Making a difference
As a doctor, one of my key objectives is to improve my patients’ health, wellbeing and quality of life. I’m sure that you share this goal. Making a real difference in someone’s life is what gets me up every day. But how do I really know that I’m making the difference I think I am?
Often the results of my interventions are more immediate. I help a patient make an informed decision about an immunisation, or I clean and stitch a wound minimising the scar and risk of infection. I might have diagnosed a case of pneumonia and prescribed a course of treatment to relieve and eradicate my patient’s symptoms.
Other times it is less immediate. I might work with a patient to empower them to better manage their chronic disease, aiming to minimise its advance, the risks of associated multi-morbidities and its impact on their everyday life. This is much harder to measure and assess.
Aside from what I can see with my own eyes at an individual level, to confirm I am making a difference, the reality is that I need to record my actions, review the outcomes of my actions and evaluate this against my peers, or a best practice benchmark.
Understanding how I am performing can enable me to identify where I could do better and provide a personal benchmark from which I can follow a process of continuous improvement that will improve the efficiency of my practice and the quality of the health care I provide my patients.
While this can be challenging, it is very important to ensure my clinical practice is evolving in line with my peers, enhancing my effectiveness and helping me to deliver the health care my patients value.
Continuous quality improvement is often sold as a package of principles, methods and techniques that can be overwhelming and seemingly unsustainable for a busy GP. The best way to eat an elephant, I’ve been told, is one mouthful at a time. This is the approach I believe is required to implement a sustainable process of continuous quality improvement in general practice. But where to start?
The key to any objective evaluation is quality data. The key to quality data is standardised clinical terminology – in other words, coding. Before the end of this year it is expected that the two largest providers of clinical software will have enabled mapping of their coding systems to the SNOMED clinical terminology. This will be a huge enabler for many practices when extracting and analysing their data. They will be able to undertake simplified data extractions and compare apples with apples.
Accreditation and incentives such as those provided under the Practice Incentive Program, Quality Improvement and Continuing Professional Development requirements have been instrumental in facilitating GPs in improving their practices and processes, and in keeping their knowledge and skills up to date. But at the end of the day, the question that really matters is – did we make a difference.
The challenge is how to answer this question. Much of the answer is potentially at our finger tips or sitting in front of us, in our clinical data. For example, what percentage of our patients have their cholesterol levels recorded, what percentage have improved their levels in 12 months since a diagnosis of high cholesterol. How many have levels within the optimum range. Do our patients feel better, can they cope, can they move more freely, is their pain managed, did we listen to them, did we help them understand their condition and treatment options, did we follow up on them?
The discussion about quality improvement in general practice has started. The Health Care Home initiative will look at how practices can develop quality assurance processes, and it is important for general practice to do more to demonstrate to Government just how good our standards of care are. This is not about pay-for-performance but rather, how we ensure that GPs have the tools and information they need to better support a culture of continuous quality improvement.