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A vision for quality improvement in primary care

Primary care
21 September 2016

Dr John Wellingham is the chair of the Health Quality & Safety Commission’s primary care expert advisory group.

Quality improvement science has changed significantly in the last two decades. New Zealand general practice in the mid-1990s struggled with defining quality, had little concept of what indicators were and feared the topic could become an audit and blame opportunity.

We have made major strides since then and we now know the difference between quality improvement and quality assurance and have a set of measures and standards that make up the Cornerstone process (a tool to improve the safety of our facilities and the services we deliver to our enrolled populations).

We also have the Health Quality & Safety Commission to support quality improvement in the health sector. To date, the Commission has focused on hospital settings; some of us in primary health care have seen this as both a blessing and a problem.

The national lens hasn’t been on general practice and we could continue doing what we have always done in the belief that we are doing the right thing and doing it well. The problem is that general practice is not part of a supported improvement approach, does not fully understand the quality of our service delivery and does not know when the quality lens will focus on us and if we would be ready.

The next step is to understand how we can continually improve primary health care delivery. This will include collaboration to improve how we wrap ever-improving services around consumers, rather than creating a static system which they must navigate. Of course this needs to be achieved within available resources so everyone in the community can equally access and achieve the best possible outcomes.

The Commission is working with primary care to build on existing knowledge and expertise and learn the techniques and processes (science of) quality improvement.

A primary care expert advisory group (EAG) has been established and I have been appointed chair. The role of the EAG is to provide strategic guidance and leadership for the Commission’s work in primary care, and strengthen relationships across the sector. The EAG advised the Commission to set three initial ‘big bold intentions’ as the platform for this work: the improvement of equity, consumer engagement and integration. Initially this work will be with general practices and other primary care providers such as Māori health providers.

This is captured in the Whakakotahi primary care quality improvement challenge. Whakakotahi means to be as one – the premise of uniting different health professionals for the purpose of hauora (health). Initiatives will be chosen by the participating organisations but must focus on achieving improvements in health care outcomes, health equity, consumer engagement and integration.

The programme will be developed in subsequent years to build on what is learnt from earlier initiatives. Expressions of interest for the first round have closed, and a second round is likely to take place in early 2017. This project is innovative as it is sector driven.

Remember – this is not about being given a fish. This is about learning to fish!