A Journey of Excellence in General

Practice

Paresh Dawda
South Street Surgery, Bishop’s Stortford
 Abstract
•In 2006 South Street Surgery, a large 20000 patient training practice, embarked upon a journey of excellence

Background and the practice was one of the first in the country to be awarded the European Foundation of Quality
Management’s (EFQM) Committed to Excellence Award.
•The aim was to become a “transformational organisation” in which quality improvement is part of everyone’s
job and for improvement to happen in a structured measured manner so that it was sustainable.

•An organisational audit using a multifaceted approach with the EFQM’s Excellence Model as a framework
was conducted. Existing metrics e.g. patient surveys, data from QOF, complaints and financial performance
were analysed. A staff survey was conducted and the partners and management team completed a self

Method assessment tool. An external facilitator undertook one to one interviews with partners, managers and small
group interviews with staff.
•Feedback workshops with the partners were held and an organisational development plan was developed
and implemented. This was communicated to all staff using a variety of methods. As improvement projects
have taken place using quality improvement tools such as lean or six sigma members of staff have been
increasingly involved in improvement events.

•We have become a more patient centred and process based organisation. The project is ongoing but a

Results number of benefits have already been identified including improvement to patient telephone access, a
reduction in patient complaints, an improvement in follow up staff questionnaires, and the establishment of
a patient forum to engage patients more.

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 South Street Surgery

A large General Practice with a registered list size of

20,000 patients. It operates over split sites and is a
multidisciplinary teaching practice.

Ten partners including one nurse partner,

approximately 50 employed staff in addition to an
attached Primary Health Care Team. It provides a
number of essential, additional and enhanced services
under the nGMS contract framework.

The practice’s mission is to be ‘Delivering Excellence in

Healthcare’ and it's vision is ‘To be recognised as an
excellent healthcare organisation’.

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 Introduction
The Start

• The practice embarked on this journey in 2006. Initially the objectives were not very clear. To define the
objectives more precisely the author therefore discussed the ideas and expectations with partners
individually. The emerging themes were very varied and non-specific. For example, comments included
phrases such as “to bring about change more effectively”, “overhaul everything and start from scratch”,
and “to change the culture of the practice”. However, culture is very complex.

Organisational Audit

• It was agreed that the aim of this project would be to perform an organisational audit using a
multifaceted approach and use the results of that audit to produce an organisational development plan.

Excellence Model

• This needed a tool that is valid, reproducible and applicable to healthcare. It was agreed to use the
European Foundation Quality Management (EFQM) Excellence Model (EFQM, 1992) as the instrument.

Benefits Anticipated

• Patients: An improved culture of the practice will mean that it is more driven by patient needs and the
“Voice of the Customer.” This will ultimately lead to improved patient focused care that will ultimately
benefit the patients of the practice.
• Practice: An increase in efficiency of the practice will enable it to make better use of resources and at the
same time increase staff satisfaction and morale
• NHS: Locality & PCT & Sharing good practice

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 The Excellence Model
The Excellence Model
• Encompasses 9 criteria
• There are 5“enabler”
criteria
• There are 4 “results”
criteria
• They have different
weighting
• Innovation and Learning is a
critical success factor
Enablers
• We focused on this area
• We used a multifaceted
approach
• Partners and management
completed Business
Excellence Survey
• Staff completed a staff
survey
• An external facilitator
interviewed all staff and
partners
Results
• We used existing results to
inform the right hand side of
the model
• Financial results
• QOF
• Patient Complaints
• Patient Surveys
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 Outcome
•Clarification of values, mission and vision, to help
communicate business goals to staff and patients.
Leadership •Develop a business management structure with training for
partners in leadership and management.

Policy and •Explicit short and long term objectives as part of a cohesive
strategy.
•Move to process based management to help with decision
Strategy making and implementation.

Partnership •Develop a financial strategy with management accounting

system.
and •Need to improve partnership working with existing players in
primary care e.g. PCT, locality groups, new entrants and
Resources voluntary sector.

•Improve learning from bottom up by encouraging feedback,

empowerment and innovation.
People •Skills assessment and objective setting for all staff, including
non-clinical staff.

•Improve customer focus by seeking and listening to feedback

and acting accordingly.
Processes •Move to a structure of process based management with a
development strategy.

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 Organisational Structure
The key change was to create a two dimensional organisational structure combining
the traditional organisational chart with the new process based architecture.

Organisational Chart Process Based Architecture

Partners

Business
Excellence
Director

Business
Support
Administrator

Practice
Practice Services
Salaried Doctors Nurse HCA Administration
Manager
Manager

Medical
Receptionists
Secretaries

Finance
Rota Supervisor
Administration

Private Income
Administration

Summarisers

Coders

Results
Administration

General
Administration
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 How it works

• Each Process has a lead which is a Partner or Manager

The Business Excellence Committee

Process Lead
monitors the other process and
provides the leadership.

• The process leads put together a process team

• e.g. The ‘Recording and Monitoring Process’ is a team consisting of Lead Partner, Practice
Administration Manager and representation from the summarisers and coders
Process Team

• There is a programme of regular meetings for each of the process teams

• Process issues are discussed in those teams and ideas for improvement are put forward
• Decision making previously made at partnership meeting has been devolved to process
Process Work teams

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 Quality Improvement
Projects

• There are a large number of projects identified 45

Vision and mission/
for improvement strategy
• BEC prioritises the projects based strategy 40 Technology
agreed by partners
35 Recording &
Monitoring
Systemic Approach
30 People
• Quality improvement in undertaken using proven
25 Patient Relationships
methods such as The Improvement Method,
Lean or Six Sigma 20
• Staff are all involved in improvement Patient Care

• Patient focus is key to each and every 15

improvement New premises
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Health & Safety
Dashboard 5
Finance
• We have an internal dashboard that monitors 0
our progress against our strategy and our own
External Relationships
KPI
• We are developing a data warehouse and
Developing products
implementing Business Process Intelligence and services
systems

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 Achievements
Patient Focus
• Patient Participation Group
• Improved communication with patients via website and regular newsletters
• Patient Involvement : A number of methods of seeking patient views are used including a survey
website through which we can obtain patient views using surveys

Scorecard
• We use a number of metrics to monitor our service and quality of care
• We have seen improvements in patient telephone access, complaints, staff satisfaction
• We are using tools such as the “Primary Care Trigger Tool”, as well as significant event auditing, staff
reporting and clinical audit to improve patient safety and care

Recognition
• We are one of the practices in the country to achieve the European Foundation of Quality
Management’s Committed to Excellence Award and are progressing towards the next level known
as Recognised for Excellence
• We are members of the British Quality Foundation and have also achieved Investors in People
• We have had a number of write ups about our work and have members of the practice have
presented at National Conferences such as Lean and Six Sigma in Healthcare.

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