Quality Improvement

CQI is ‘a philosophy of continual improvement of the processes associated with providing a service or good that meets consumer expectations’.2 It derives from industry but has been applied to the health care setting since 1989 when Berwick published a landmark paper on this subject.3 He compared the ‘Theory of Bad Apples’, where the means to better outputs relies on strict vigilance, punitive controls and correcting or weeding out the malefactors, to the ‘Theory of Continuous Improvement’ which assumes that it is the processes rather than the players in a system which determine its outputs, and that improvement is linked to study of these processes.

Under this theory defects in the system or mistakes in processes are seen as opportunities to make adjustments and thereby achieve better outputs. It is based on the recognition of the systemic nature of problems in health care delivery and that to improve performance, change must occur to systems of care, not simply individual components of health services. Berwick3 describes four skills required in a model for quality improvement.

These are:
  • Being clear about what is going to be accomplished
  • Measuring change and being able to recognise whether this change constitutes improvement
  • Having a series of good ideas about quality alternatives to current practice
  • Being able to test real changes on a small scale and making further adjustments accordingly

(Resources for Divisions to promote Evidence Based Medicine in General Practice - Monash Division of General Practice, 2000)

Quality Improvement is a relatively new concept to General Practice.  In the late 1990's improvement activities such as Accreditation and the Practice Incentives Program were developed as an incentive for practices to maintain a high standard of quality.

There are certain Quality Improvement requirements for Accreditation. Please see your chosen Accreditation Company for more information or see the RACGP Standard on Quality Improvement.

IDENTIFYING PATIENT NEEDS

Data Extraction
Quality improvement activities are underpinned by effective information management techniques that allow practices to analyse their practice data and make decisions for service changes based on the data collected. Innovative use of information technology can assist practices in performing quality improvement activities to improve the health of their practice population. Ideally, practices need to investigate their own practice data for quality improvement purposes. There are two main extraction tools currently being used in Sunshine Coast Practices:

  • PEN Clinical Audit Tool
  • Canning Extraction Tool

For more infomation please see our IMIT Data Extraction Page.

Data Cleansing
The data that you extract needs to be accurate. You cannot plan effectively from unclean data. There are many steps you can take to cleanse your data, some tasks are a 'one off ' while others must be done regulary to ensure you are gettting good quality data. For more information please see our IMIT Data Cleansing Page.

PLANNING FOR PATIENT NEEDS