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Header image for GP Excellence website for Greater Manchester: The GP Excellence website for Greater Manchester enables the sharing of knowledge and experience to support GPs and practices with quality improvement activities

RCGP Quick guide: The QI Wheel for Primary Care

Published: 17th February 2016

This RCGP Quick guide explains the Quality Improvement wheel for primary care, a simple visual representation that illustrates the the main elements to consider in design, delivery and evaluation of a QI project, acting as a guide to the stages involved.

Download RCGP Quick guide: The QI Wheel for Primary Care

The QI wheel is made up of five rings:

  1. Culture and context – to help you create the right conditions for a successful project.
  2. QI cycle – to guide you through project implementation
  3. Patient involvement – providing ideas to harness vital patient input for successful improvements
  4. Engagement – to provide ideas on which stakeholders to engage and how to involve them
  5. Improvement science – to provides you with the big picture context that your QI work fits into

Hover over the different sections on the QI wheel below to see what each area is about.

Quality Improvement Wheel
Diagnose Plan and test Implement and embed Sustain and spread Culture and context Patient involvement Engagement Improvement science

1. Culture and context

‘Culture and context’ is at the centre of the wheel as without this element being keen to experiment, and supportive of trying something new, it will be hard for change to occur, or be sustained, regardless of what tools or methods you use.

Culture and context are the soil in which the intervention will germinate. The soil needs to be as favourable as possible to ensure the intervention is successful. Context is the local and national environment in which you operate. Culture covers your practice values, attitudes and ways of working, including your practice team, patients and stakeholders.

2. The QI Cycle

These are the implementation steps for a cycle of quality improvement. It is broken down into four steps. Consider each of the 4 steps as a way of framing the implementation of your QI project:

  • Step 1: Diagnose – Assess the area of your practice or organisation that requires improvement, and generate some baseline data
  • Step 2: Plan and test – Decide the aims, methods and monitoring of your change. You can also test your intervention in a graded fashion
  • Step 3: Implement and embed – Make any successes part of your systems or processes
  • Step 4: Sustain and spread – Consider how your aims or intervention can continue to be implemented on a larger scale, if appropriate, and how the conclusions can be made more widely available.

The QI Cycle

3. Patient involvement

Patients are part of your culture and context. Involving them in our QI work means we see our work through the eyes of the people who need our care. This helps us to design, implement and evaluate each individual quality improvement project. The position of the patient involvement ring indicates it acts as scaffolding, to support any QI project.

4. Engagement

Engagement represents all stakeholders relevant to your project. You will have internal stakeholders in your own practice and external stakeholders such as pharmacists, social care services, and health infrastructure bodies at the local and national level. In a similar way to patients, your stakeholder involvement can support the different stages of your QI project.

5. Improvement science

Improvement science is research to identify and demonstrate the best and most appropriate methods for improvement in the quality and safety of health services. Improvement science is the ‘containing’ ring because it is the big picture context for your QI work. Once you have made progress on your QI journey and have gained confidence using the approach explained in this guide, the Improvement science section signposts you to other improvement methodologies that you and your team may wish to explore.

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2 comments about 'RCGP Quick guide: The QI Wheel for Primary Care'

  • The challenge for me will be how to integrate this into my practice as a locum working one day a week at many different practices on a very variable calendar.

    • Bill Taylor

      Thanks for the feedback Russell
      Locums do face challenges in integrating QI into their work when frequently changing practices. However because locums experience so many different practices, they are very well-placed for assessing many contextual factors for Qi, including organisational culture. Locums are also likely to spot problem areas within practice’s systems and processes that the practice themselves may be unaware of, because they are ‘too close’ to the situation.  Though this would need to be very carefully handled, it may be possible to use this unique position to given feedback to the practice, that may trigger a QI project, that may help the practice create safer more efficient processes.
      In terms of implementing personal QI, it is easier to start in a small way and tackle a potential problem that you have direct control. This could be your prescribing e.g. of antibiotics. You could ask a few of the practices to search for the antibiotic prescriptions you have initiated. You could review the data and see if there were any potential areas for improvement. You would then use the tools in the plan and test section. The work you do on this can be usefully submitted in your appraisal material. If any locums are reading this post have they any examples of what QI work they have done?
      Bill Taylor (co-author of the quick guides)

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