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QUALITY: MK

A whole system approach to quality improvement

driven by primary care, patient engagement and evidence

Dr Nicholas Hicks, Chief Executive / Director of Public Health

March 2009

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The presentation

Introducing Quality:MK

Primary care led; evidence-based

Public & patient engagement

What would we do the same...

and what would we do differently?

How does it look to you?

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Principles

Placing evidence, service users and primary care right at the heart of decision making and quality improvement - and keeping them there

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Partnership

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LINks Milton Keynes

NHS Milton Keynes

Centre for Evidence

Based Medicine

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Embedding evidence

Clinical pathways:Systematic review Spreading

bright ideas

GlitazonesCarpal tunnel

Lipid modificationDelayed prescribing

DiabetesAlcohol

DepressionDyspepsia

Smoking cessationWeight management

Complex patientsPatient empowerment

CLINICAL ENGAGEMENT

PUBLIC AND PATIENT ENGAGEMENT

EVIDENCE-BASED CARE AND COMMISSIONING

A WHOLE SYSTEM APPROACH

Projects

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Project team

Board of 4

Award group of 8

Steering group of 16

12 task and finish groups

10 evidence-based

discussion groups

1 programme manager

2 information specialists

2 GP champions

1 clinical effectiveness pharmacist

1 IM&T development officer

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Quality:MK - Embedding Quality into Care

Primary Care Live TV highlights the work of Quality:MK - a partnership between MKPCT, health:mk, the PPIF and the Centre for Evidence-Based Medicine. The film focuses on two areas of care, diabetes and smoking cessation.

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CLINICAL ENGAGEMENT AND PUTTING EVIDENCE INTO

PRACTICE

Dr Nicola Smith

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HOW WE ARE IMPROVING THE QUALITY OF PATIENT CARE

Linking academic research to everyday practice.

Solving everyday clinical problems by looking at the best evidence

Changing practice in light of new evidence

Encouraging leadership from primary care clinicians to drive change

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OUR APPROACH

Journal Clubs and EBDGs (Evidence based discussion groups)

Librarian support recording of discussions and sharing them on PCT intranet, Toolkit on intranet

55 topics discussed across all EBDGs 36 in GP practices At least 4 led to measurable change in the

practice

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EXAMPLE 1:Management of carpal tunnel syndrome in a practice

Audit current practice- 6 GPs all do it differentlyEvidence search supported by Outreach LibrarianEBDG look at the evidence + discussed with expert in the

practiceAgree evidence based pathway (Map of Medicine)Use new pathwayPatient involvement- Questionnaire + Health:MK patient

focus groupLink with PCT/Practice based Commissioning Collaborative

to spread evidence based care to other practices and link with services in secondary care.

Identification of training need (Injection skills)Repeat audit

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EXAMPLE 2:Prescribing projects

Glitazone prescribing

Lipid management

Antibiotic prescribing by delayed prescriptions

All topics discussed at practice EBDGs

Evidence based change in practice identified

Support from pharmacist to develop projects and for changes to be adopted in other practices

Patient involvement ?

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Successes

Engaging clinicians in stimulating clinical discussion

Evidence based changes in patient care in practices

Evidence based changes adopted in more than one practice

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Key factors in ensuring Success

Motivated clinical lead in each practice

Librarian support

Implementation support (QMK-GP, pharmacist, audit)

Funding

Linking with other local initiatives to drive wider dissemination.

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Challenges

Sustainability current EBDGs

Encouraging the establishment of EBGDs in more practices

Link with education/revalidation

Try virtual EBDGs for locums

Patient / Public involvement- How + When

How to decide which topics to prioritise for wider implementation

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PUBLIC AND PATIENT ENGAGEMENT

John NeedhamMilton Keynes Local Involvement Network

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What have we achieved?

“A dynamic & organic shift”

“The success of this programme can be seen in the high level of patient and clinician involvement”

“... with greater use of evidence”

“There is an explosion of patient involvement”

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A self-improving system

Multiple channels for innovation and improvement; Mainstreaming a systematic approach to service review

and redesign Adopting Map of Medicine Defining, documenting, tools & templates Toolkits: communications, engagement, evidence Attending to information data flows System and process eg PEC, eg HR Seeing it through; supporting the change leads Making it easier to work with these values, than not to

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What would we do sooner ... or differently?

Recruit GP championsInvite local expertiseStrengthen channels for

engagementOffer better information &

support for PPEClearer terms of referenceLearn about social

marketing

Worry less about QI

process techniques Pay more attention to

how to implement change

Greater use of persuasive

data

Listen to Paul Plsek

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We have learnedUse the evidencePrioritiseRaise the flagImportance of leadershipClear objectivesFocus on outcomesNurture the partnership; build the teamDon’t make assumptionsDiagnose barriers to changeIdentify QI skills as core competenciesReflect

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External evaluation: Interim findings

The three principles are beginning to reach beyond the specific programme to impact on the wider PCT.

In the words of two participants in our December workshop:

“Quality:MK provided a way to do it…”

“… that’s how we do it here”