Use of the tools of quality improvement

As already mentioned, ‘improving quality’ and ‘quality improvement’ (QI) are not necessarily the same thing; the latter usually implies ‘a systematic approach that uses specific techniques to improve quality’ and ‘a “method” (an approach with appropriate tools)’. This part of the report looks at the use of formal improvement tools by GPs and practice managers – which ones they have heard of and found useful as well as their interest in training in formal QI techniques.

Familiarity with quality improvement tools

Respondents were given a list of common QI tools, including some that are specific to general practice, and asked to select all the ones they had used. Table 4.1 shows the results by respondent type.

Table 4.1: Quality improvement tools and methods used, by GP type and practice managers (%)

GP partner

Salaried GP

Trainee GP

All GPs

Practice manager

Audit

93

90

81

90

85

Significant Event Audit

95

91

63

90

90

PDSA Cycles

25

13

8

21

31

Change Management

25

13

6

20

42

Root Cause Analysis

21

15

18

19

25

Process Mapping

21

9

5

16

32

Model for Improvement

6

4

7

6

13

Run Charts

3

2

2

3

7

It is probably to be expected that the most commonly used are Audit and Significant Event Audit as these are standard tools in general practice that feature prominently in GP training, appraisal and revalidation. PDSA (Plan, Do, Study, Act) Cycles, Change Management, Root Cause Analysis and Process Mapping are also fairly common improvement and management tools, although the numbers of GPs and practice managers using these are relatively low. It is perhaps not surprising that practice managers are more likely to have used these tools (apart from Root Cause Analysis) than GPs, as they are probably more likely to have come across them in management training courses.

In terms of who has received training, as might be expected training in Audit and Significant Event Audit are the most common among GPs (Table 4.2). Apart from the two types of audit, practice managers have received training more often than GPs in QI tools, again, perhaps because they have come across these in management training courses.

Table 4.2: GPs and practice managers who have received training in quality improvement tools (%)

GP partner

Salaried GP

Trainee GP

All GPs

Practice manager

Audit

74

72

68

73

42

Significant Event Audit

69

62

39

64

49

PDSA Cycles

23

16

12

20

33

Change Management

17

11

4

14

43

Root Cause Analysis

14

12

11

13

24

Process Mapping

13

9

3

11

29

Model for Improvement

5

5

3

4

12

Run Charts

4

4

4

4

8

Not trained in any

18

18

16

18

25

Don’t know if received training

2

4

9

3

1

Table 4.3: GPs and practice managers who expressed an interest in receiving training in the use of quality improvement tools (%)

GP partner

Salaried GP

Trainee GP

All GPs

Practice manager

Model for Improvement

38

40

42

39

44

Change Management

36

40

38

37

32

Process Mapping

35

38

38

36

35

Root Cause Analysis

34

32

42

35

37

Run Charts

32

31

30

31

35

PDSA Cycles

29

34

32

31

29

Significant Event Audit

10

17

34

15

27

Audit

11

16

24

13

31

Other

4

4

1

3

4

Not interested in training in any of these

22

18

8

20

18

Don’t know

16

17

17

16

9

Both GPs and practice managers were interested in receiving training in the use of QI tools. Of those who answered this question, only 20% of GPs and 18% of practice managers said that they were not interested in training, and a further 16% and 9%, respectively, selected ‘don’t know’ (Table 4.3). This indicates that 64% of GPs and 73% of practice managers are interested in receiving training in a wider range of QI tools, which supports the argument that practices are interested in improving the services they provide and want new skills to help with this. The question allowed respondents to select multiple answers, depending on how many tools they were interested in receiving training in.

Table 4.4: Preferred method of receiving training among GPs and practice managers who have expressed an interest in training (%)

GP partner

Salaried GP

Trainee GP

All GPs

Practice manager

In-practice training

75

73

69

74

58

Workshops

65

71

64

66

73

Online learning (for example, webinars or e-learning

54

57

46

53

54

One-to-one via a senior colleague/mentor

14

18

34

18

12

Printed materials

15

12

16

16

21

Informal networking opportunity

15

18

12

15

25

One-to-one via a peer

10

11

10

10

9

Other

1

1

0

1

1

No preference in training methods

2

2

2

2

3

Of those who expressed an interest in training, the most popular format for GPs was ‘in-practice training’ (74%), followed by attendance at workshops (66%) and online or distance learning (53%), suggesting they prefer face-to-face training over an online format (Table 4.4). The advantage for the practice of in-house training is that the whole team can work together and use directly relevant examples from within the practice as training exercises. Conversely, practice managers favoured getting out of the practice to workshops (73%), followed by in-house training (58%) and then online learning (54%). While both GPs and practice managers probably value time spent with colleagues from other practices at workshops, it is likely to be easier for practice managers to be absent from the practice than for GPs who would have to fund a locum to cover any missed surgeries. Training by printed materials, one-to-one with a peer, or with a mentor/senior colleague were not rated highly as training methods by either GPs or practice managers.

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