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What is Quality Improvement?
Quality Improvement (QI) is an activity undertaken with the purpose of reviewing, monitoring, evaluating, and improving the quality of services, processes, or experiences delivered at your practice.

Northern Queensland Primary Health Network (NQPHN) is dedicated to assisting providers in engaging in quality improvement activities. This toolkit provides the information required to successfully carry out quality improvement by guiding you through a process of:

  1. ensuring quality data
  2. identifying areas for improvement
  3. planning QI activities
  4. implementing QI activities
  5. evaluating QI activities.

Undertaking QI allows your practice to deliver improved care and health outcomes to people in your community, as well as improving staff wellbeing and increasing the sustainability of your business by reducing costs or finding new revenue streams.

In your practice, QI activities could focus on:

  • safety - avoiding harm to patients
  • effectiveness - providing evidence-based care and only providing services that are likely to be of benefit
  • patient-centered care - providing care that is responsive to each individual patient’s preferences, needs, and values
  • timeliness - reducing waiting times for care and avoiding harmful delays
  • efficiency - avoiding waste
  • equity - providing care of the same quality regardless of personal characteristics such as gender, ethnicity, location, or socio-economic status.[1]

[1] North West Melbourne PHN, Quality Improvement Guide and Tools, Edition 2, pg. 6

Medical practice staff with patient

The Australian Government’s Practice Incentives Program Quality Improvement (PIP QI) Incentive commenced on 1 August 2019. It is a payment to general practices for activities that support continuous quality improvement in patient outcomes and the delivery of best practice care.

There are no prescribed targets for PIP QI, as every practice is different and can focus their activities on their own clinical data outcomes and the needs of their practice population and staff. However, the Australian Government has offered ten improvement measures that your practice can focus on.

It is important to maintain accurate, consistent, and current clinical data, and use this data to identify gaps in services or practices. NQPHN assists general practices in achieving PIP QI through data analysis and reporting on our GP Dynamic Dashboard, as well as the provision of resources in this website.

To claim the PIP QI, practices must:

  • be registered for the PIP via the Australian Department of Human Services
  • share de-identified clinical data with NQPHN through the CAT4 software
  • undertake continuous QI activities.

Find out if your practice is PIP QI ready

NQPHN has created PIP QI checklists to support your practice. Click on the links below to download.

Applying for PIP QI

To apply for PIP QI, visit Health Professional Online Services (HPOS) or use this DHS IP001 form.

For more support, use NQPHN’s How To Guide.

Once approved, you will need to provide your PIP Practice ID to NQPHN. This is a unique identification number that the Department of Human Services will use to identify your practice.

How to apply for PIP QI

If this is your first time applying for a practice incentive program:

  1. Log into PRODA.
  2. Go to HPOS.
  3. Click on ‘My Programs’.
  4. Click on ‘Practice Incentive Program (PIP).’
  5. Click ‘Apply Now’.
  6. Read terms and conditions and click on ‘Next’ right at the bottom on the page
  7. Click ‘Eligibility Check’.
  8. Fill in the registration form.
  9. Give you Practice PIP ID to NQPHN.

If you have claimed other practice incentive programs, but not PIP QI:

  1. Log on to HPOS.
  2. Click My Programs.
  3. Go to the PIP tile.
  4. Click the Update button.
  5. The Program and PIP information screen will appear.
  6. Click the Exit button at the bottom of the information.
  7. Look for the Main menu (red header at top-left of screen), and click Incentive summary
  8. In the Quality Stream section > Quality Improvement Incentive, click the Apply link.
  9. Read the terms.
  10. Tick the Participation Payment option.
  11. Click Submit.
  12. Give you Practice PIP ID to NQPHN.

Register for PIP QI here.

The information available on your clinical software system is a valuable tool for QI. However, the information needs to be accurate and up-to-date.

The reasons to maintain quality data are to:

  • enable high quality continuity of care
  • improve decision making about care processes or services
  • allow the review of clinical processes and outcomes
  • use resources effectively (e.g. recalls, reminders, and research)
  • allow appropriate triaging and decision making in a timely manner
  • document clinical processes and services to protect the interests of the patient and health provider (e.g. litigation, third party claims, health funders, privacy principles)
  • provide an accurate, timely, and complete narrative on the patient’s health care and services
  • assist with answering research questions.

 PenCS CAT4 and PAT CAT are the clinical data tools we use to provide data reports via our GP Dynamic Dashboard. CAT4 and PAT CAT are compatible with many clinical information systems, including Medical Director, Pracsoft, Best Practice, Zedmed, Genie, Medtech, practiX, Communicare, MMEX, PCIS, and others.

Many healthcare providers use the 'quadruple aim' to measure the impact of their QI activities. When planning a QI activity, you should identify which of the four areas below it would affect. If it impacts all four, then you have an ultimate 'quadruple aim'.

  1. Improved patient experience
    Improved, safe, and quality care with timely and equitable access where patient and family needs are met.
  2. Improved provider experience
    Quality improvement culture in practice through increased clinician and staff satisfaction, leadership, and teamwork.
  3. Population health
    Improved health outcomes, reduced disease burden, and improvement in physical and mental health.
  4. Sustainable cost
    Efficient and effective services, increased resources for primary care, and effective commissioning.[2]

[2] North West Melbourne PHN, Quality Improvement Guide and Tools, Edition 2, pg. 7

Once you have identified your area for QI, the next step is to plan how change will occur. This is best done as a team, bringing in stakeholders from across your clinic to brainstorm, process, map, and plan.

The Model for Improvement and Plan, Do, Study, Act (PDSA)

The Model for Improvement (MFI), developed by Associates in Process Improvement, is a recognised method for developing, testing, and implementing quality improvement activities in general practice.

The model has two parts[3]:

  1. Three fundamental questions, which can be addressed in any order. These questions help you develop a relevant goal, and the measures and ideas that will form your activity plan.
    • What are we trying to measure?
    • How will we know that a change is an improvement?
    • What changes can we make that will result in improvement?
       
  2. The Plan-Do-Study-Act (PDSA) cycle – to test changes in real work settings. The PDSA cycle guides the test of a change to determine if the change is an improvement.
    The PDSA cycle allows you to use simple measurements to monitor and evaluate the effect of change over time. Begin with small changes, which, once proven, can come into effect at a larger scale.

[3] Institute for Healthcare Improvement, How to Improve, http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx

Your QI plan

You QI plan should include:

  • Goals – these should be SMART goals, in that they are specific, measurable, achievable, relevant, and time-based. Learn about setting SMART goals here.
  • Actions – what will be done to implement the change? Consider any implications on existing systems and processes
  • Measurements – what are you going to measure and how often? Collect a baseline at the beginning to measure against.
  • Roles and responsibilities – who will do activities to achieve this goal and when?
  • Costs – will this change require financial investment and where will the money come from?
  • Timeline – How and when will resources be assigned?
  • Reporting requirements – who needs to be kept up-to-date and how will outcomes be reported?

 

QI activities are extremely varied, such as changing systems, updating procedures, training staff, or increasing patient engagement. Whatever activity is occurring, it is important to regularly review the process to ensure it continues to align with your QI goal. Regular team meetings should take place to assess progress.

It is also vital to communicate the QI activity effectively with practice staff and maintain strong project leadership. Your team should agree on the communications channels used to ensure information is received in the most convenient, appropriate manner.

As well as keeping everyone informed, it is also important to provide feedback to involved team members and recognise good work being done.

The RACGP’s General Practice Management Toolkit has some great information about change management. Find it here. 

Collecting data

Throughout the QI process, you will have to collect data to help inform outcomes. This data could be quantitative, qualitative, or both. Data collection can be done several ways:

  • clinical audit tool (CAT4)
  • worksheets
  • patient experience forms
  • customer complaints register
  • staff feedback.

Once you have completed the activity, it’s time to ascertain the results. This is done by collecting the associated data and studying it against the baseline data. By summarising the changes and lessons learnt, you can report the results and plan next steps.

You might:

  • describe the outcomes against your original objectives
  • show relationships between variables
  • demonstrate if improvement has occurred over time
  • explain the significance of the outcome and what the benefits will be.[4]

If the QI process was successful, it can be implemented at scale. If not, it is important to identify why and redesign the next PDSA cycle accordingly. 

PenCS CATPlus can assist with your reporting requirements. Learn about it here. They also have useful resources on data mapping

In addition, using your GP Dynamic Dashboard is another way to determine the results of your QI activities. The dashboard is populated using de-identified data from your practice. Sharing this data with NQPHN is mandatory to be eligible for PIP QI. This does not apply to Aboriginal Community Council Health Services or any services funded by the Indigenous Australians’ Health Programme.

[4] The Victorian Government Department of Human Services, A guide to using data for health care quality improvement, https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0006/273336/vqc-guide-to-using-data.pdf

20 August 2020
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