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In the front line of general practice, Quality Improvement (QI) can be hard to get to. The needs and challenges presented by patient care, service demand, human resources and business viability fill every day to capacity (and that’s before you add a global pandemic into the mix). 

That’s why Healthy North Coast (HNC) launched new online resources in late May via the “Primary Care Impact (PCI)” website, to make it quicker and easier to plan and initiate quality improvement. PCI offers pre-populated quality improvement topics with links to key resources as well as a few basic improvement ideas to get the ball rolling.

It also provides a PDSA (Plan-Do-Study-Act)template embedded with simple strategies to help ensure success. These include canvassing staff on what difference they believe the quality improvement will make, how important it is  to them to do it and how confident they are that the team will succeed.

Monika Wheeler, Executive Director Wellness at Healthy North Coast said, “everything that goes into a PCI QI page is designed to quickly get to the core of that particular QI activity and support general practice owners, principles, managers and nurses to move forward easily”.

Achieving real change through QI is something to be celebrated and peer sharing is a great way to inspire others to take things on. On PCI, practices can elect to share a PDSA or video about their activity. This becomes easily available to their peers across the footprint, making QI in general practice a social space where practices can be aware of and learn from and encourage one another.

The initial response to PCI has been positive with many practices initially engaging on the COVID-19 pages for flu vaccination clinics and increasing patient and staff safety (infection control). 

Forseeing the challenges for practices delivering flu vaccination to vulnerable groups during the first wave of the pandemic, a pre-launch QI (pilot) page was published directing practices to a set of resources and promoting flu clinic modification as a quality improvement. General practices on the North Coast certainly rose to the challenges posed by COVID-19 and shared many innovative and ingenious modifications to normal practice. 

Aggregated data from data sharing practices was used to show vaccination progress over the period from March to June and Healthwise and Durri Aboriginal Medical Service shared videos on how they tackled vaccination during COVID-19.  

Since then Central Pottsville Medical Centre has shared their PDSA for increasing vaccination to vulnerable groups. These PDSAs have been picked up by the National Centre for Immunisation Research and Surveillance (NCIRS) who ran a newsletter article to their readership about Central Pottsville Medical Centre’s QI and invited HNC and the practice to be part of a national PHN showcase on improving immunisation rates next year.

Five months on, 69 practices across the region have engaged with PCI including 13 who have shared PDSAs either with everyone or with HNC. The PDSAs are a great tool for learning and growth and everyone in general practice is encouraged, no matter how complex or humble, to share their PDSA.

“The positive reaction from practices and our own Primary Health Coordinator staff has surpassed our expectations and we are looking to improve and develop PCI further” said Monika Wheeler.

The introduction of the PIP QI incentive payment in August 2019 has also been at the forefront of thinking in PCI and the topics page includes templated activity pages with resources and ideas for each of the ten PIP QI measures. QI activities on the topics page are coded orange or green to denote the level of involvement required to complete them. PIP QI activities focusing on recording key health data and other activities that are less involved or intrusive to the practice as a whole are coded orange.  

In addition to orange level activities, PCI also includes more complex QI activities around recalls and reminders and health coaching – these are coded green to denote the fact that they will involve more staff and require more time and change to current practice. HNC has contracted Medicoach to provide personalised practical in-practice facilitation for practices working on green level activities to help principals and managers get on top of more involved activities more easily and get the team working towards their QI goals. HNC’s Primary Health Coordinators and Aboriginal Health Coordinators are also available to assist practices and Aboriginal Medical Services achieve their QI goals. 

To date more than 23 practices have requested in-practice assistance from Medicoach with nine others in the enquiry phase. While Medicoach has been able to provide practical assistance to develop whole-of-practice chronic disease management and care planning systems, many practices have also requested and been provided with team-building and communication workshops to re-energise and focus teams weary from dealing with the constant threat of COVID-19. The feedback on personalised in-practice facilitation has been very positive:

“Thank you so much, that’s made such a difference already. I haven’t seen them that motivated… ever. I have been trying to implement chronic disease systems for three years,” said one Practice Manager and “thank you for this educational opportunity and the motivation to move forward in quality improvement” said another.

Data sharing practices have received and signed their data sharing agreement with HNC over August and September 2020. These agreements detail what data is shared and how it is stored and used. Practices upload their data once each quarter to meet their obligations under the PIP QI program and currently, quarterly reports are delivered to general practice summarising individual practice progress on the PIP QI ten measures alongside aggregated progress data for the whole of the footprint. HNC looks forward to further integrating activity on PCI with shared data in order to help practices see their quality improvements come to life.

 You can talk with your Primary Care Coordinator or Aboriginal Health Coordinator (https://hnc.org.au/coordinators) and visit Primary Care Impact on the HNC website (https://hnc.org.au/primary-care-impact) for more information.