The quality improvement section of this website contains the quality improvement wheel for primary care which illustrates the main stages in the design, delivery and evaluation of an improvement project. This article explains more about each of the stages.
This section acts as a guide to the stages involved in an improvement project. Each stage contains an explanation of what it involves followed by collections of resources, case studies and discussions that are relevant to it. You can also find members who have expressed an interest in that aspect of improvement work.
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.
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.
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.
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.
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 Statistical Process Control (SPC) charts to measure your progress. It would be good if you could share any improvement stories with colleagues on this website.
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.
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.
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.