Primary Care Quality Improvement Whakakotahi Nelson Marlborough Health & Harley Street Medical Health Quality & Safety Commission
Session description Overview of Whakakotahi Nelson improvement project: Overview of the project Key learnings, challenges and enablers Question time
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
Whakakotahi Focus on: equity integration consumer engagement
Finding Answers: http://www.solvingdisparities.org/tools/roadmap.
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 1 September 2017 expressions of interest process closed for 2018 projects
Central Law of Improvement Every system is perfectly designed to deliver the results it produces. Langley GJ, Moen RD, Nolan KM, et al. 2009. The improvement guide: a practical approach to enhancing organizational performance. San Francisco: Jossey-Bass/Wiley.
Improvement science The rationalism of science and the messiness of practice do not have to be incompatible. Improvement science can give practitioners the tools to plan, implement, evaluate, and embed new approaches more effectively into practice. Marshall M, Baker M, Rafi I, et al. 2014. What can science contribute to quality improvement in general practice? Br J Gen Pract 64(622): 254-6.
Langley et al. 1996. The Improvement Guide. San Francisco: Jossey-Bass.
Nelson Marlborough Health & Harley Street Medical Living better for longer after a heart attack.
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
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)
Why Whakakotahi? Improving communication between and within primary secondary and community care
Cause and Effect Diagram
Inefficiencies
What have we done? Driver Diagram Process Mapping Plan Do Study Act cycles (PDSAs) Patient Experience interviews Audit of the GP post stent patient management Introduction of new processes in primary care
Progress to date 1. Patient experiences 2. Patient education 3. Discharge summaries 4. GP Practices managing discharge summaries Percentage of post stent patients counselled before discharge baseline n=34
Number of days First GP consult within 30 days Baseline March 2014 March 2017. Target is 30 days or less
What we have learned? The power of primary, secondary and community care working together Model for Improvement skills Awareness of the barriers to care
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
What are the benefits for our staff/team? Hearing the post stent patient stories An integrated approach for the patient A Cornerstone project for quality improvement
What are the benefits for our patients? A patient-centric integrated approach Improving health literacy for heart disease Increasing their understanding of their medications
Summary of key points Awareness of barriers Improved appreciation between primary, secondary and community care Consumer input Learning new quality improvement skills
Questions?
Find out more at: www.hqsc.govt.nz/our-programmes/primary-care and