voyage to quality

Dr Roshan PereraDr Roshan Perera 1113 February 200913 February 2009

Voyage to QualityVoyage to Quality

Dr Roshan PereraDr Roshan Perera

13 February 200913 February 2009 Dr Roshan PereraDr Roshan Perera 22

This presentationThis presentation

• Introduction and overviewIntroduction and overview

• What is the V2QWhat is the V2Q

• What it involvesWhat it involves

• Why are we doing it/why is it neededWhy are we doing it/why is it needed

• What is the value addedWhat is the value added

• Next steps and issuesNext steps and issues

• Questions posedQuestions posed


• Prof Tony DowellProf Tony Dowell

• Dr Tannis LaidlawDr Tannis Laidlaw

• Maureen GillonMaureen Gillon

• Board of Quality and clinical Board of Quality and clinical leaders RNZCGPleaders RNZCGP

AcknowledgemenAcknowledgementsts


Voyage to qualityVoyage to quality

• A three year programme of workA three year programme of work• Undertaken in partnership between Undertaken in partnership between

RNZCGP and Dept PHC&GP WSMRNZCGP and Dept PHC&GP WSM• Aim – to develop a quality framework and Aim – to develop a quality framework and

clinical governance structure for general clinical governance structure for general practice. practice.

• Enable integrationEnable integration– Performance management (indicators and IT)Performance management (indicators and IT)– RNZCGP programmes (education/prof dev/A4E RNZCGP programmes (education/prof dev/A4E

etc) etc) – Quality improvement initiativesQuality improvement initiatives


What it What it involvesinvolves

5 streams of work5 streams of work

• Engagement strategy (WS1)Engagement strategy (WS1)

• Framework development (WS2)Framework development (WS2)– Mapping the quality landscapeMapping the quality landscape

– Creating the frameworkCreating the framework

• Clinical governance structure Clinical governance structure – Dev of Measurement ToolsDev of Measurement Tools (WS3)(WS3)– Implementation strategy Implementation strategy

(WS4&5)(WS4&5)


Why is it Why is it needed? needed?

““We don’t have a shared We don’t have a shared understanding of what quality is and understanding of what quality is and the purpose of it in general practice the purpose of it in general practice in NZ. All have individual ideas and in NZ. All have individual ideas and pursuing separate goals and its all pursuing separate goals and its all rather ad hoc”rather ad hoc”

RNZCGP interview respondentRNZCGP interview respondent


““In a fragmented environment its In a fragmented environment its possible to get different versions [of possible to get different versions [of quality] …because we focus on the quality] …because we focus on the needs of the organisation rather than needs of the organisation rather than the higher purpose”the higher purpose”




““Thousand flowers blooming are great, Thousand flowers blooming are great, but sooner or later someone has to ask but sooner or later someone has to ask where are we going with all this?”where are we going with all this?”


Why is it needed? Why is it needed?


““Senior management is not talking to Senior management is not talking to the workers who have organised the workers who have organised themselves into little areas of interest themselves into little areas of interest and are beavering away, but not and are beavering away, but not talking to senior management so talking to senior management so innovations are not disseminated and innovations are not disseminated and shared”shared”




• Fragmentation of activity, good work Fragmentation of activity, good work happening in isolation, good ideas not sharedhappening in isolation, good ideas not shared

• Impact on quality activityImpact on quality activity– For an individual (potential for parallel activities For an individual (potential for parallel activities

being required – practice/clinical networks/PHO etc)being required – practice/clinical networks/PHO etc)– At strategic level (lots of players in arena pursuing At strategic level (lots of players in arena pursuing

separate goals; where and with whom does separate goals; where and with whom does responsibility lie)responsibility lie)

• Monitoring of quality activity difficultMonitoring of quality activity difficult– Includes having “outgrown” existing IT frameworkIncludes having “outgrown” existing IT framework



““We’re facing fiscally constrained times We’re facing fiscally constrained times … international trends are about getting … international trends are about getting more explicit about monitoring quality… more explicit about monitoring quality… Quality becomes more important Quality becomes more important because need to say what can we because need to say what can we afford to do and cant afford to do. We afford to do and cant afford to do. We can afford what is clinically important, can afford what is clinically important, and cost effective.... and cost effective....

Sector interview respondentSector interview respondent



““Health has created a situation where it Health has created a situation where it has got itself out of the main currents of has got itself out of the main currents of the river and into the eddies on the the river and into the eddies on the side, and got itself a long way back side, and got itself a long way back being stuck to the river bank”being stuck to the river bank”




““We can’t do piecemeal projects…we We can’t do piecemeal projects…we will miss big gaps, and only do what is will miss big gaps, and only do what is easy, ‘sexy’…and miss the wood for easy, ‘sexy’…and miss the wood for the trees” ;the trees” ;

““A framework is needed …to allow A framework is needed …to allow you to populate programmes, you to populate programmes, measure the right things in the right measure the right things in the right areas and be sellable to other areas and be sellable to other people”.people”.




• Imperative for a sea change identified to ensureImperative for a sea change identified to ensure– AccountabilityAccountability– Prioritising within fiscal constraintsPrioritising within fiscal constraints– Efficiency to provide quality but be affordableEfficiency to provide quality but be affordable– CohesionCohesion

• Necessity for proactive leadership within the Necessity for proactive leadership within the context of clinical governancecontext of clinical governance

• Structure and strategic directionStructure and strategic direction



Call for Call for • An overarching frameworkAn overarching framework

– to make sense of a crowded quality to make sense of a crowded quality landscape and a complicated set of landscape and a complicated set of organisational and funding organisational and funding arrangements;arrangements;

• A clinical governance structure A clinical governance structure – For integration of the four aspects of For integration of the four aspects of

quality activityquality activity•measurementmeasurement to determine nature of to determine nature of

existing care, identify gaps, to enable existing care, identify gaps, to enable •actionaction to be taken to promote to be taken to promote •changechange in behaviour or systems in behaviour or systems

design anddesign and•evaluationevaluation to determine which to determine which

changes result in improvementchanges result in improvement. .


• ImperativesImperatives– Base on empirical knowledge not expert Base on empirical knowledge not expert

opinionopinion– Build a structure around what already Build a structure around what already

existsexists– Focus at practice levelFocus at practice level– Balance expediency and rigourBalance expediency and rigour

• NZ’s small size provides unique NZ’s small size provides unique opportunityopportunity

• Need sector wide engagementNeed sector wide engagement


Value addedValue added

• Strategic level – efficiency and cohesionStrategic level – efficiency and cohesion

• Collective level – sharing of knowledgeCollective level – sharing of knowledge

• Individual level – link identification of Individual level – link identification of gaps with processes to enable required gaps with processes to enable required change for improved patient outcomeschange for improved patient outcomes


The way forwardThe way forward

• The first step: ‘think piece’ – outline of The first step: ‘think piece’ – outline of the vision and rationalethe vision and rationale

• Followed by (March 09 – Feb 10): Followed by (March 09 – Feb 10): – Mapping the landscape Mapping the landscape – Framework development Framework development – Indicator development Indicator development

• Next steps: Integration with RNZCGP Next steps: Integration with RNZCGP programmes and ongoing sector programmes and ongoing sector initiativesinitiatives


IssuesIssues

• Tight timeframesTight timeframes

• Depth and scope of data collection Depth and scope of data collection

• Prioritisation, sharing knowledge, Prioritisation, sharing knowledge, and integration with existing and integration with existing initiativesinitiatives

• 2 way communication with key 2 way communication with key stakeholders vitalstakeholders vital


Questions along the wayQuestions along the way

• Is quality optional?Is quality optional?– Virtue or necessityVirtue or necessity– Required activity v constraints of Required activity v constraints of

time/resources/workload time/resources/workload – Small business model within publically Small business model within publically

funded health systemfunded health system– Personal responsibility v imposed Personal responsibility v imposed

modelsmodels– Autonomy/Independence v complianceAutonomy/Independence v compliance– QA or QIQA or QI


• Energising activity?Energising activity?– Goodwill and ‘professional conscience’ v Goodwill and ‘professional conscience’ v

Incentive paymentsIncentive payments– Feedback v financial bonusesFeedback v financial bonuses– Meeting direct and opportunity costs v Meeting direct and opportunity costs v

creating perverse incentivescreating perverse incentives– Relative poverty of the health system v Relative poverty of the health system v

success of incentivessuccess of incentives

Questions along the wayQuestions along the way


•Learn the answers along the wayLearn the answers along the way

•Need to undertake the journey Need to undertake the journey togethertogether


•To be continued…..To be continued…..


Thank you for your attentionThank you for your attention

voyage to quality

Documents

frameworkdr roshan perera

monitoring quality quality

quality framework

quality landscapecreating

quality activityfor

different versions of

senior management

good ideas