RCGP Quick guide: The QI Wheel for Primary Care
Published: 17th February 2016This 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:
- Culture and context – to help you create the right conditions for a successful project.
- QI cycle – to guide you through project implementation
- Patient involvement – providing ideas to harness vital patient input for successful improvements
- Engagement – to provide ideas on which stakeholders to engage and how to involve them
- 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.

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Culture and context
You can consider your culture and context to be the soil in which the intervention will germinate. The soil needs to be as favourable as possible to allow the intervention to be successful. Context is the local and national environment in which you operate.
Culture covers your practice values, attitudes and ways of working. It includes your practice team, patients and stakeholders: how you involve them and interact together on a daily basis. Your patients and stakeholders are therefore included at the heart of the QI wheel.
This section of the website provides you with tools to analyse your own context and culture, which you can then use to and the best way to create a context that is supportive of the change(s) you wish to make.
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Diagnose
Having understood your culture and context, you can undertake a diagnosis to identify areas of practice that could be improved or would benefit from change.
This section contains a variety of tools that support effective diagnosis. You can choose to use one tool or several together. We have grouped them into analysis tools, external data and new data.
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Plan and test
From the diagnosis phase of your project you will have identified areas to learn from that you already do well, and areas where there is scope for improvement. With some of the diagnostic techniques you will have also generated ideas for change and potential solutions. You can now plan your changes and how they will be tested. This starts with identifying a clear purpose and measure of success and the actions that will deliver that purpose. You will then plan out how each individual cycle of change will be implemented and measured to identify which changes result in an improvement or not.
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Implement
Having tested your change, you will know whether or not it has been successful; whether it needs modification; and whether or not it should be continued. If it was successful, you can demonstrate the success to your team and implement the change as part of your regular systems or processes.
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Sustain
You will want to sustain any improvement within your practice or organisation. This can be supported by the same methods and measurements that you originally used to test the changes. If by now you feel confident with run charts, you might like to try using the more sophisticated SPC charts to measure your progress. It would be good if you could share any improvement stories with colleagues on this website.
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Patient involvement
Patients are part of your culture and context. Patient involvement 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 in the QI wheel indicates it acts as scaffolding, to support any QI project.
This section of the website provides you with ideas on how to harness patient input into the design and delivery of your projects and their measures of success.
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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.
This section of the website helps you to consider the who, when and how of involving your stakeholders.
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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 of the QI wheel because it is the big picture context for your QI work.
This section of the website signposts you to other improvement methodologies that you and your team may wish to explore.
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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.
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'
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Posted on 9th April 2017 at 9:43 am
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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.