Quality Improvement Programme (QIP)

Based on feedback from practices, we have made changes to the reporting templates to make this easier for practices to use. In the PDSA template, you'll find an empty template with prompts on one side and an immunisation example on the other. This is a Word document, so it can be directly written into. The original PDSA template is still available to practices if you find this one easier to use. These updated resources are found at the bottom of this page.

As part of the Quality Improvement Plan, practices identify a number of change ideas to test. As a team, choose one of these ideas, making it small and specific. This will make it easier for you to see if that change has made a difference. The new template outlines what to consider for each section and includes prompts. 

When doing a PDSA cycle, you need to be able to measure change to determine whether an improvement was made. This is where the family of measures come in, try to make these simple. 

An outcome measure is directly related to the aim statement and in many cases could be the aim statement. What are your trying to achieve?

A process measure acts as a pulse check and are often outputs. In the example to increase immunisation rates, using a newborn welcome pack gift to whānau which includes immunisation information, the process measure used is the number of welcome packs sent / newborn enrolments received. 

A balance measure looks at an area of the business, or even the wider system, that may be affected. In the immunisation example, the practice is looking at recalls as this is another task the primary care assistant does that may be affected when considering creating welcome packs. 

If you would like more information about how to do these, please reach out to your development manager or refer to Module 3 of the Pinnacle training. This video quickly explains the difference between the three measures. 

On 1 July we moved to building capability in quality improvement methodology through the quality improvement (QI) programme, which will ultimately lead to improved health outcomes for patients.

At its core, QI looks at systems and processes through a cycle of improvement, which includes problem identification, planning and testing change ideas, data collection and analysis, and evaluation.

The focus of the first year of the programme is to build quality improvement skills in general practice through online training and putting learning into practice.

This means for the first quarter (July-September), practices identify two areas of focus (immunisation and one of five other indicators relating to CVD, respiratory and diabetes) and will develop two quality improvement plans for these - the training will step you through this. The one-page templates, and other QI resources, can be found linked below. 

In quarters two to four, practices will test their change ideas using the PDSA cycle, finishing with an end of year report.

Quality Improvement or QI is planned and proactive, involving a systematic and coordinated approach to solving a problem using specific methods and tools with the aim of bringing about a measurable improvement. At a broad level, QI considers the population and their different needs including inequities, the quality, safety and experience of care for the individual and the value for system resources in which health care is being delivered.

You can use your own data for the plans and we have also created a number of clinical dashboards (CVD, diabetes and respiratory).

The QI programme utilises Power BI dashboards, which have been developed and/or refreshed for diabetes, CVD and respiratory conditions. These clinical dashboards provide visual information around evidence-based clinically relevant outcomes for individual patients and your practice population. This is part of a concerted effort to use data to inform practice.

Not all your core QI team will want or need access to Power BI but having both clinical and administrative/data support will strengthen how it is used. Dashboards are one source of data. Additional sources of accessible data may include PMS query builds, Patient Experience Survey, incidents/learning from harm, complaints, and patient and whānau voice.  

Pinnacle currently funds two licences per practice, which will increase to three licences. The additional licence is specifically indicated for quality improvement activities and can be applied for now. Practice managers will manage the allocation of their licences and will be the contact point with Sam Yean, practice support administrator, who manages licence access for Pinnacle. 

There has been a huge amount of work within practices over the last three months to put together your two quality improvement plans. Some great kōrero around improvement has occurred in practices and some ideas have been generated to test as part of a PDSA cycle. It is great that so many practices have taken up the challenge to grow your capability around quality improvement skills in general practice.

Over the next month, your development manager or key quality improvement person will be working with you to support you in tightening your quality improvement plan and also testing one of your change ideas for this quarter.

An aim statement needs to be specific and include a baseline per cent, a target per cent, the people you are targeting and a timeframe. This is found in the first module of the Pinnacle training – slide 18.

An example: 

To increase/decrease 6wk childhood immunisation from 85% to 90% by 31 December 2024 in Māori tamariki.

Once you have tightened your aim statement, review your change ideas (also found the quality improvement plan that you submitted) and think about which ones will have the most effect and are the easiest for you to test. Testing quick, simple change ideas through a PDSA cycle is a good place to start. Ensure your change idea is small and specific. Your key quality improvement person/s in your area will be able to support you in this. Contact them for any support. 

The HQSC has a good example of PDSA cycles in their document 'From PES to PDSA'. 

Slide 18 for reference.

Practices will receive an allocation of funding based on their registered patient numbers (ESUs). This is set at $10.64/ESU (GST exclusive) for the first year of the three-year programme. Our contract with Te Whatu Ora is on a yearly basis and, without knowing future changes to PHO funding, we cannot make funding decisions beyond this. 

To support practice cashflow, the QI programme payment will be made monthly on the 20th of the month, with an adjustment each quarter based on the ESU total from the last full month of the previous quarter. This is the same quarterly adjustment made for Healthcare Home. Other payments such as Capacity and Coverage or Healthcare Home funding remains unchanged. 

Importantly, practices will still have access to the Quality Plan reports, poster and data. The Quality Plan continues to support important public health imperatives. The reason for the change to a new QI focus was that the Quality Plan was not working universally. 

Please note: In July you will receive two ‘quality’ payments - the first of the monthly QI programme payments will commence on 20 July and the last quality plan payment (current system) will be on 31 July.   

The funding calculator (linked below) will provide an approximation of your monthly funding amount. This funding amount will change each quarter based on ESU and washup.

The Pinnacle QI online training (3 x 30-minute sessions) complements the introductory online four-module QI training provided by the Health, Quality and Safety Commission (HQSC). A link will be sent to practice managers to identify the core practice QI team for Pinnacle QI training. A total of three QI training licences are allocated per practice.

Training is expected to be completed first. This consists of two parts.

1. HQSC Improving Together: Introduction training (as a guide, the four modules take approximately 2 hours).
2. Pinnacle QI training (as a guide, these are three half-hour lessons). This training moves the theory into practice and steps you through the process of completing your QI plan. There are three training spots available per practice. Please talk to your practice manager if you'd like one of these spots. Use the training supplement (linked below) to develop your thinking around the potential gaps and biases. 

QI tools and methods allow practice staff to form a deep understanding of the needs of their populations. Health inequities are defined as differences in health between groups that are unnecessary, avoidable, unfair and unjust. When working through your QI plan/project, a series of questions will encourage you to consider how you structure your ideas through an equity lens. Whether it be in reviewing your data, analysing the problem, checking in on assumptions and biases or tracking progress of equity gaps, your QI project is the opportunity to make a change.  

The quality improvement programme steps practices through equity considerations, alongside their data, as they prepare how to structure their quality improvement plan, encouraging proactivity rather than reactivity, and helping support a health service equitable for all.

QI is a team effort. Teamwork refers to working collaboratively with a group towards a common objective, while working in a team involves working independently to accomplish tasks and responsibilities. Good teamwork improves patient outcomes as well as staff wellbeing. A core QI team in general practice will ideally have a minimum of three members – although diversity of roles and perspectives is more important than size. These people might be three staff with access to Power BI, people who provide clinical leadership, technical/subject matter expertise or day-to-day leadership for QI within the practice.

The team member or members most competent with sourcing data, for example, might gather the information first before bringing it back for wider discussion. This ensures several people are not tied up at any one time, but input to the process at crucial points.