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The work of general practice
Published in Peter Davies, Lindsay Moran, Hussain Gandhi, Adrian Roebuck, Clare J Taylor, The New GP′s Handbook, 2022
There is now a more explicit recognition that the quality of medical care needs to be assessed, measured and improved. Over the last 10 years we have seen the emergence of the medical appraisal system, the move to revalidation, and new roles in local primary care such as appraisers, appraisal leads and medical directors. Once revalidation is launched, responsible (for performance) officers will emerge. This work is crucial to improving the quality and consistency of primary care, and to trying to reduce unwarranted variations between doctors and practices. This work is likely to expand over time and create more vacancies for GPs. It is interesting and important work.
Organisational structure
Published in Stephen Gillam, Paul Cosford, Leadership and Management for Doctors in Training, 2021
Harrison has defined a dominant form of rationality underpinning contemporary health- and social care policy, which he terms the ‘scientific bureaucratic’ model.5 This centres on the assumption that valid and reliable knowledge is mainly to be obtained from the accumulation of research conducted by experts according to strict scientific criteria Working clinicians are held to be too busy or insufficiently skilled to interpret and apply such knowledge themselves. Professional practice is therefore to be driven by the systematic aggregation and distillation of research findings into protocols, algorithms and guidelines. These are then communicated to practitioners with the expectation that practice will be improved. He argues that this approach is scientific in providing rational foundations for clinical decisions but deficient in taking account of what changes clinical behaviour. The challenge here is to distil research findings into guidelines for best clinical practice - in order to reduce the unwarranted variation that occurs when professionals simply take their own (some-times idiosyncratic) view on treatments - without undermining professionalism. Medical Royal Colleges and the National Institute for Health and Clinical Excellence (NICE) seek to promote quality improvement and clinical audits while avoiding overly prescriptive protocols that could form the basis of unthinking regulation.
Treat improvement like an experiment and measure it
Published in Amar Rughani, Joanna Bircher, The Leadership Hike, 2020
QI data is different – it usually doesn’t need you to understand statistics, just be able to follow simple rules.It’s too complicatedData can often look, and be, very complicated. But it doesn’t have to be. Looking back at our experience of general practice data and how it is presented to us over the years tells us where this impression comes from. Supporting GPs, nurses and trainees with clinical audit over the years has shown us that we often make the data complicated ourselves. When conducting an audit we choose too many indicators, and choose indicators that can only be measured by either manually looking through individual patient records, or rely too heavily on, often inaccurate or variable clinical coding. This kind of data is time-consuming to gather, frustrating to interpret and often ineffective at measuring improvement. The other type of data we see is data about how our practice is interacting with the wider health service, such as our referral and admission data. This can sometimes be overwhelming, presented as a spreadsheet and lack any useful guidance on how to interpret it, or how to tell the difference between expected variation and unwarranted variation.
Obstetrics and gynaecology: one specialty or two?
Published in Journal of Obstetrics and Gynaecology, 2023
The national median rate for laparoscopic hysterectomy for benign indications in women <50 years in the NHS was only 42.1% (range 21.2–84%) in Q3 of 2022/2023 (NHS Model Health System 2023). Getting It Right First Time (GIRFT), a national programme designed to improve the treatment and care of patients, had set a national benchmark of 77.7% (Richmond and Sherwin 2021). The contemporary health services in the developed countries are committed to reduce unwarranted variations in clinical practice and outcomes, health inequalities and access to care. This very low rate of laparoscopic hysterectomy in the UK defeats the concept of equality in providing health care where women served by hospitals offering laparoscopic surgery, by focussed high volume specialists, are privileged when compared with others.
Academic detailing in oral healthcare – results of the ADVOCATE Field Studies
Published in Acta Odontologica Scandinavica, 2020
Fatiha Baâdoudi, Denise Duijster, Neal Maskrey, Fatima M. Ali, Kasper Rosing, Geert J. M. G. van der Heijden
Reducing variation is a key in optimizing oral healthcare delivery. ‘Optimal quality care’ refers to care that is accessible, reliable, efficient and based on the best available evidence, and incorporating individual patient preferences [1,2]. Even though all stakeholders aim for optimal quality care, actual care may vary in many aspects including safety, effectiveness, equity and the individualization of care using the values and preferences of patients. Unwarranted variation in care delivery should concern oral health professionals, as it may indicate wasteful, ineffective practices and the possibility that care is not optimally serving the needs of the patient. This may be due to, for example, mistaken or limited individual professional knowledge, attitudes or skills, or disparate organizational performance [3].
Improving oral healthcare using academic detailing – design of the ADVOCATE Field Studies
Published in Acta Odontologica Scandinavica, 2019
F. Baâdoudi, D. Duijster, N. Maskrey, F. M. Ali, S. Listl, H. Whelton, G. J. M. G. van der Heijden
Reducing unwarranted variation in preference-sensitive care for discretionary treatments requires a better evidence base, a better understanding of the current evidence base, transparency of care delivery and changes in the way conversations with patients are undertaken and decisions are reached. Academic detailing (AD) is an approach which has the potential to achieve these aims [17]. As originally described, AD is a university or non-commercial-based educational outreach which involves face-to-face education of healthcare practitioners by other trained healthcare professionals, often peers. It can be used to improve the dissemination and uptake of evidence-based practice, the aim being improved patient care, reduced unwarranted variation and possibly reduced healthcare costs [18,19].