Health Needs Assessment and Quality Improvement

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Health Needs Assessment and Quality Improvement

• Dr Luc Seuntjens

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My presentation 3 examples

• Significant event analysis
• European Practice Assessment
• Regional assessment of test-ordering and
  intervention using small quality groups

DISCUSSION
DISCUSSION
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From needs to.quality issues
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A large bouquet of Quality Improvement approaches

• Implementation of clinical guidelines
• Total Quality Management
• Accreditation and Certification
• Patient Empowerment and Partnership
• Organisational Development methods
• Indicators, accountability and transparancy
• Public reporting and physician profiling
• Business Process Reengineering and Business
  Innovation
• Breakthrough Collaboratives
• Clinical pathways, case management, managed care
• Balanced Score Cards
• Risk Management , Significant event analysis
• Knowledge management
• Leadership development
• Etc.

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Quality assessment and quality improvement
(Rhydderch,J Eval Clin Pract. 05)
Externally-led quality assurance/assessment Externally-led quality assurance/assessment Externally-led quality assurance/assessment Internally-led quality improvement
Primary Stakeholder Accrediting agency Government Government Professional body Practice
Purpose commercial accountability regulation accountability regulation self-regulation education service development
Assessment by external assessors (industry based) external assessors external assessors external assessors combined with internal (self) assessment internal (self) assessment
Emphasis accrediting agency-led primary care -led primary care -led GP-led practice-led
Values summative summative summative summative and formative formative
End point certificate certificate licensing contract payment certification local criteria achieved
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Significant event analysis a little girl with
high fever
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Fish bone analysis planning improvement
people
infrastructure
Gap of knowledge
No test material
Missed diagnosis of RSV infection
Not aware of RSV epidemic
Friday night
No assistant present
Laboratory does not provide test
practice
external
Planning Improvement
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Significant event analysis

• Describe the event in a detailed way
• Analyse
• What can be improved?
• Plan actions

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Round table discussion 1

• How do you deal with significant events in your
  practice?
• Discuss the strengths and weaknesses of
  significant event analysis in your specific
  situation.

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Take home messages

• Needs/Quality problems should be analysed
• Needs are not isolated but refer to different
  causes of problems interdependency of needs.
• Significant event analysis is a well-accepted and
  powerful tool to detect needs and initiate
  change.

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European Practice Assessment (Engels,Grol 2005)

• Researchers from 6 European countries developed
  a set of European indicators for management of
  primary care
• 6 national panels rated the indicators and
  achieved a national consensus on a large set of
  indicators
• A pilot test in 9 countries data collection in
  30 practices / country

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EPA domains

• Infrastructure
• Staff
• Information
• Finance
• Quality and safety

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EPA the instrument

• Short self-administered questionnaires
• Principle GP or practice manager
• Individual GPs
• Staff members
• Patients
• Observer/facilitator visits the practice
• Structured interview with GP/PM
• Checklist

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The urgency bag
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The interview
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Feedback (VISOTOOL 04)
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Feedback (Visotool 04)
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Prioritize and plan improving your practice
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NA Planning Cycle
Start
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Quality assessment and quality improvement
(Rhydderch,J Eval Clin Pract. 05)
Externally-led quality assurance/assessment Externally-led quality assurance/assessment Externally-led quality assurance/assessment Internally-led quality improvement
Primary Stakeholder Accrediting agency Government Government Professional body Practice
Purpose commercial accountability regulation accountability regulation self-regulation education service development
Assessment by external assessors (industry based) external assessors external assessors external assessors combined with internal (self) assessment internal (self) assessment
Emphasis accrediting agency-led primary care -led primary care -led GP-led practice-led
Values summative summative summative summative and formative formative
End point certificate certificate licensing contract payment certification local criteria achieved
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Take home messages

• Needs assessment is a team activity
• Needs assessment is successful in a practice
  where improving quality is felt as an internal
  responsibility, as part of normal GP work, of
  identity, of professionalism
• (R.Grol)

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Quality assessment and quality improvement
(Rhydderch,J Eval Clin Pract. 05)
Externally-led quality assurance/assessment Externally-led quality assurance/assessment Externally-led quality assurance/assessment Internally-led quality improvement
Primary Stakeholder Accrediting agency Government Government Professional body Practice
Purpose commercial accountability regulation accountability regulation self-regulation education service development
Assessment by external assessors (industry based) external assessors external assessors external assessors combined with internal (self) assessment internal (self) assessment
Emphasis accrediting agency-led primary care -led primary care -led GP-led practice-led
Values summative summative summative summative and formative formative
End point certificate certificate licensing contract payment certification local criteria achieved
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Prescription rate of antihypertensive drugs in
Belgium
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Regional assessment of test- orderingVerstappen
W, WOK, JAMA May 03

• Involving peer interaction and social
  influence improves physician test-ordering
  behaviour.

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Feedback on test ordering Verstappen W, 2004
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The crucial importance of small group work
Verstappen W, WOK, JAMA, 2003
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Round table discussion 2

• Government organisations put community priorities
  on the "needs" agenda. For example cost-
  efficiency related items.
• How are these priorities in your country/practice
  integrated in your personal or practice CPD
  agenda?

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Take home messages

• Needs of the community/society are to be
  integrated in local improvement projects
• Quality groups can learn to analyse aggregated
  data and prioritize action plans
• The power of peers needs assessment in touch
  with local attitudes