Voyage to Quality

1. V2Q Voyage to Quality Dr Roshan Perera Dr Roshan Perera

2. This presentation V2Q • Introduction and overview • What is the V2Q • What it involves • Why are we doing it/why is it needed • What is the value added • Next steps and issues • Questions posed Dr Roshan Perera

3. Acknowledgements V2Q • Prof Tony Dowell • Dr Tannis Laidlaw • Maureen Gillon • Board of Quality and clinical leaders RNZCGP Dr Roshan Perera

4. Voyage to quality V2Q • A three year programme of work • Undertaken in partnership between RNZCGP and Dept PHC&GP WSM • Aim – to develop a quality framework and clinical governance structure for general practice. • Enable integration • Performance management (indicators and IT) • RNZCGP programmes (education/prof dev/A4E etc) • Quality improvement initiatives Dr Roshan Perera

5. What it involves V2Q 5 streams of work • Engagement strategy (WS1) • Framework development (WS2) • Mapping the quality landscape • Creating the framework • Clinical governance structure • Dev of Measurement Tools(WS3) • Implementation strategy (WS4&5) Dr Roshan Perera

6. Why is it needed? V2Q “We don’t have a shared understanding of what quality is and the purpose of it in general practice in NZ. All have individual ideas and pursuing separate goals and its all rather ad hoc” RNZCGP interview respondent Dr Roshan Perera

7. Why is it needed? V2Q “In a fragmented environment its possible to get different versions [of quality] …because we focus on the needs of the organisation rather than the higher purpose” RNZCGP interview respondent Dr Roshan Perera

8. Why is it needed? V2Q “Thousand flowers blooming are great, but sooner or later someone has to ask where are we going with all this?” RNZCGP interview respondent Dr Roshan Perera

9. Why is it needed? V2Q “Senior management is not talking to the workers who have organised themselves into little areas of interest and are beavering away, but not talking to senior management so innovations are not disseminated and shared” RNZCGP interview respondent Dr Roshan Perera

10. Why is it needed? V2Q • Fragmentation of activity, good work happening in isolation, good ideas not shared • Impact on quality activity • For an individual (potential for parallel activities being required – practice/clinical networks/PHO etc) • At strategic level (lots of players in arena pursuing separate goals; where and with whom does responsibility lie) • Monitoring of quality activity difficult • Includes having “outgrown” existing IT framework Dr Roshan Perera

11. Why is it needed? V2Q “We’re facing fiscally constrained times … international trends are about getting more explicit about monitoring quality… Quality becomes more important because need to say what can we afford to do and cant afford to do. We can afford what is clinically important, and cost effective.... Sector interview respondent Dr Roshan Perera

12. Why is it needed? V2Q “Health has created a situation where it has got itself out of the main currents of the river and into the eddies on the side, and got itself a long way back being stuck to the river bank” RNZCGP interview respondent Dr Roshan Perera

13. Why is it needed? V2Q “We can’t do piecemeal projects…we will miss big gaps, and only do what is easy, ‘sexy’…and miss the wood for the trees” ; “A framework is needed …to allow you to populate programmes, measure the right things in the right areas and be sellable to other people”. RNZCGP interview respondent Dr Roshan Perera

14. Why is it needed? V2Q • Imperative for a sea change identified to ensure • Accountability • Prioritising within fiscal constraints • Efficiency to provide quality but be affordable • Cohesion • Necessity for proactive leadership within the context of clinical governance • Structure and strategic direction Dr Roshan Perera

15. V2Q Call for • An overarching framework • to make sense of a crowded quality landscape and a complicated set of organisational and funding arrangements; • A clinical governance structure • For integration of the four aspects of quality activity • measurementto determine nature of existing care, identify gaps, to enable • actionto be taken to promote • change in behaviour or systems design and • evaluationto determine which changes result in improvement. Dr Roshan Perera

16. V2Q • Imperatives • Base on empirical knowledge not expert opinion • Build a structure around what already exists • Focus at practice level • Balance expediency and rigour • NZ’s small size provides unique opportunity • Need sector wide engagement Dr Roshan Perera

17. Value added V2Q • Strategic level – efficiency and cohesion • Collective level – sharing of knowledge • Individual level – link identification of gaps with processes to enable required change for improved patient outcomes Dr Roshan Perera

18. The way forward V2Q • The first step: ‘think piece’ – outline of the vision and rationale • Followed by (March 09 – Feb 10): • Mapping the landscape • Framework development • Indicator development • Next steps: Integration with RNZCGP programmes and ongoing sector initiatives Dr Roshan Perera

19. Issues V2Q • Tight timeframes • Depth and scope of data collection • Prioritisation, sharing knowledge, and integration with existing initiatives • 2 way communication with key stakeholders vital Dr Roshan Perera

20. Questions along the way V2Q • Is quality optional? • Virtue or necessity • Required activity v constraints of time/resources/workload • Small business model within publically funded health system • Personal responsibility v imposed models • Autonomy/Independence v compliance • QA or QI Dr Roshan Perera

21. Questions along the way V2Q • Energising activity? • Goodwill and ‘professional conscience’ v Incentive payments • Feedback v financial bonuses • Meeting direct and opportunity costs v creating perverse incentives • Relative poverty of the health system v success of incentives Dr Roshan Perera

22. V2Q • Learn the answers along the way • Need to undertake the journey together Dr Roshan Perera

23. V2Q • To be continued….. Dr Roshan Perera

24. V2Q Thank you for your attention Dr Roshan Perera