CQI and Accreditation Network 2 June 2004

1. CQI and Accreditation Network 2 June 2004

2. CQI and Accreditation Network 2 June 2004 Notes pages are provided with this presentation. Choose View / Notes Page

3. Agenda • 1.Welcome • Divisions survey responses • 2.Introducing CQI Principles and Practices • Susan Webster, Divisions Consultant, GPDV • 3.Standards and systems for Financial • Management • Helen Threlfall, Divisions Consultant, GPDV

4. GPDV Survey of Victorian and Tasmanian Divisions about CQI and divisions accreditation May 2004 • Early survey results from 13 divisions • 6 metropolitan • 7 rural

5. Knowledge about systems for Accreditation

6. Meeting National Standards 1 = Not aware of standards10 = Confident division complies 1 = Not interested10 = Highly interested

7. Network Support for CQI • Location • Melbourne: 12 • Regional: 1 • Frequency • 2 months: 1 • 3 months: 10 • 6 months: 2 • Length • Half Day: 7 • Full Day: 6

8. An introduction to CQI Principles and Practices What are CQI principles and what do they look like in practice? Susan Webster

9. CQI Principles and Practices What does the literature say? . Curtis P. McLaughlin, Arnold D. Kaluzny (eds) 1999 Continuous quality improvement in health care: theory, implementation and applications. 2nd ed. Gaithersburg: Aspen

10. CQI Principles and Practices Key features. Curtis P. McLaughlin, Arnold D. Kaluzny Empowering people at different levels to analyse and improve systems Rational, data based approaches to analysis and change Focus on customers as judges of quality Ensuring implementation of best practice through planned organisational learning Understanding and adapting to the external environment Multidisciplinary /team approaches Planned, philosophical approach to ongoing change and adaptation

11. Focus on “customers” as judges of quality • In CQI terms customers is the generic term that refers to the end users: a colleague, a member, someone from another organisation, a funder • Customer satisfaction is one ultimate test of process and product quality • Practice examples of a focus on customers might include: • newsletter evaluation by readers • staff satisfaction questionnaire • evaluation of learning outcomes from CPD activity

12. Discussion Question: Defining customer /consumer using CQI principles • Consider a division system for conducting CPD events • 1. Who might be included as the internal “customers” of this system. • 2. Who are the end users? • 3. Are there other external customers?

13. Participant suggestions from the discussion: Internal customers might include: program staff, admin staff, finance staff, CEO, GP adviser or Program Manager End users might include: GPs practice staff, allied health providers. External customers might include: funding bodies or sponsors, This discussion generated debate in several small groups around whether “customer” for CPD systems extends to GP patients.

14. “ Adopting a planned, articulated philosophy of ongoing change and adaptation” • The expectations of “customers” will change over time because of changes in knowledge, economics, technology and culture. Dynamic between changing expectations and continuous efforts to meet these expectations. • CQI is about “mastering change effectively” • Practice examples of a planned, articulated philosophy might include: • Board policy statement on quality improvement • Quality improvement plan

15. Board and management have explicitly embraced a policy of aiming for CQI across the whole organisation

16. Using rational, data based, cooperative approaches to system analysis and change. • Capturing and using “hard” and “soft” data. • Identifying and tracking the full range of factors that affect system performance • “In God we trust, all others send data” • Practice examples of rational, data- based analysis: • CPD designs reflect results of member self assessment of learning needs, perhaps following clinical audit • Temperature logging of fridges used for vaccine storage informs decisions about cold chain integrity

17. Organisation systematically use data analysis to inform planning and decision making

18. Discussion question: In relation to a division system for ensuring occupational health and safety what are some examples of data that might usefully be collected and analysed to indicate how well the system is performing?

19. Participants in this session suggested the following examples of data: • Report of falls audit • Report of staff training in OH&S over last 12 months • Sick leave summary • Staff days lost due to stress leave or unexplained absences • Accident/injury log • Time elapsed between report of hazard or injury and action to reduce future risk. • Hazard audit report Good Practice Tip: Make an OH&S compliance and risk report to Board regularly

20. Empowering people at different levels to analyse and improve processes /systems • Multi-disciplinary, team approaches • People already involved with a process or system are needed to help identify how to solve problems with the system, achieve improvement and respond effectively to external influences on the system • “CQI still calls for a significant amount of management thought, oversight and responsibility” • Practice examples of different levels of people being empowered might include: • multi level membership of a CQI Committee • multi disciplinary membership of a quality improvement task group

21. Staff are familiar with & generally use systems thinking in their work

22. Most work involves multi functional teams where people who use / or are affected by systems of working or by outcomes have a say in how those systems work

23. Practice Examples: Consider these practice examples of team approaches from Dandenong and Monash Divisions

24. Ensure implementation of best practice through planned organisational learning • Management needs to master a set of skills….and to develop implementation and support systems • Individuals need training in a variety of tools; systems thinking, using data, problem solving in a systems framework • Examples of evidence might include: • ongoing staff training in CQI • self assessment against national quality standards

25. One or more key staff have training and or experience in using CQI principles and practices

26. Discussion Question: What are some of the methods currently used in divisions to provide training and support for building quality?

27. Participant input included the following: • GPDV facilitated workshops for program staff • Skill sharing and presentations at division staff meetings • Self assessment against skill sets. • Designating one person within the division to “lead” others • Training offered by universities (including Monash and Melbourne , PHCRED and LaTrobe , Australian Institute of Primary Care • Inter-divisional visits GPDV agreed to develop a list of sources for training and support for divisions in CQI and to make this available on the website.

28. Customer focus Leadership through CQI Policy Skills and standards CQI Principles Empowered teams Decisions based on Data

29. Are CQI Principles and Practices enough ? What does the literature say? . Critical implementation issues in total quality management. Dooyoung Shin; Jon G Kalinowski; Gaber About El-Enein S.A.M. Advanced Management Journal; Winter 1998 63,1: ABI/ INFORM Global p.10

30. Using CQI Principles and Practices • Know thyself • Create a culture that is conducive to and supportive of CQI implementation • CQI should be clearly aligned to your strategic priorities, competitive environment and goals • Understand the necessary time and effort

31. Using CQI Principles and Practices • CQI implementation should be unique to your organisation. There is no “one size fits all” • Take a holistic approach • Plan for total participation, total commitment and total responsibility of everyone in the division • CQI is a journey, not a destination