There is a growing international consensus regarding the impact of organisational elements on the delivery of quality care and as enablers of successful continuous quality improvement. Elements included leadership, practical and human resources; active engagement of all staff; and attention to multifaceted interventions and coordinated action at all levels of the health system, such as investment in training and development of robust and timely data through supported information technology.
The relationship between practice assessment, organisational development and assessment and quality improvement is highly complex. An understanding of the elements of high-performing practices may contribute to the development of organisational and cultural assessment processes, which in turn lead to organisational development relevant to primary care as part of the broader concept of successful continuous quality improvement. Conversely, undertaking successful continuous quality improvement through activities associated with organisational development; using organisational assessment approaches may, in turn, indicate elements integral to high-quality practice performance. Indeed, there is dearth of evidence related to the impact of organisational components of general practice and patient outcomes. However, there is currently no single tool available to general practices combining the traditional areas of practice organisation (clinical governance and the use of information technology) with more contemporary and, as yet, less widely used elements (such as change management and leadership) in an internally facilitated approach.
The development of an innovative approach to continuous organisational quality improvement in primary health care and general practice presented a particular challenge because it had to address the following needs: (i) the capacity to be adapted to variable and dynamic individual service settings; (ii) include elements or characteristics of most relevance to general practice and primary health care; (iii) address both clinical governance and the impact of organisational management as part of an ongoing quality improvement cycle; (iv) be led by Practice Managers as an internal process based on a whole-of-practice approach; and (v) be delivered online and at low cost.
This report describes the three-phase approach to the development, pilot, trial and preliminary validation of a new approach to organisational performance improvement designed for and with, general practice and primary health care services. The initial focus was to identify those elements demonstrated as integral to high quality practice performance. For the purpose of this study, practice organisation was defined as systems, structures and processes which aim to facilitate or enable the delivery of good quality patient care’, but which exclude clinical processes and clinical outcomes.
Following this, we developed and piloted the Primary Care Practice Improvement Tool (PC-PIT) with a focus on determining content and process validity. The final phase was the national trial and validation of the PC-PIT with 15 practices nationwide. The findings from each phase, including the cyclical feedback from end users, partners and stakeholders, informed the direction and focus of each subsequent phase. Ethics approval was granted by the University of Queensland Behavioural and Social Sciences Ethical Review Committee. The national trial is ongoing with results from a further ten practices available in early 2015. The final section of this report looks towards embedding the PC-PIT approach in existing quality improvement programs.