Improving quality in primary care. Leading with purpose and possibility.
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The document focuses on quality improvement in general practice led by Dr. Robert Varnam, emphasizing the need for holistic and coordinated care. It discusses ideas surrounding human performance, the importance of teamwork, and the principles of effective care, including fostering a culture of commitment and using data-driven methods for improvement. Additionally, it introduces the Plan-Do-Study-Act (PDSA) cycles as a mechanism for testing changes and promoting better health outcomes.
Improving quality in primary care. Leading with purpose and possibility.
- 1. www.england.nhs.uk @robertvarnam @NHSEngland Quality improvement in general practice. Leading through purpose & possibility Dr Robert Varnam MRCGP PhD MSc Head of general practice development @robertvarnam robert.varnam@nhs.net 28.04.15
- 2. www.england.nhs.uk @robertvarnam @NHSEngland How hard can it be?
- 3. www.england.nhs.uk @robertvarnam @NHSEngland What do you want to achieve for patients in your practice?
- 4. www.england.nhs.uk @robertvarnam @NHSEngland How do you feel?
- 5. www.england.nhs.uk @robertvarnam @NHSEngland Health & wellbeing-promoting care Right access Holistic, personalised, proactive & coordinated care Wider primary care at scale
- 6. www.england.nhs.uk @robertvarnam @NHSEngland How do others respond when change is proposed?
- 8. www.england.nhs.uk @robertvarnam @NHSEngland Leading with purpose. Lashing with compliance or unleashing commitment.
- 10. www.england.nhs.uk @robertvarnam @NHSEngland How do you feel?
- 12. www.england.nhs.uk @robertvarnam @NHSEngland What stories do we tell?
- 18. www.england.nhs.uk @robertvarnam @NHSEngland Birth Postnatal midwife assesses risk Midwife gives Vitamin D End
- 19. www.england.nhs.uk @robertvarnam @NHSEngland Birth Postnatal midwife assesses risk Midwife writes to GP End
- 20. www.england.nhs.uk @robertvarnam @NHSEngland End Discharge Birth Health visitor assesses risk Health visitor gives Vitamin D
- 21. www.england.nhs.uk @robertvarnam @NHSEngland End Discharge Birth Health visitor assesses risk Health visitor writes to GP GP issues prescription
- 22. www.england.nhs.uk @robertvarnam @NHSEngland End Discharge Birth GP/PN assesses risk in baby clinic GP issues prescription
- 23. www.england.nhs.uk @robertvarnam @NHSEngland End Discharge Birth GP assesses risk at postnatal check GP issues prescription
- 24. www.england.nhs.uk @robertvarnam @NHSEngland End End Discharge Birth Postnatal midwife assesses risk Midwife gives Vitamin D Midwife writes to GP GP assesses risk at postnatal check GP/PN assesses risk in baby clinic Health visitor assesses risk Health visitor gives Vitamin D Health visitor writes to GP GP issues prescription End
- 25. www.england.nhs.uk @robertvarnam @NHSEngland End End Discharge Birth Postnatal midwife assesses risk Midwife gives Vitamin D Midwife writes to GP GP assesses risk at postnatal check GP/PN assesses risk in baby clinic Health visitor assesses risk Health visitor gives Vitamin D Health visitor writes to GP GP issues prescription End
- 26. www.england.nhs.uk @robertvarnam @NHSEngland How do you feel?
- 27. www.england.nhs.uk @robertvarnam @NHSEngland Vitamin D prophylaxis Leading with purpose vimeo.com/76794094
- 28. www.england.nhs.uk @robertvarnam @NHSEngland Leading with possibility. The problem of human performance.
- 29. www.england.nhs.uk @robertvarnam @NHSEngland How does good care happen? Be a good person Train well Maintain good intentions Work hard
- 30. www.england.nhs.uk @robertvarnam @NHSEngland Please pay attention… Watch the video There is a team wearing white shirts and a team wearing dark shirts Count all passes made by the white team
- 31. www.england.nhs.uk @robertvarnam @NHSEngland Remember … Be a good person Train well Maintain good intentions Work hard
- 33. www.england.nhs.uk @robertvarnam @NHSEngland Remember … Be a good person Train well Maintain good intentions Work hard
- 35. www.england.nhs.uk @robertvarnam @NHSEngland ‘You can’t change the human condition, but you can change the conditions under which humans work’ James Reason Error is normal ... what are you going to do about it?
- 36. www.england.nhs.uk @robertvarnam @NHSEngland OUTPUTS HUMAN FACTORS HUMAN FACTORS INTERNAL PROCESSES & PROCECEDURES INPUTS Success = systems x people Whether I like it or not, it’s not just about me.
- 37. www.england.nhs.uk @robertvarnam @NHSEngland Vincent, C. A. (2004). Analysis of clinical incidents: a window on the system not a search for root causes. Qual Saf Health Care, 13(4), 242–3. What is ‘the system’?
- 38. www.england.nhs.uk @robertvarnam @NHSEngland What is ‘the system’?
- 39. www.england.nhs.uk @robertvarnam @NHSEngland New improvement design principles Be a good person Train well Maintain good intentions Work hard Make it easier to do the right thing Make it harder to do the wrong thing Spot & stop inevitable errors
- 40. www.england.nhs.uk @robertvarnam @NHSEngland Leading with possibility. The model for improvement.
- 41. VIDEO Gever Tully, Tinker School TED Talk bit.ly/1Iia0vh
- 42. www.england.nhs.uk @robertvarnam @NHSEngland How do you feel?
- 44. www.england.nhs.uk @robertvarnam @NHSEngland Prototyping • anything that tests an idea and answers a question • helps test boundaries and manage risk • is less about the actual ‘product’ and more about the interaction it provokes Start small A prototype needs only to be as good as it needs to be in order to learn more about the idea.
- 46. Peter Van Manen, MD McLaren Electronic Systems. • Easy to simulate. ‘You can’t move for laptops.’ • Reliance on data. ‘Measurement is cheaper than mistakes.’ • Easy to mock-up. ‘Don’t pontificate, prototype.’
- 47. www.england.nhs.uk @robertvarnam @NHSEngland Talk it or try it ? This is my idea. I’m right. Do it! We tried a couple of ideas, and this happened. versus
- 48. 48
- 49. www.england.nhs.uk @robertvarnam @NHSEngland What are we trying to accomplish? How will we know that change is an improvement? What change can we make that will result in improvement? The Model for Improvement Langley, G., Nolan, K., and Nolan, T., 1994. The Foundation of Improvement, Quality Progress, June 1994
- 50. www.england.nhs.uk @robertvarnam @NHSEngland PDSA Cycles SOMETHING BIG! A P DS How can we achieve this? A P DS A P DS A P DS
- 51. www.england.nhs.uk @robertvarnam @NHSEngland This is not the same as audit !
- 52. www.england.nhs.uk @robertvarnam @NHSEngland Your turn ... Plan Do Study Act
- 53. www.england.nhs.uk @robertvarnam @NHSEngland PDSA vs audit?
- 54. www.england.nhs.uk @robertvarnam @NHSEngland What’s the big ambition?
- 55. www.england.nhs.uk @robertvarnam @NHSEngland How could we chunk it down? How could we test it out?
- 56. www.england.nhs.uk @robertvarnam @NHSEngland Are you a leader?
- 57. www.england.nhs.uk @robertvarnam @NHSEngland Don Berwick myth-busting livestream.com/IFQSH/ForumLIVE What's wrong with audit? bit.ly/WhatsWrongWithAudit1 Introduction to driver diagrams bit.ly/DriverDiagramIntros1 The Productive General Practice bit.ly/PGP2014 What next?
- 58. www.england.nhs.uk @robertvarnam @NHSEngland Leading with purpose vimeo.com/76794094 Burning platform or burning ambition youtu.be/Tfn6vD4yyC4 These slides What next?
- 59. www.england.nhs.uk @robertvarnam @NHSEngland • Berwick, D.M., 1996. A primer on leading the improvement of systems. BMJ : British Medical Journal, 312(7031), pp.619-622. • Varnam, R.M., Dawda, P. & Jenkins, R., 2010. Quality improvement in general practice. Discussion paper., London: The King’s Fund. www.kingsfund.org.uk/current_projects/gp_inquiry/dimensions_ of_care/quality_improvement.html • Bendell, T., Penson, R. & Carr, S., 1995. The quality gurus – their approaches described and considered. Managing Service Quality, 5(6), pp.44-48. www.emeraldinsight.com/10.1108/09604529510104383 • Langley, G. et al., 2009. The improvement guide : a practical approach to enhancing organizational performance 2nd ed., San Francisco: Jossey-Bass. ISBN 978-0470192412 What next?