Adapting total quality management for general practice: evaluation of a programme.

Abstract

Objective -Assessment of the benefits and limitations of a quality improvement programme based on total quality management principles in general practice over a period of one year (October 1993 -4 Traditional audit is limited in achieving and showing overall service improvement in primary care.' 2 This is largely because audit tends to be topic based, retrospective, and usually involves few members of the primary healthcare teams.2 3 Total quality management seems to offer a more comprehensive approach to improvement, emphasising the need to set an overall strategy, concentrating on satisfying the needs of the customer or patient, developing improvement projects based on need, involving all members of the team, with the use of tools (only one of which is audit) to achieve improvement. In 1990 each of the 95 family health service authorities in England and Wales were required to establish a Medical Audit Advisory Group to support and monitor audit in the practices for which they were responsible.4 The groups usually appointed full or part time facilitators to work on audit with general practice teams. In 1993 the four Medical Audit Advisory Groups of the old Oxford Region together agreed to introduce and support a quality improvement programme for a group of practices, adapting total quality management methodology as appropriate for general practice. The programme was funded by the Department of Health, which required emphasis to be placed both on audit and Health of the nation topics.'The programme was based heavily on the approach to quality improvement developed by Deming,6 7 and adapted for health care by the Institute of Health Care Improvement in Boston, Massachusetts.8 The three key elements to quality improvement emphasised are: for the practice leaders to set the strategy taking into account needs of both patients and the practice; for the practice to establish a culture for quality improvement with emphasis on communication and team working; and then for small multidisciplinary teams to use specific tools to carry out quality improvement projects.We recommended that each participating practice establish a team of key people from each discipline (the quality executive) to manage the quality improvement programme. In consultation with the partners and practice members they were to agree strategy, select the projects, and arrange resources. For each project they set up and briefed a quality improvement team with at least one repesentative of each involved discipline, and supported and monitored the teams (fig 1).The approach recommended for the project was Juran's solution (the Juran journey, fig 2),89 by which each small multidisciplinary quality improvement team defined its problem, examined this problem in more detail and considered possible solutions to identify the best, introduced that solution , and evaluated the change. The aim was to enable practices to develop a focus on quality, committed 151 on 12 May 2018 by guest. Protected by copyright.

Evaluation study of a resource for developing education, audit and teamwork in primary care

“…These findings are congruent with those of earlier research where the provision of protected time is seen as an essential prerequisite to many quality improvement activities (Grol and Wensing, 1995;Chambers et al, 1996;Lawrence and Packwood, 1996;Hearnshaw et al, 1998;Johnston et al, 2000). However, protected time for part-time staff is less easily achieved and further approaches to ensuring protected time for these practice team members needs to be pursued.…”

Continuing medical education: Interprofessional working and continuing medical education

“…18 19 As they build their knowledge about how things currently work, such groups are likely to discover that their difficulties are more often derived from the processes they use than from each other. A recent study in Oxford showed that one consequence of establishing multiprofessional improvement teams in general practices was increased collaboration and focus on planning and strategy within the practices 20. A powerful incentive for greater teamwork among professionals is created by directing attention to the areas where changes are likely to result in measurable improvements for the patients they serve together, rather than concentrating on what on the surface seem to be irreconcilable professional differences.…”

Setting up improvement projects in small scale primary care practices: feasibility of a model for continuous quality improvement

“…1 2 Continuous quality improvement has advantages over former profession oriented models for quality assurance because it combines managerial and collaboration aspects with a systematic approach. [3][4][5] In another paper in this issue we present a model for continuous quality improvement in small scale general practice. This model was based on core elements of continuous quality improvement, which were identified as management, collection of factual data, systematic approach, and collaboration.…”