornerstone applicable to your practice Use your PHO support Seek help when you do not understand use the RNZCGP or other colleagues or champions around the country if you need Make it BAU
Resources Interpretation Guide RNZCGP Resources Healthy Practice (if you subscribe) Mauri Ora Associates ( training) CALD (Cultural Competency) Auckland Healthpoint (Auckland)- pathways HDC website Privacy Commissioners Office HQSC website
Some feedback the RNZCGP hears or I have heard I always know when I go into an accredited practice.organised and presented well Great learning experience - valuable occasion Great input from both assessors- use them for ideas- We learnt an enormous amount from the Assessor The interpretation guide was a very useful tool. Providing us with ideas for improvement Great sense of accomplishment and relief We are very proud of ourselves. Welcomed the opportunity to do this review First time I have had a review with the owners- was great to sit and feel I had personal time with my Manager Had an opportunity to do some learning ( receptionist) Feel safer in lots of ways Often worried that we were not doing (that) correct- now we are Cornerstone is useful in maintaining standards
Post Assessment Phase Does anyone want a brief on that process
Annual Cycle
Annual Programme - RNZCGP User Guide The RNZCGP will send you the Guide
Annual Cycle The annual programme is based on a 4 year cycle. The annual programme assists the practice to embed continuous quality improvement into everyday process and business as usual. Each year a practice will participate in an ongoing cycle of assurance and quality improvement activities including the completion of: mandatory criteria ( 11 ) regionally selected or practice selected criteria ( 9 sets per annum) one quality improvement activity targeted at clinical care one audit of the practice s choice (this may be non clinical) To retain an accredited status the practice must complete all the annual activities each year and upload evidence into Geethal Data Systems. The RNZCGP will externally assess the annual processes The practice will then have an on site assessment every four years. HDANZ provide external validation of the accreditation process.
Step 1: Registration You need to register with the RNZCGP for the Annual programme This can be done on line or via hard copy
On line registration http://www.rnzcgp.org.nz/cornerstonegeneral-practice-accreditation-programmeregistration-form
Completing the form This is pretty straight forward but you may need some assistance with question: 3. The Practice Please provide a breakdown of the practice population from the practice database Your PHO may be able to assist you with this information or do a query builder Chronic conditions list Use DrInfo Disease Register for CVD, Diabetes, COPD
Completing the form Once the on line form is complete Submit to the RNZCGP For the hard copy form follow instructions on the form Please return the Registration Form to: CORNERSTONE General Practice Accreditation Programme, RNZCGP, PO Box 10440 Wellington 6143, or fax (04) 496 5997
Step 2. RNZCGP Communication and Process The RNZCGP will send the practice the following: 1. Contract- you need to sign and send back one copy 2. Folder resources for the practice 3. Invoice for Year 1 you need to pay this amount Step 3 RNZCGP acknowledge payment and signed contract
Step 4. GDSL (Geethal) Login details will be sent via email from GDSL(support@gdsl.com) - will be sent to name listed on registration form
Step 5 Getting underway for Yr 1 You MUST use GDSL (Geethal) on line self assessment Mandatory criteria (11) these MUST be completed every year for the 4 years -set a Plan for completion of these each year and who is going to be responsible for completing these and loading the evidence into Geethal.
18.1 There is an audit to monitor the servicing of Copy of the record scanned into Geethal (front page is adequate) showing date completed. Step 6 Guide to complete Mandatory criteria The RNZCGP has defined a set of mandatory criteria that must be completed every year. The criteria are required on an annual basis either by regulation e.g. 19.2 evacuation/ fire drills or considered by the College to be best practice e.g. 18.5 annual emergency drill. Criteria Action required 5.1 The practice has a documented Maori Health Plan 10.2 The practice has a current Quality Plan that outlines clinical goals for the year The practice already has a Maori Health Plan- your Maori Health Plan should be a working document annually this needs to be reviewed and updated accordingly. Update your demographics for your Maori enrolled patients; any change in contacts; the health stats and your action plan. The practice already has a Quality Plan- your Quality Plan should be a working document annually this needs to be reviewed and updated accordingly. Update your quality improvements identified; add in your 2 annual quality activities to the plan; add in any audits completed; add in any PDSA s completed 10.4 The practice identifies an annual quality improvement activity related to the management of a targeted area of clinical care 16.4 A current calibration and validation record is available for the steriliser It is recommended that this activity is documented through the PDSA process/ CQI activity process N.B. this is in addition to the 2 annual quality activities. Sterilizers are to be calibrated and validated annually. If the practice does not have a sterilser- indicate this as not applicable in Geethal. Copy of the record scanned into Geethal
Step 7 - Selected Indicators ( 9 sets) Selected Indicators ( 9 sets) it is the practice decision to decide which 9 sets of Indicators will be done each year. Remember: if the practices chooses a set- all the criteria in that set MUST be completed Suggestion: look at doing those Indicators in Year 1 that you felt needed more work to imbed- so that your systems and processes related to these Indicators get firmed up as business as usual e.g. Indicator 19 and 20 and Section 4.
How to select Indicators ( 9 sets) on Geethal Login Click Self Assessment Click on Prepare
The view you see will be as below Pink Mandatory Grey you chose from the Greyed out Indicator set
Follow directions in the GDSL User Guide Geethal User Guide download
Note: Annual criteria not in Mandatory list There are some criteria that are required to be completed annually that are not in the Annual Mandatory list e.g. 34.1 annual practicing certificates 36.2 position descriptions..with annual review dates 36.6 annual performance reviews Make sure the practice has systems in place to complete these annually
Step 7 - Quality Improvement Activity/Audits - Two (2) annually One MUST be clinical One can be non clinical Use the PDSA process to document each Activity Note: at this stage the two quality improvement activities are uploaded against criterion 10.4
Guide for Quality Improvement Activity Important Choose a topic that is relevant to your practice. Choose an activity that has been identified needing a quality improvement focus. Work systematically through the process. Analyse current processes and use the PDSA quality model to work through the quality improvement. Use the process to understand outcomes of clinical care and where improvements in technical interventions would make a difference. Understand the global picture and break down the layers to map problems, understand linkages and discover where integration might help improve continuity of care.
Step 9 Completing the Self-Assessment Important to use the online GDSL (Geethal) to complete your self assessment throughout the year Important to write up Gaps/ Needs Improving How did you verify that the requirements have been met The RNZCGP and prior to your accreditation visit (end of 4 th year) the Assessor will read this information
Step 10 - Loading evidence onto Geethal There is a list outlining what evidence is needed to show the RNZCGP how you have Met the criteria- this list is in the 4 Year Annual Programme book sent to you from the RNZCGP
Notifying the College Once the self-assessment has been completed please email the College Joyce.Brown@rnzcgp.org.nz.
RNZCGP Actions Review of Annual Information Once the practice has completed the annual requirements the College will review the information and provide feedback, note this will only occur at/or around the annual anniversary. The practice will be provided with a short report and any improvements are completed via a post assessment process.
Annual Programme opportunity to sustainability of the quality model Mandatory criteria ( 11) Selected Indicators ( 9 sets) Quality Improvement Activity/Audits x 2 per year
Quality Improvement Activity/Audits x 2 per year Opportunity to embed a quality culture where this is not the case Needs to be done through a PDSA process- documented Buy in from GPs MOPS Buy in from nurses- PDRP
PDSA Process Quality Activities need to be documented through the PDSA quality framework
Helpful hints from an Assessor Be organised for your assessment date All staff must have read the A4E Standard and understand the Indicators applicable to them, even if they have not been heavily involved in the process Make the process yours Make the policies yours ( templates from the PHO/other practices or other sources great BUT you must make them yours) Assessors expect to see an improvement each assessment Use GDSL Assessors read the information now and this gives a good outline and feeling about your process/ practice Feel proud about what you have done and will achieve
RNZCGP Foundation Standard Developed in 2013 Focus of FS is safety It is Quality Assurance ( just like A4E started off like ) Entry Level for MOH IPIF Imbedded into PHO Service Agreement making it a contractual requirement for PHO to ensure practice meet FS MOH has advised PHOs will be required to demonstrate practice compliance with FS by 30/6/2016 ( when IPIF is fully functional)
Assessment- draft RNZCGP Board/ MOH/PHOs- considering how to assess All practices to be assessed HOW?? And by when? 30/6/2016 Self assessment, then PHO, then External assessment??, then MOH audit Tool for assessment?? Online Moderation Variation in assessment Structure on subsequent auditing/assessment Cost is there a cost and what will it be???
Contact details rosemary@procare.co.nz 021576542