Improving Outcomes for People with Diabetes in Primary CareNational Conference - Wednesday 8 February 2017

Programme

Improving Outcomes for People with Diabetes in Primary CareNational Conference - Wednesday 8 February 2017

Programme

Improving quality what works

Martin Marshall

Professor of Healthcare Improvement UCL

Improving quality for people with diabetes in primary care

8th February 2017

Challenges

1 What we do to improve patient care and health

services is insufficiently influenced by science

2 Science is insufficiently focused on the needs of

those undertaking improvement activities

6

benefit for patients

The sciences that influence patient care

Translation gap

Basic

Sciences

Clinical

Sciences

T1

implementation

T2

7

benefit for patients

The sciences that influence patient care

Translation gaps

Basic

Sciences

Clinical

Sciences

Improvement

Sciences

T1 T2 T3

Some things that we know

from theory and empirical

evidence about how to

organise and deliver high

quality health care

(but often fail to put into practice)

1 We know what lsquogoodrsquo looks like

1 Develop quality as a core strategy

2 Ensure organisational skills to support

improvement

3 Use information as a platform for change

4 Focus on learning

5 Develop leadership

High Performing Healthcare

Systems Delivering Quality by

Design

Baker GR MacIntosh-Murray A

Porcellato C Dionne L Stellmacovich K

Born K 2009

Clinical teams

Education and training

Clinical audit

Peer review collaboration

Guidelines

Health system

Performance management

Regulation

Incentivessanctions

Competition

Commissioning

Organisations

Org development

TQMCQI BPR

PDSA Lean 6 sigma

2 We know that there are many

ways of improving qualityhelliphellip

hellipbut most of them are usually

only moderately effective

4 We know that improvement efforts

are most effective when we use

multiple interventions which combine

technical and social elements

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

Improving Outcomes for People with Diabetes in Primary CareNational Conference - Wednesday 8 February 2017

Programme

Improving quality what works

Martin Marshall

Professor of Healthcare Improvement UCL

Improving quality for people with diabetes in primary care

8th February 2017

Challenges

1 What we do to improve patient care and health

services is insufficiently influenced by science

2 Science is insufficiently focused on the needs of

those undertaking improvement activities

6

benefit for patients

The sciences that influence patient care

Translation gap

Basic

Sciences

Clinical

Sciences

T1

implementation

T2

7

benefit for patients

The sciences that influence patient care

Translation gaps

Basic

Sciences

Clinical

Sciences

Improvement

Sciences

T1 T2 T3

Some things that we know

from theory and empirical

evidence about how to

organise and deliver high

quality health care

(but often fail to put into practice)

1 We know what lsquogoodrsquo looks like

1 Develop quality as a core strategy

2 Ensure organisational skills to support

improvement

3 Use information as a platform for change

4 Focus on learning

5 Develop leadership

High Performing Healthcare

Systems Delivering Quality by

Design

Baker GR MacIntosh-Murray A

Porcellato C Dionne L Stellmacovich K

Born K 2009

Clinical teams

Education and training

Clinical audit

Peer review collaboration

Guidelines

Health system

Performance management

Regulation

Incentivessanctions

Competition

Commissioning

Organisations

Org development

TQMCQI BPR

PDSA Lean 6 sigma

2 We know that there are many

ways of improving qualityhelliphellip

hellipbut most of them are usually

only moderately effective

4 We know that improvement efforts

are most effective when we use

multiple interventions which combine

technical and social elements

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

Improving quality what works

Martin Marshall

Professor of Healthcare Improvement UCL

Improving quality for people with diabetes in primary care

8th February 2017

Challenges

1 What we do to improve patient care and health

services is insufficiently influenced by science

2 Science is insufficiently focused on the needs of

those undertaking improvement activities

6

benefit for patients

The sciences that influence patient care

Translation gap

Basic

Sciences

Clinical

Sciences

T1

implementation

T2

7

benefit for patients

The sciences that influence patient care

Translation gaps

Basic

Sciences

Clinical

Sciences

Improvement

Sciences

T1 T2 T3

Some things that we know

from theory and empirical

evidence about how to

organise and deliver high

quality health care

(but often fail to put into practice)

1 We know what lsquogoodrsquo looks like

1 Develop quality as a core strategy

2 Ensure organisational skills to support

improvement

3 Use information as a platform for change

4 Focus on learning

5 Develop leadership

High Performing Healthcare

Systems Delivering Quality by

Design

Baker GR MacIntosh-Murray A

Porcellato C Dionne L Stellmacovich K

Born K 2009

Clinical teams

Education and training

Clinical audit

Peer review collaboration

Guidelines

Health system

Performance management

Regulation

Incentivessanctions

Competition

Commissioning

Organisations

Org development

TQMCQI BPR

PDSA Lean 6 sigma

2 We know that there are many

ways of improving qualityhelliphellip

hellipbut most of them are usually

only moderately effective

4 We know that improvement efforts

are most effective when we use

multiple interventions which combine

technical and social elements

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

Challenges

1 What we do to improve patient care and health

services is insufficiently influenced by science

2 Science is insufficiently focused on the needs of

those undertaking improvement activities

6

benefit for patients

The sciences that influence patient care

Translation gap

Basic

Sciences

Clinical

Sciences

T1

implementation

T2

7

benefit for patients

The sciences that influence patient care

Translation gaps

Basic

Sciences

Clinical

Sciences

Improvement

Sciences

T1 T2 T3

Some things that we know

from theory and empirical

evidence about how to

organise and deliver high

quality health care

(but often fail to put into practice)

1 We know what lsquogoodrsquo looks like

1 Develop quality as a core strategy

2 Ensure organisational skills to support

improvement

3 Use information as a platform for change

4 Focus on learning

5 Develop leadership

High Performing Healthcare

Systems Delivering Quality by

Design

Baker GR MacIntosh-Murray A

Porcellato C Dionne L Stellmacovich K

Born K 2009

Clinical teams

Education and training

Clinical audit

Peer review collaboration

Guidelines

Health system

Performance management

Regulation

Incentivessanctions

Competition

Commissioning

Organisations

Org development

TQMCQI BPR

PDSA Lean 6 sigma

2 We know that there are many

ways of improving qualityhelliphellip

hellipbut most of them are usually

only moderately effective

4 We know that improvement efforts

are most effective when we use

multiple interventions which combine

technical and social elements

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

6

benefit for patients

The sciences that influence patient care

Translation gap

Basic

Sciences

Clinical

Sciences

T1

implementation

T2

7

benefit for patients

The sciences that influence patient care

Translation gaps

Basic

Sciences

Clinical

Sciences

Improvement

Sciences

T1 T2 T3

Some things that we know

from theory and empirical

evidence about how to

organise and deliver high

quality health care

(but often fail to put into practice)

1 We know what lsquogoodrsquo looks like

1 Develop quality as a core strategy

2 Ensure organisational skills to support

improvement

3 Use information as a platform for change

4 Focus on learning

5 Develop leadership

High Performing Healthcare

Systems Delivering Quality by

Design

Baker GR MacIntosh-Murray A

Porcellato C Dionne L Stellmacovich K

Born K 2009

Clinical teams

Education and training

Clinical audit

Peer review collaboration

Guidelines

Health system

Performance management

Regulation

Incentivessanctions

Competition

Commissioning

Organisations

Org development

TQMCQI BPR

PDSA Lean 6 sigma

2 We know that there are many

ways of improving qualityhelliphellip

hellipbut most of them are usually

only moderately effective

4 We know that improvement efforts

are most effective when we use

multiple interventions which combine

technical and social elements

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

7

benefit for patients

The sciences that influence patient care

Translation gaps

Basic

Sciences

Clinical

Sciences

Improvement

Sciences

T1 T2 T3

Some things that we know

from theory and empirical

evidence about how to

organise and deliver high

quality health care

(but often fail to put into practice)

1 We know what lsquogoodrsquo looks like

1 Develop quality as a core strategy

2 Ensure organisational skills to support

improvement

3 Use information as a platform for change

4 Focus on learning

5 Develop leadership

High Performing Healthcare

Systems Delivering Quality by

Design

Baker GR MacIntosh-Murray A

Porcellato C Dionne L Stellmacovich K

Born K 2009

Clinical teams

Education and training

Clinical audit

Peer review collaboration

Guidelines

Health system

Performance management

Regulation

Incentivessanctions

Competition

Commissioning

Organisations

Org development

TQMCQI BPR

PDSA Lean 6 sigma

2 We know that there are many

ways of improving qualityhelliphellip

hellipbut most of them are usually

only moderately effective

4 We know that improvement efforts

are most effective when we use

multiple interventions which combine

technical and social elements

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

Some things that we know

from theory and empirical

evidence about how to

organise and deliver high

quality health care

(but often fail to put into practice)

1 We know what lsquogoodrsquo looks like

1 Develop quality as a core strategy

2 Ensure organisational skills to support

improvement

3 Use information as a platform for change

4 Focus on learning

5 Develop leadership

High Performing Healthcare

Systems Delivering Quality by

Design

Baker GR MacIntosh-Murray A

Porcellato C Dionne L Stellmacovich K

Born K 2009

Clinical teams

Education and training

Clinical audit

Peer review collaboration

Guidelines

Health system

Performance management

Regulation

Incentivessanctions

Competition

Commissioning

Organisations

Org development

TQMCQI BPR

PDSA Lean 6 sigma

2 We know that there are many

ways of improving qualityhelliphellip

hellipbut most of them are usually

only moderately effective

4 We know that improvement efforts

are most effective when we use

multiple interventions which combine

technical and social elements

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

1 We know what lsquogoodrsquo looks like

1 Develop quality as a core strategy

2 Ensure organisational skills to support

improvement

3 Use information as a platform for change

4 Focus on learning

5 Develop leadership

High Performing Healthcare

Systems Delivering Quality by

Design

Baker GR MacIntosh-Murray A

Porcellato C Dionne L Stellmacovich K

Born K 2009

Clinical teams

Education and training

Clinical audit

Peer review collaboration

Guidelines

Health system

Performance management

Regulation

Incentivessanctions

Competition

Commissioning

Organisations

Org development

TQMCQI BPR

PDSA Lean 6 sigma

2 We know that there are many

ways of improving qualityhelliphellip

hellipbut most of them are usually

only moderately effective

4 We know that improvement efforts

are most effective when we use

multiple interventions which combine

technical and social elements

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

Clinical teams

Education and training

Clinical audit

Peer review collaboration

Guidelines

Health system

Performance management

Regulation

Incentivessanctions

Competition

Commissioning

Organisations

Org development

TQMCQI BPR

PDSA Lean 6 sigma

2 We know that there are many

ways of improving qualityhelliphellip

hellipbut most of them are usually

only moderately effective

4 We know that improvement efforts

are most effective when we use

multiple interventions which combine

technical and social elements

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

hellipbut most of them are usually

only moderately effective

4 We know that improvement efforts

are most effective when we use

multiple interventions which combine

technical and social elements

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

4 We know that improvement efforts

are most effective when we use

multiple interventions which combine

technical and social elements

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

Intervention

5 We know that improvement requires more than an effective intervention

Implementation

Context

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

Journal of Health Services Research and Policy 2007

6 We know culture is important and

changing it is difficult

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

7 We know that we need to adopt a

whole systems approach to change

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

PhysicalPsychological

Sources of behaviour

Policy categories

Intervention functions

Behaviours

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

8 We know that all efforts to improve

have unintended consequences

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

9 We know that restructuring health

services can be a distraction

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

10 We know something about different

approaches to achieving change

Stacey 2012

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

So how can we put these

lessons more effectively

into practice

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

Adapted from Canadian Health Services Research Foundation 2003

Problem

Knowledge transfer

Solution

Improved dissemination of evidence to users (lsquoPushrsquo) or

demand for evidence from users (lsquoPullrsquo)

Knowledge production

Work together to define refine generate and implement evidence (lsquoCo-creationrsquo)

Nature of evidence

A product

A process

Nature of decision process

One-off event

Iterative social

process

Mobilising knowledge

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

Barnsley FC

Poet-in-residence

All England Tennis

Club

Artist-in-residence

British Library

Innovator-in-residence

Researcher-in-Residence Model

1 The researcher is a core member of

an operational team

2 They are explicit about their expert

contribution to the team

bull the evidence base

bull theories of change

bull evaluation both formal and

informal

bull use of data

3 Their focus is on negotiation and

compromise of their expertise rather

than imposition ndash lsquoa meeting of

expertsrsquo

Researcher-in-Residence Model

Operational Researcher-in-Residence at

Great Ormond Street Hospital for

Children

Examples

Health Service Researcher-in-

Residence in Whittington Health

Integrated Care Organisation

Anthropologist-in-Residence at

UCLH

Operational Researcher-in-Residence at

Great Ormond Street Hospital for

Children

Examples

Health Service Researcher-in-

Residence in Whittington Health

Integrated Care Organisation

Anthropologist-in-Residence at

UCLH

Political Scientist-in-Residence in Newham

general practice

Critical Discourse Social Scientist-in-

Residence in an East London integrated

care programme

Examples

Health Service Researcher-in-Residence in

Essex care homes

martinmarshalluclacukwwwuclacukpcphisl

MarshallProf

National Diabetes Audit 2015-2016Some findings and their implications

Bob Young

NDA Specialist Clinical Lead

National Diabetes Audit

National Diabetes Footcare

Audit

National Pregnancy in

Diabetes Audit

National Diabetes

Inpatient Audit

Insulin Pump Audit

Transition Audit

httpsdigitalnhsukfootcare

httpsdigitalnhsuknpid

httpsdigitalnhsukdiabetesinpatientaudit

National Diabetes Audit

httpsdigitalnhsuknda

httpsdigitalnhsuk

nda_trans

National Diabetes Audit

National Diabetes Footcare

Audit

National Pregnancy in

Diabetes Audit

National Diabetes

Inpatient Audit

Insulin Pump Audit

Transition Audit

httpsdigitalnhsukfootcare

httpsdigitalnhsuknpid

httpsdigitalnhsukdiabetesinpatientaudit

National Diabetes Audit

httpsdigitalnhsuknda

httpsdigitalnhsuk

nda_trans

National Diabetes Audit

National Diabetes Footcare

Audit

National Pregnancy in

Diabetes Audit

National Diabetes

Inpatient Audit

Insulin Pump Audit

Transition Audit

httpsdigitalnhsukfootcare

httpsdigitalnhsuknpid

httpsdigitalnhsukdiabetesinpatientaudit

National Diabetes Audit

httpsdigitalnhsuknda

httpsdigitalnhsuk

nda_trans

NDA Continuous Linked Data

GP and Specialist Electronic Records (Routine Records)

Core NDA (2004)

NHS number Diabetes Type Year Sex Post Code (IMD) YoB

BMI Smoking BP HbA1c TC eGFR UACR

Education Pump Data Foot (amp Eye) checks

Hospital Episode StatisticsPEDW

NHS number

Admission for

DKA Amputation

DialysisTransplant

Angina MI HF Stroke

ONS (MRIS)

NHS number

Date of death

Cause of Death

Unlinked (snapshot)

NaDIA Inpatients (2011)

NDFA Foot Ulcers

Transition NPDA

(2015)

Deliveries NNC

Foot Disease Admission

Specialist Care OPD

NPiD Antenatal

Participation 2015-16

31

Participation 824 per cent

(2721292 PWD)

Participation lt50 in only 16 CCGs

For more information on the level of participation in

2015-16 by CCG and LHB please see the

participation report

A dashboard showing participation over the last 3

years for CCGs and LHBs can be found here

Participation 2015-16

31

Participation 824 per cent

(2721292 PWD)

Participation lt50 in only 16 CCGs

For more information on the level of participation in

2015-16 by CCG and LHB please see the

participation report

A dashboard showing participation over the last 3

years for CCGs and LHBs can be found here

What this talk will cover

bull NDA 2015-16 Type 2 Diabetes core reports

bull Variation and possible explanations for

Variation in

ndash Blood Glucose Treatment Target

achievement rates (HbA1clt58mmoll

(75)

ndash Blood Pressure Treatment Target

achievement rates (BPlt14080)

32

Characteristics of People with Type 2 Diabetes

33

Age and gender of patients with Type 2 and other diabetes

England and Wales 2015-2016

Male gt Female

Older gt Younger 36 lt

65yr

Care Processes ndash Time Series

34

Percentage of people with diabetes receiving NICE recommended care processes by

care process diabetes type and audit yearEngland and Wales

Type 2 and other3

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

HbA1c 931 909 931 935 948 950

Blood pressure 957 956 954 949 961 957

Cholesterol928 921 919 924 928 927

Serum creatinine935 935 932 934 945 947

Urine albumin 767 775 747 844 746 667

Foot surveillance855 864 858 862 867 867

BMI905 909 909 857 831 827

Smoking854 857 863 855 852 852

Eight care processes 4

623 621 612 676 587 537

There is a lsquohealth warningrsquo regarding the screening test for early kidney disease (Urine Albumin Creatinine Ratio UACR) prior to 2013-14 please

see the NDA Data Quality statement

34 Please see full list of footnotes in the definitions and footnote section

Characteristics of People with Type 2 Diabetes

33

Age and gender of patients with Type 2 and other diabetes

England and Wales 2015-2016

Male gt Female

Older gt Younger 36 lt

65yr

Care Processes ndash Time Series

34

Percentage of people with diabetes receiving NICE recommended care processes by

care process diabetes type and audit yearEngland and Wales

Type 2 and other3

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

HbA1c 931 909 931 935 948 950

Blood pressure 957 956 954 949 961 957

Cholesterol928 921 919 924 928 927

Serum creatinine935 935 932 934 945 947

Urine albumin 767 775 747 844 746 667

Foot surveillance855 864 858 862 867 867

BMI905 909 909 857 831 827

Smoking854 857 863 855 852 852

Eight care processes 4

623 621 612 676 587 537

There is a lsquohealth warningrsquo regarding the screening test for early kidney disease (Urine Albumin Creatinine Ratio UACR) prior to 2013-14 please

see the NDA Data Quality statement

34 Please see full list of footnotes in the definitions and footnote section

Care Processes ndash Time Series

34

Percentage of people with diabetes receiving NICE recommended care processes by

care process diabetes type and audit yearEngland and Wales

Type 2 and other3

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

HbA1c 931 909 931 935 948 950

Blood pressure 957 956 954 949 961 957

Cholesterol928 921 919 924 928 927

Serum creatinine935 935 932 934 945 947

Urine albumin 767 775 747 844 746 667

Foot surveillance855 864 858 862 867 867

BMI905 909 909 857 831 827

Smoking854 857 863 855 852 852

Eight care processes 4

623 621 612 676 587 537

There is a lsquohealth warningrsquo regarding the screening test for early kidney disease (Urine Albumin Creatinine Ratio UACR) prior to 2013-14 please

see the NDA Data Quality statement

34 Please see full list of footnotes in the definitions and footnote section

Treatment Target ndash Time Series

35

Percentage of people with diabetes achieving their treatment targets by

diabetes type and audit yearEngland and Wales

Type 2 and other3

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

HbA1c

lt 58 mmolmol665 658 649 668 661 657

Blood pressure

lt 14080 614 666 686 736 742 736

Cholesterol

lt 5mmolL780 774 767 778 775 771

Meeting all three treatment

targets 351 374 373 414 410 402

Treatment targets - Locality Variation Type 2

36

The range of CCGLHB treatment target achievements for people with Type

2 and other diabetes 2015-2016England and Wales

0 10 20 30 40 50 60 70 80 90 100

Meet all three treatment targets

Cholesterol lt5mmolL

Cholesterol lt4mmolL

BP lt=14080

HbA1c lt=86mmolmol (100)

HBA1C lt=58mmolmol (75)

HbA1c lt48mmolmol (65)

Percentage of patients

Treatmenttarget

T2 Treatment Targets ndash Salford Practices

37

HbA1clt58mmolmol (75)

BPlt14080

652

755

T2 Treatment Targets ndash Newham Practices

38

HbA1clt58mmolmol (75)

BPlt14080

634

787

T2 Treatment Targets ndash Barnet Practices

39

HbA1clt58mmolmol (75)

BPlt14080

674

720

40

So What Could Explain the Variation

bull Just Normal Cause Variation

bull Multivariate Statistical models show that Care Process Completion Rates

ARE appreciably explained by age sex duration and type of diabetes

ethnicity social deprivation (C statistic 08+)

bull Multivariate Statistical models show that Treatment Target Achievement

rates ARE NOT appreciably explained by age sex duration and type of

diabetes ethnicity social deprivation (C statistic 06)

bull Can that Really be True

41

ldquoClosing off the escape routesrdquo

I see that our diabetes treatment targets are

lower than others but we have an older

populationhelliphellip

Our practice is sitting in a deprived area

which is very different to practices

generallyhellip

Therersquos variation here because wersquore not the

same as our local CCGs ndash wersquore different with

high numbers of ethnic minoritieshellip

43

CCG average T2 DM Treatment Target Rates

lowest two

IMD Quintiles

HbA1c

lt58mmolmol

BPlt14080

England 458 659 737

Salford 718 652 755

Newham 824 634 787

Barnet 296 674 720

44

T2 Treatment Targets ndash Salford Practices

45

HbA1clt58mmolmol (75)

BPlt14080

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

Treatment targets - Locality Variation Type 2

36

The range of CCGLHB treatment target achievements for people with Type

2 and other diabetes 2015-2016England and Wales

0 10 20 30 40 50 60 70 80 90 100

Meet all three treatment targets

Cholesterol lt5mmolL

Cholesterol lt4mmolL

BP lt=14080

HbA1c lt=86mmolmol (100)

HBA1C lt=58mmolmol (75)

HbA1c lt48mmolmol (65)

Percentage of patients

Treatmenttarget

T2 Treatment Targets ndash Salford Practices

37

HbA1clt58mmolmol (75)

BPlt14080

652

755

T2 Treatment Targets ndash Newham Practices

38

HbA1clt58mmolmol (75)

BPlt14080

634

787

T2 Treatment Targets ndash Barnet Practices

39

HbA1clt58mmolmol (75)

BPlt14080

674

720

40

So What Could Explain the Variation

bull Just Normal Cause Variation

bull Multivariate Statistical models show that Care Process Completion Rates

ARE appreciably explained by age sex duration and type of diabetes

ethnicity social deprivation (C statistic 08+)

bull Multivariate Statistical models show that Treatment Target Achievement

rates ARE NOT appreciably explained by age sex duration and type of

diabetes ethnicity social deprivation (C statistic 06)

bull Can that Really be True

41

ldquoClosing off the escape routesrdquo

I see that our diabetes treatment targets are

lower than others but we have an older

populationhelliphellip

Our practice is sitting in a deprived area

which is very different to practices

generallyhellip

Therersquos variation here because wersquore not the

same as our local CCGs ndash wersquore different with

high numbers of ethnic minoritieshellip

43

CCG average T2 DM Treatment Target Rates

lowest two

IMD Quintiles

HbA1c

lt58mmolmol

BPlt14080

England 458 659 737

Salford 718 652 755

Newham 824 634 787

Barnet 296 674 720

44

T2 Treatment Targets ndash Salford Practices

45

HbA1clt58mmolmol (75)

BPlt14080

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

T2 Treatment Targets ndash Salford Practices

37

HbA1clt58mmolmol (75)

BPlt14080

652

755

T2 Treatment Targets ndash Newham Practices

38

HbA1clt58mmolmol (75)

BPlt14080

634

787

T2 Treatment Targets ndash Barnet Practices

39

HbA1clt58mmolmol (75)

BPlt14080

674

720

40

So What Could Explain the Variation

bull Just Normal Cause Variation

bull Multivariate Statistical models show that Care Process Completion Rates

ARE appreciably explained by age sex duration and type of diabetes

ethnicity social deprivation (C statistic 08+)

bull Multivariate Statistical models show that Treatment Target Achievement

rates ARE NOT appreciably explained by age sex duration and type of

diabetes ethnicity social deprivation (C statistic 06)

bull Can that Really be True

41

ldquoClosing off the escape routesrdquo

I see that our diabetes treatment targets are

lower than others but we have an older

populationhelliphellip

Our practice is sitting in a deprived area

which is very different to practices

generallyhellip

Therersquos variation here because wersquore not the

same as our local CCGs ndash wersquore different with

high numbers of ethnic minoritieshellip

43

CCG average T2 DM Treatment Target Rates

lowest two

IMD Quintiles

HbA1c

lt58mmolmol

BPlt14080

England 458 659 737

Salford 718 652 755

Newham 824 634 787

Barnet 296 674 720

44

T2 Treatment Targets ndash Salford Practices

45

HbA1clt58mmolmol (75)

BPlt14080

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

T2 Treatment Targets ndash Newham Practices

38

HbA1clt58mmolmol (75)

BPlt14080

634

787

T2 Treatment Targets ndash Barnet Practices

39

HbA1clt58mmolmol (75)

BPlt14080

674

720

40

So What Could Explain the Variation

bull Just Normal Cause Variation

bull Multivariate Statistical models show that Care Process Completion Rates

ARE appreciably explained by age sex duration and type of diabetes

ethnicity social deprivation (C statistic 08+)

bull Multivariate Statistical models show that Treatment Target Achievement

rates ARE NOT appreciably explained by age sex duration and type of

diabetes ethnicity social deprivation (C statistic 06)

bull Can that Really be True

41

ldquoClosing off the escape routesrdquo

I see that our diabetes treatment targets are

lower than others but we have an older

populationhelliphellip

Our practice is sitting in a deprived area

which is very different to practices

generallyhellip

Therersquos variation here because wersquore not the

same as our local CCGs ndash wersquore different with

high numbers of ethnic minoritieshellip

43

CCG average T2 DM Treatment Target Rates

lowest two

IMD Quintiles

HbA1c

lt58mmolmol

BPlt14080

England 458 659 737

Salford 718 652 755

Newham 824 634 787

Barnet 296 674 720

44

T2 Treatment Targets ndash Salford Practices

45

HbA1clt58mmolmol (75)

BPlt14080

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

T2 Treatment Targets ndash Barnet Practices

39

HbA1clt58mmolmol (75)

BPlt14080

674

720

40

So What Could Explain the Variation

bull Just Normal Cause Variation

bull Multivariate Statistical models show that Care Process Completion Rates

ARE appreciably explained by age sex duration and type of diabetes

ethnicity social deprivation (C statistic 08+)

bull Multivariate Statistical models show that Treatment Target Achievement

rates ARE NOT appreciably explained by age sex duration and type of

diabetes ethnicity social deprivation (C statistic 06)

bull Can that Really be True

41

ldquoClosing off the escape routesrdquo

I see that our diabetes treatment targets are

lower than others but we have an older

populationhelliphellip

Our practice is sitting in a deprived area

which is very different to practices

generallyhellip

Therersquos variation here because wersquore not the

same as our local CCGs ndash wersquore different with

high numbers of ethnic minoritieshellip

43

CCG average T2 DM Treatment Target Rates

lowest two

IMD Quintiles

HbA1c

lt58mmolmol

BPlt14080

England 458 659 737

Salford 718 652 755

Newham 824 634 787

Barnet 296 674 720

44

T2 Treatment Targets ndash Salford Practices

45

HbA1clt58mmolmol (75)

BPlt14080

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

40

So What Could Explain the Variation

bull Just Normal Cause Variation

bull Multivariate Statistical models show that Care Process Completion Rates

ARE appreciably explained by age sex duration and type of diabetes

ethnicity social deprivation (C statistic 08+)

bull Multivariate Statistical models show that Treatment Target Achievement

rates ARE NOT appreciably explained by age sex duration and type of

diabetes ethnicity social deprivation (C statistic 06)

bull Can that Really be True

41

ldquoClosing off the escape routesrdquo

I see that our diabetes treatment targets are

lower than others but we have an older

populationhelliphellip

Our practice is sitting in a deprived area

which is very different to practices

generallyhellip

Therersquos variation here because wersquore not the

same as our local CCGs ndash wersquore different with

high numbers of ethnic minoritieshellip

43

CCG average T2 DM Treatment Target Rates

lowest two

IMD Quintiles

HbA1c

lt58mmolmol

BPlt14080

England 458 659 737

Salford 718 652 755

Newham 824 634 787

Barnet 296 674 720

44

T2 Treatment Targets ndash Salford Practices

45

HbA1clt58mmolmol (75)

BPlt14080

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

So What Could Explain the Variation

bull Just Normal Cause Variation

bull Multivariate Statistical models show that Care Process Completion Rates

ARE appreciably explained by age sex duration and type of diabetes

ethnicity social deprivation (C statistic 08+)

bull Multivariate Statistical models show that Treatment Target Achievement

rates ARE NOT appreciably explained by age sex duration and type of

diabetes ethnicity social deprivation (C statistic 06)

bull Can that Really be True

41

ldquoClosing off the escape routesrdquo

I see that our diabetes treatment targets are

lower than others but we have an older

populationhelliphellip

Our practice is sitting in a deprived area

which is very different to practices

generallyhellip

Therersquos variation here because wersquore not the

same as our local CCGs ndash wersquore different with

high numbers of ethnic minoritieshellip

43

CCG average T2 DM Treatment Target Rates

lowest two

IMD Quintiles

HbA1c

lt58mmolmol

BPlt14080

England 458 659 737

Salford 718 652 755

Newham 824 634 787

Barnet 296 674 720

44

T2 Treatment Targets ndash Salford Practices

45

HbA1clt58mmolmol (75)

BPlt14080

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

ldquoClosing off the escape routesrdquo

I see that our diabetes treatment targets are

lower than others but we have an older

populationhelliphellip

Our practice is sitting in a deprived area

which is very different to practices

generallyhellip

Therersquos variation here because wersquore not the

same as our local CCGs ndash wersquore different with

high numbers of ethnic minoritieshellip

43

CCG average T2 DM Treatment Target Rates

lowest two

IMD Quintiles

HbA1c

lt58mmolmol

BPlt14080

England 458 659 737

Salford 718 652 755

Newham 824 634 787

Barnet 296 674 720

44

T2 Treatment Targets ndash Salford Practices

45

HbA1clt58mmolmol (75)

BPlt14080

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

43

CCG average T2 DM Treatment Target Rates

lowest two

IMD Quintiles

HbA1c

lt58mmolmol

BPlt14080

England 458 659 737

Salford 718 652 755

Newham 824 634 787

Barnet 296 674 720

44

T2 Treatment Targets ndash Salford Practices

45

HbA1clt58mmolmol (75)

BPlt14080

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

CCG average T2 DM Treatment Target Rates

lowest two

IMD Quintiles

HbA1c

lt58mmolmol

BPlt14080

England 458 659 737

Salford 718 652 755

Newham 824 634 787

Barnet 296 674 720

44

T2 Treatment Targets ndash Salford Practices

45

HbA1clt58mmolmol (75)

BPlt14080

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

T2 Treatment Targets ndash Salford Practices

45

HbA1clt58mmolmol (75)

BPlt14080

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

46

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

Treatment Target ndash By Age

47

Percentage of people with Type 2 diabetes achieving all three treatment targets

by age 2015-2016England and Wales

0

10

20

30

40

50

60

70

80

90

100

20 30 40 50 60 70 80

Percentage

Age of person with diabetes

Type 2 and Other

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

48

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

49

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

50

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

51

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

52

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

53

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

54

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

Conclusions

bull Treatment target variation does not seem to be

explained by differences in patient characteristics

bull Some of the treatment target variation is not lsquonormal

causersquo

bull People of Working Age and younger should be a

priority for improving Treatment Target Achievement

Rates

bull Change is possible

bull Practices can use NDA results with confidence

ndash to benchmark themselves and select priorities for

improvement

ndash to measure the effectiveness of their improvement

projects

55

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

RCGP QUALITY IMPROVEMENT TOOLKIT

FOR DIABETES CARE

Roger Gadsby NDA GP Lead

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

WHY NOW

Increasing demandIncreasing complexityIncreasing elderlyPressure on resources

Improvements need to be effective efficient and sustainable

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

THE QUALITY IMPROVEMENT WHEEL

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

PILOT PROJECT

bull Betsi Cadwaladr ndash 8 practices

bull Wiltshire ndash 5 practices

bull Southport ndash 9 practices

bull Walsall ndash 7 practices

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

USEFUL QI TOOLS

bull Context

bull Process Mapping

bull Fishbone diagrams

bull Model for improvementPDSA

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

CONTEXT CHECKLIST

bull Culturebull Leadershipbull Team working bull Technological bull Capacitybull Socialdemographicsbull Capabilitybull Opportunitybull Motivation

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

CONTEXT CHECKLIST

bull Immediate solutionsndash leader

technology

bull Solutions difficultndash involve patients

time

motivate others in QI

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

PROCESS MAPPING

bull Used in process of review appointments

bull Used in first abnormal HbA1C to first appointment with diabetes nurse

bull Areas to improve ndash invitations

dealing with results

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

FISHBONE DIAGRAM

TARGET

BP NOT

MET

DOCTORPATIENT

PROCESS

Poor concordancewith therapy

Side effects

Maximum Tolerated therapy

BP not being taken

Abnormal BPs not being followed up

No search for abnormal BP

Abnormal BPs not being followed up

No prompt on computer screen

Not aware of target

Does not believe target appropriate

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

COMMON AREAS FOR IMPROVEMENT

bull Process ndash ACRs

Numbers attending for review

Responding to HbA1C results

bull Targets ndash cholesterol

HbA1C

Blood pressure

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

SATISFACTION WITH TOOLS

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

DATA

bull National Diabetes Audit

bull QOF

bull PRIMIS

bull Eclipse

bull Audit plus

bull Practice soft ware systems

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

DISPLAYING DATA

bull Line graph - HbA1C lt 58

cumulative ACRs

bull Run chart ndash foot checks

cholesterol lt 5

bull Visual display

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

QI GUIDES - GENERIC

bull Quality improvement for General Practice

bull Mini guides ndash run charts

process mapping

MFIPDSA

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

TRAINING MATERIALS

bull Presentation

bull Group work ndash context

process mapping

MFIPDSA

run charts

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

PROJECT MANAGEMENT TOOLS

bull Follow up check list

bull Multi practice plan

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

REPORT AND EVALUATION

bull As submitted to HSCIC (Now NHS Digital)

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

EVALUATION TOOLS

bull Reflection template

bull Interview template

bull Baseline questionnaire

bull Follow up questionnaire

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

EVALUATION

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

CONTEXTUAL FACTORS

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

PROCESS FACTORS

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

IMPACT

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

Percentage of cholesterol results le 5mmoll 2013-2015

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

PATIENT INVOLVEMENT

Little evidence in projectWebinar

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

ENGAGEMENT

CCG or LHB involvement can have a significant impact on success

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

FURTHER INFORMATION

RCGP QI toolkit for diabetes care

httpwwwrcgporgukclinical-and-researchtoolkitsquality-improvement-toolkit-for-diabetes-careaspx

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

Diabetes care in general practice a person with diabetesrsquo experience

Marianne Littleford

Patient representative NDA Partnership Board

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399

GET IN TOUCHwwwdiabetesorguk

healthcarediabetesorguk

0345 123 2399