New 'quality seal' for general practice
New 'quality seal' for general practice
General practices around New Zealand enter a new era today - for the first time, they have a set of Practice Standards against which they can assess the performance of their practice.
“It's a tremendous step forward for the quality of care that general practice can offer patients,” says Royal NZ College of GPs Deputy President Dr Jim Vause. “Previously, doctors themselves were held to a standard of professional practice through the College's Maintenance of Professional Standards programme. But this looks at everything else that happens in a practice, all of which contributes to the level of care offered to patients.”
Practices are assessed against a wide range of indicators, covering everything from disposal of hazardous waste to the provision of disabled parking. Specially trained assessors visit the practice, and work with staff to identify areas where gains could be made, as well as reinforcing the things practices are doing right. The assessors aren't just GPs - recognising that quality general practice is the result of teamwork, assessors include Practice Nurses and Practice Managers. The NZ College of Practice Nurses and the Practice Managers' and Administrators' Association, along with consumer and Maori input, were instrumental in helping draw up and trial the Standards.
More than 650 people were involved in testing the Standards, which have been trialed in 81 general practices throughout the country between November 2000 and August 2001. There are now 61 trained assessors but it's anticipated that these people will pass on their skills to others. While undergoing an assessment isn't compulsory for practices, the College anticipates that it will become a popular option. “The feedback from practices in the trial was extremely positive,” Dr Vause explains. “Many said that not only had it helped them improve systems which would benefits patients, but also increased efficiency which reduced some of the pressure on staff, including doctors.”
“The debriefing stage of the assessment was often one of the rare occasions during which staff were able to stop, and share ideas that would benefit both patients and the practice,” Dr Vause said. “They found the experience extremely valuable”
Aiming for Excellence: The outcome
Key results and findings from the RNZCGP Practice Standards Validation Field Trial Final Report
The RNZCGP trained 61 general practitioner, practice nurse and practice manager assessors. They assessed 81 general practices between November 2000 and August 2001. In total, in excess of 650 people were involved in the trial from the outset, including GPs, Practice Nurses, Practice Managers, consumers and Maori.
The aim was to provide a process to help practices deal with increased pressures, maintain patient-centered care, and clarify and strengthen practice systems. In doing so, practices are able to improve outcomes for their individual patients and patient populations.
The findings of the field trial show that practices are committed to high quality care - putting patients first. However, practice policies and administrative systems get less attention.
This highlights the importance of ensuring that administrative demands on general practice are relevant, practical and do not create additional burdens. A reduction in administrative demands would provide opportunities and time to provide patients with more information about improving health outcomes.
Why Practice Standards? · A process such as this assists with public accountability. · Quality improvement is fundamental to good practice and is cost effective. It helps with public health risk management by providing a framework that supports a culture of no blame, but focuses on strengthening systems and processes in the practice in a safe, open and positive environment. · It promotes teamwork in general practice. · Identifies legal and safety requirements and provides external feedback on the practices' performance. · A risk management process that safeguards patients and encourages the team to work together to plan improvement and implement change. · The RNZCGP can assist DHBs with a national framework that supports quality in general practice.
How well did the practices in the trial perform? The Practice Standards tool measures practices against indicators in five broad criteria: A factors affecting patients B physical factors affecting the patient C practice systems D practice and patient information management E quality assurance and professional development.
The essential areas in Section A where practices identified opportunities for greatest improvement were better access to patient information, and implementing changes as a result of patient feedback about practice services. The three areas of essential criteria in which practices scored highest were: · That patients are able to access the practice via telephone or fax for appointments, advice or information. (100% of practices) · That reception staff know how to access practice nurses or doctors if patients need immediate attention. (100% of practices) · Patients who are unable to pay and need a doctor in an emergency are not denied access. (99% of practices)
In Section B, practices scored highest for the cold chain and disposal of sharps. The areas where there is potential for improvement were infection control, Occupational Safety and Health, and the Fire Code. In this section, practices also scored well on meeting patients' privacy and comfort needs but could strengthen approaches on the disposal of bio-contaminated waste.
In Section C, essential criteria scores were highest for having resources to support the care that general practices provide, particularly for immunisation. However, some practices could improve on identifying outcomes of care - for instance smoking cessation.
Essential criteria from Section D show that practices have procedures that ensure continuity of care for patients. The management of patient tests scored highly. Some practices did not score so well on the actual recording of some aspects of patient information. The recording of telephone consultations, for instance, scored 57%.
Results from Section E identify that practices do continue to keep relevant texts and information in the practice, and that they are available to all staff. However, they could make better use of the information if there was a designated quality assurance person responsible for implementing quality assurance policies in the practice.
The RNZCGP is to examine targeting future resources to areas in which practices didn't meet the criteria, as these have the potential to make greater gains for patient care. The areas identified were in practice planning (preparing a strategic plan), improving health outcomes for Maori, and greater patient involvement in the services that practices provide.
GPs and staff welcome new standards
“To tell you the truth, I hate… demands, credits etc. But this assessment is wonderful! It is a thing that needs to be done” - a typical reaction to having undergone a Practice Standards assessment visit.
GPs and practice staff are welcoming the introduction of new Practice Standards for general practices launched in Wellington yesterday. The majority who took part in a trial of the Standards anticipate that the quality of their healthcare delivery will improve as a result of the assessment process. Eighty one practices were involved in trialing the Standards tool between November 2000 and August 2001.
“As a cynic… I thought this assessment was worthwhile. We board suggestions and tried to do something about them.”
The effects of taking part in the Practice Standards programme will last well beyond the actual assessment, with many involved commenting on the increased level of practice team participation, planning and development as a result of the visit. Most said they would welcome taking part in another assessment.
The assessment provided an opportunity for the practice team to assess their strengths and weaknesses, and identify where care can be improved and where time can be saved, and who is the best person to implement changes. A written report made specific recommendations to practices.
Those who took part were pleased that the assessment confirmed that they are doing well and that the information provided by assessors made the team feel good about the practice. All practices had a debrief with the practice team following the visit and it enabled team members to contribute their ideas about improvements.
One practice described the visit as the “first positive thing that has happened in five years”. Another commented that “the assessor picked up that we have all these wonderful creative ideas and we don't review them”.
Contact: Dr Jim Vause (03) 578-0470 or (027) 410-0102 Claire Austin, CEO (04) 496-5990 or (021) 606-154 or: Rex Widerstrom (04) 496-5962 or (027) 454-9637