Quality Improvement Programme

On 1 July we moved to building capability in quality improvement methodology through the quality improvement (QI) programme, which will ultimately lead to improved health outcomes for patients.

At its core, QI looks at systems and processes through a cycle of improvement, which includes problem identification, planning and testing change ideas, data collection and analysis, and evaluation.

The focus of the first year of the programme is to build quality improvement skills in general practice through online training and putting learning into practice.

This means for the first quarter (July-September), practices identify two areas of focus (immunisation and one of five other indicators relating to CVD, respiratory and diabetes) and will develop two quality improvement plans for these - the training will step you through this. The one-page templates, and other QI resources, can be found linked below. 

In quarters two to four, practices will test their change ideas using the PDSA cycle, finishing with an end of year report.

Quality Improvement or QI is planned and proactive, involving a systematic and coordinated approach to solving a problem using specific methods and tools with the aim of bringing about a measurable improvement. At a broad level, QI considers the population and their different needs including inequities, the quality, safety and experience of care for the individual and the value for system resources in which health care is being delivered.

You can use your own data for the plans and we have also created a number of clinical dashboards (CVD, diabetes and respiratory).

The QI programme utilises Power BI dashboards, which have been developed and/or refreshed for diabetes, CVD and respiratory conditions. These clinical dashboards provide visual information around evidence-based clinically relevant outcomes for individual patients and your practice population. This is part of a concerted effort to use data to inform practice.

Not all your core QI team will want or need access to Power BI but having both clinical and administrative/data support will strengthen how it is used. Dashboards are one source of data. Additional sources of accessible data may include PMS query builds, Patient Experience Survey, incidents/learning from harm, complaints, and patient and whānau voice.  

Pinnacle currently funds two licences per practice, which will increase to three licences. The additional licence is specifically indicated for quality improvement activities and can be applied for now. Practice managers will manage the allocation of their licences and will be the contact point with Sam Yean, practice support administrator, who manages licence access for Pinnacle. 

Practices will receive an allocation of funding based on their registered patient numbers (ESUs). This is set at $10.64/ESU (GST exclusive) for the first year of the three-year programme. Our contract with Te Whatu Ora is on a yearly basis and, without knowing future changes to PHO funding, we cannot make funding decisions beyond this. 

To support practice cashflow, the QI programme payment will be made monthly on the 20th of the month, with an adjustment each quarter based on the ESU total from the last full month of the previous quarter. This is the same quarterly adjustment made for Healthcare Home. Other payments such as Capacity and Coverage or Healthcare Home funding remains unchanged. 

Importantly, practices will still have access to the Quality Plan reports, poster and data. The Quality Plan continues to support important public health imperatives. The reason for the change to a new QI focus was that the Quality Plan was not working universally. 

Please note: In July you will receive two ‘quality’ payments - the first of the monthly QI programme payments will commence on 20 July and the last quality plan payment (current system) will be on 31 July.   

The funding calculator (linked below) will provide an approximation of your monthly funding amount. This funding amount will change each quarter based on ESU and washup.

The Pinnacle QI online training (3 x 30-minute sessions) complements the introductory online four-module QI training provided by the Health, Quality and Safety Commission (HQSC). A link will be sent to practice managers to identify the core practice QI team for Pinnacle QI training. A total of three QI training licences are allocated per practice.

Training is expected to be completed first. This consists of two parts.

1. HQSC Improving Together: Introduction training (as a guide, the four modules take approximately 2 hours).
2. Pinnacle QI training (as a guide, these are three half-hour lessons). This training moves the theory into practice and steps you through the process of completing your QI plan. There are three training spots available per practice. Please talk to your practice manager if you'd like one of these spots. Use the training supplement (linked below) to develop your thinking around the potential gaps and biases. 

QI tools and methods allow practice staff to form a deep understanding of the needs of their populations. Health inequities are defined as differences in health between groups that are unnecessary, avoidable, unfair and unjust. When working through your QI plan/project, a series of questions will encourage you to consider how you structure your ideas through an equity lens. Whether it be in reviewing your data, analysing the problem, checking in on assumptions and biases or tracking progress of equity gaps, your QI project is the opportunity to make a change.  

The quality improvement programme steps practices through equity considerations, alongside their data, as they prepare how to structure their quality improvement plan, encouraging proactivity rather than reactivity, and helping support a health service equitable for all.

QI is a team effort. Teamwork refers to working collaboratively with a group towards a common objective, while working in a team involves working independently to accomplish tasks and responsibilities. Good teamwork improves patient outcomes as well as staff wellbeing. A core QI team in general practice will ideally have a minimum of three members – although diversity of roles and perspectives is more important than size. These people might be three staff with access to Power BI, people who provide clinical leadership, technical/subject matter expertise or day-to-day leadership for QI within the practice.

The team member or members most competent with sourcing data, for example, might gather the information first before bringing it back for wider discussion. This ensures several people are not tied up at any one time, but input to the process at crucial points.