In 2006, Milton Keynes PCT joined with health:mk (the Milton Keynes practice-based commissioning collaborative), the Joint PPI (LINk:MK) and the Centre for Evidence-Based Medicine, University of Oxford, to respond to a call for proposals from The Health Foundation around Engaging with Quality in Primary Care.
The bid was selected from among 170 applicants to benefit from funding from The Foundation over three years, 2007-10. The programme quickly became known as ’Quality:MK’ and much of the work and learning had been around getting research into practice, stakeholder engagement and developing system and process to achieve quality improvement.
Our mantra: three values
Recognising the challenge of implementing and spreading quality improvement initiatives across the system, the programme aimed to improve patient outcomes by shaping a whole system approach to quality improvement, making a reality of three widely used slogans:
It aimed to contribute to health improvement by empowering colleagues to apply these principles, building capability, enabling access to the knowledge base and putting in place efficient processes to drive quality improvements across the system, in a coordinated way.
Sue Lacey-Bryant, Programme Manager, Quality:MK, June 2010
In 2007 the steering group deliberately took an ambitious approach, with multiple projects and work-streams - a mix of innovation driven from the coal-face of primary care, initiatives drilling down from the top, and enabling work to underpin the two. This allowed Quality:MK to observe progress, behaviours and hurdles across multiple projects.
Using a transparent process of priority setting, the project Steering Group chose to support work on six clinical pathways and two ‘bright ideas’ in practice and to initiate and lead an innovative programme to get evidence into practice via journal clubs, which became known as IMPACTE (Improving Medical Practice by Assessing CurrenT Evidence) groups.
The project team
Quality:MK assembled a small, part-time team which drew on the support of the programme Board and the steering group. Eight people from the latter completed leadership development training funded by The Foundation as part of the award, and joint staff team/ ‘award development’ meetings became a key problem-solving group for programme.
The team supported project leads across all the workstreams. Those setting out on large-scale pathway reviews, for example, were leading this work as part of their day job - and indeed a number of staff changes significantly slowed progress in the first 18 months of the programme. Other leads were taking forward pilot projects or developments initiated through Quality:MK. The programme looked to find flexible approaches to contribute to each project.
Three members of the team stayed with Quality:MK throughout the three years: a GP, a librarian and the progamme manager. A project information specialist was quickly recruited, and in all four GP champions worked with Quality:MK. The team itself led on the evidence-based work-stream, and on embedding the learning and new ways of working.
The project approach
The Quality:MK programme worked through:
Building a self-improving system: the approach
Working through this portfolio of projects, an ongoing process of continual self-conscious change was applied to build the infrastructure of a self-improving system within which:
Reporting on outcomes
Project leads were supported in setting performance indicators and evaluating their work. The outcome data below report on five component projects. The final project reports a are in no sense “victory narratives”. They identify challenges and what has not worked well as well as recording progress. For many projects the results cannot be attributed to any one intervention; many activities have had an impact. Hence project leads were asked to comment on how participation in Quality:MK made a difference.
1 Brief interventions in alcohol pilot
“The ability to involve the GP within the TAF group through the availability of funding ... made a significant contribution to the development of the pilot LES. Quality: MK has changed mind sets, with the main winner being public and patient involvement .. right from the beginning... we have talked about it for years but probably never got this embedded in our thinking. Coming in second would be the requirement for good evidence underpinning the service. Third and much more problematic... as I think it is difficult to find interested GPs (even with a little funding). ..“I ..found the requirement for ... reporting difficult especially where this project was so impacted on by external factors, such as the surprise introduction of a national DES at the same time as the new LES was planned..."
“funding was secured for 2 years from Quality: MK ........Benefits of participation ... also included ... Primary Care Trust stakeholders, who provided support and frameworks to complete project data and documentation which contributed to the project’s success ... Quality: MK enabled wider promotion of the work locally which has led to changes in practice in other surgeries and PCT staff ....”
5 Weight management