Practices Improving Processes in Salford, otherwise known as PIPS, was a Breakthrough Series (BTS) Collaborative designed to improve efficiency in eight Salford GP practices with a view to share learning across Salford by using Quality Improvement (QI) methodologies.
Commissioned by NHS Salford Clinical Commissioning Group (CCG) and delivered by Haelo, the programme included eight GP practices within Salford and ran for 12 months from April 2017.
There is growing pressure for general practices to continue to deliver high quality care, while meeting increasing levels of demand and diverse expectations. At the same time financial resources are being reduced, requiring practices to stretch their resources to maximum capacity.
Therefore, NHS Salford CCG wanted to offer GP practices an opportunity to participate in a 12-month long programme which would provide practice teams with suitable QI training and onsite support to redesign processes that impact on patient outcomes, patient and carer experience, staff experience and value and efficiency. The intention of the programme was to support GP practices in Salford to identify opportunities to improve how they work, use data to drive improvement, reduce waste and inefficiencies and reduce costs. By doing this, it would help the GP Practices to plan ahead and maximise the time they have.
The eight Salford GP practices included:
- Ellenbrook Medical Centre
- Mocha Parade Medical Practice
- Ordsall Health Surgery
- Orient Road Medical Practice
- Sorrel Group Practice
- The Height General Practice
- The Lakes Medical Centre
- The Willows Surgery
The fundamental QI methodologies used to enable GP practices to deliver quick win efficiencies over the programme life span were Lean, in conjunction with the Model for Improvement. These methods were selected so that the GP practices could become very specific about what they wanted to achieve, in addition to utilising their data to demonstrate their progress. Using tools which helped them to firstly, diagnose an issue and secondly, apply tools to test changes. The GP practices were then skilled to assess whether they had seen any improvement in the changes that they had been testing.
Haelo launched the PIPS programme on the 12 July 2017, and using the structure of a BTS Collaborative, GP practices came together for three learning sessions, followed by a celebration event. Each learning session was 60 days apart and in the interim periods, each GP practice would have tailored improvement coaching support to help them enable their changes.
Within the learning sessions, participating GP practices received training in the key components of Lean methodology. Underpinning the PIPS programme was the Model for Improvement; GP practices used the Plan, Do, Study, Act cycle to test their change ideas on how to improve their current problem. Lean and the Model for Improvement have synergy between them, therefore, this was a suitable balance of QI to provide the GP practices with as they strived to make changes to their current processes. The learning sessions also provided valuable space for the GP practices to work as a collaborative, share learning, experiences and initiatives to apply them to another setting where appropriate.
The GP practices decided to work upon a number of different topic areas, selected through what they felt to be issues which required change. These were:
- Back Office functions
- Reception functions
Prior to the first learning session, the practices had an opportunity to think about which of the above areas were providing them with difficulties and what waste they could eliminate in order to make their processes more efficient. This issue was then brought with them to the first learning session where they explored which tools to use and how to apply them to their issue area(s).
Haelo provided expertise in a handful of QI tools over the PIPS programme. The following tools were selected for their simplicity and their ease of application to real-life situations:
- Cause and Effect Analysis
- 5 Whys
- Spaghetti Diagram
- Process Mapping
The GP practices were supported by Haelo team during the design of the initiative they wanted to test a change on and also supported the GP practices when they put the tools into action.
For more information on the specific initiatives, please see the below case studies;
At the end of the PIPS programme, the GP practices came together to showcase their work and share reflections on their initiatives, with the aim to share and learn from each other’s experiences. The PIPS programme has helped the participating GP practices to see a series of improvements and has been positively received by their staff.
Going forward, the GP practices are keen to continue to develop their QI skills and apply what they have learnt to other areas within their processes and procedures. In addition to this, they are now looking to sustain their improvements and share them across Salford to other GP practices. The GP practices are now more reliant on their data, which has helped them to convey the message about QI but also, how they can use this to demonstrate what efficiencies they have seen.
A selection of the GP practices initiatives over the PIPS programme can be found here:
- Associates of Process Improvement/ Model for Improvement
- Breakthrough Series Collaborative
- Comparing Lean and Quality Improvement
Case study details
- Improvement topics
- Behaviour change
- Analysis tools
- Plan and test
- Patient involvement
- Improvement science
- Improvement tools
- Clinical audit
- Model for improvement
- Plan-Do-Study-Act (PDSA)
- Process mapping
- Six Sigma
- Clinical area
- Patient safety
- 6-12 months
- Patient impact
- Better clinical outcomes