Measurement for Cost and Quality case study Keywords

GP Practice, collection, system, SPC

SPC for GPs

Background
South Street Surgery is a large GP practice which achieved the Committed to Excellence Award from the European Foundation for Quality Management, following the implementation of Lean Six Sigma techniques. The surgery has implemented a culture of measurement and data-driven decisions. It developed: software and a set of metrics to reflect organisational performance; a clinical services scorecard to monitor clinical quality; a trigger tool to monitor safety and other metrics to support commissioning functions.

Description
South Street Surgery has implemented software, developed in-house by a GP partner. The software contains databases relating to a variety of clinical measures, complaints and training. Each database displays the data as Statistical Process Control (SPC) charts, enabling the surgery to link improvement initiatives to the appropriate measures. The system gives real-time access, providing information that is no more than one week old. The measurement system is used extensively to: inform decision-making regarding a variety of measures; monitor performance against services provided; monitor and understand variation in clinical indicators, monitor and understand variation in referrals; and as an improvement tool (this can be seen in the example graph above, which shows a review of gynaecology outpatient referrals and an SPC chart demonstrating the effects of improvements). South Street Surgery has also put the system onto its intranet, making this information freely available to anyone with access to the site.

Issues to consider (successes/barriers)

The measurement system has allowed South Street Surgery to redesign processes of care in a more structured and sustainable way. The surgery received the Committed to Excellence Award from the European Foundation for Quality Management. The key success factors were: having a champion for the cause, leadership commitment and walking the talk; IT expertise and the availability of open source software, which dramatically reduced implementation costs; continuously using and promoting the tool; and employee engagement from key team members and partners. The barriers were: a general reluctance to see the value of measurement at the outset; the need for training in understanding the tool; time and resources; and, until recently, the lack of a burning platform.

Contact us
If you would like more information, please contact: paresh.dawda@nhs.net