Quality Circle in Primary Care

Quality circles (QC) can be applied in the primary care setting in health care. Small groups of medical professionals from similar background meet at a regular interval to discuss and review their clinical practice. “Numerous studies suggest that QCs improve individual and group performance in terms of costs, ordering of tests, prescription habits, and adherence to clinical practice guidelines, thus resulting in better patient outcome measures and changes in performance indicators” (Rohrbasser, 2013).

In a primary care setting, all members of the QC are coming from similar backgrounds with voluntary participation. It is important to have a trained facilitator who can engage the members of the group, support the selection of the issues, reviewing information, and find solutions. Quality circles in the primary care setting can be apply to improve medication prescribing patterns. A study done in Germany show that the quality circles reduced the proportion of patients who received a prescription, and the was a reduction on the mean prescription costs per patient, which an increase on the proportion of generic drugs.

Another example of QC in health care is to improve the outcome of pediatric diabetes care. According to Holl (2002), the outcome of diabetes care for pediatric patients  is still inadequate, and the rate of severe hypoglycemia are less favorable in children and adolescents compared to adults with diabetes. Quality circles enable open discussions on how to organize patient care and approach controversial questions allow the transfer of knowledge and attitudes across all the circle members which will result in better care for pediatric patients with diabetes.

Reference

Holl, R., & Grabert, M. (2002). The quality circle: how to improve the outcome of 

         pediatric diabetes care. Hormone Research, 57 Suppl 1105-109.  

         http://eds.b.ebscohost.com.proxy1.ncu.edu/eds/pdfviewer/pdfviewer?nobk=y&

         sid=1d5c664d-6d16-4aeb-8170-8f915aaeab0f@sessionmgr110&vid=4&hid=101

Rohrbasser, A., Mickan, S. & Harris, J. (2013). Exploring Why Quality Circles Work in 

         Primary Health Care: a Realist Review Protocol. Systematic Reviews Journal. 

         2(110). doi:10.1186/2046-4053-2-110

Application of PDCA to Health Care Processes

         As a continuous quality improvement tool, PCDA are often applied to health care processes instead of individual patients. Although the target is different, the cycle still starts collecting background information and identifying problems under Plan. The managers have to keep in mind that the problem is the gap between the current state and the goal. The following the an application of PDCA cycle to the Emergency department.

Plan:

• Background Information- inconsistent emergency department work practices create a chaotic and exhausting work environment. And emergency department LOS metrics are too high.
• Problem Statement- Inconsistent practices contribute to inefficiencies for the ED discharged home patient with an average LOS of 160 minutes, which is way about the national benchmark of 90 minutes.
• Goal- To achieve the national benchmark level of ED LOS by June 2014.
• Cause Analysis- 1. Insufficient communication on patient readiness. 2. No standard workflow. 3. No standard patient assignment process for physicians. 4. Chart is placed far away from care site.

Do: Create and assigned specific tasks to individual staffs with specific time frame.

Check: measure results periodically. Verify if actual results match the planned results.

Act: Adjust if the existing plan does not work, reassess and make changes as needed. Standardized the process if it worked. Document standard process if solution solved the problem. Ensure ongoing PDCA to sustain results.

It take time for an organization to get through a complete transformation process, sometimes, it is not possible to be completely transformed due to the constantly changing environment, continuous improvement allows the organization to tackle one problem at at time.  

Client IQ Analytics (2012). Measurement and Quality Improvement. Retrieved February 23, 2014, from http://www.qualitick.com/applications.html

Reference  

Advocate Health Care (2012). Continous Improvement Methodology- PDCA. Retrieved from http://www.advocatehealth.com/documents/research/06%20Lipp%20Haussen_PDCA_Presentation.pdf

Application of PDCA to Individual Patients

         As explained in a previous blog, the Plan, Do, Check, Act cycle is an tool used for continuous improvement of products, services, or processes. If utilized correctly, it provides continuous and incremental improvements and removes unnecessary activities and variations providing increased capability, reduced costs, improved efficiency and quality over time ( Advocate, 2012). Health care organization can utilized the PDCA cycle in a wide range of areas.

The PDCA cycle can be applied and tailored to each individual patients. The following is an example of the PDCA cycle

Plan:

• Background information- Gather History and Physical information: Patient fainted after running 4 miles in the morning.
• Problem Statement- Patient is short of breath, elevated heart rate, and fainted shortly after physical exercise. Patient stated that he did not eat breakfast.
• Goal- Upon confirmation of hypoglycemic diagnosis, treat patient until vital signs return to normal range.
• Cause Analysis: CMP lab test drawn identified electrolytes level. Tested for blood glucose level. Result showed blood glucose level below normal range, supporting diagnosis of hypoglycemia.

Do:

Administer D5W IV and electrolyte replacement.

Perform glucose test in every 30 minutes.

Check:

Glucose level return to normal.

Patient does not feel dizzy.

Act:

Ensure patient is provided with education material on nutrition and exercise.

If patient comes back again for some symptoms, check for other possible illness.

Reference

Advocate Health Care (2012). Continous Improvement Methodology- PDCA. Retrieved from http://www.advocatehealth.com/documents/research/06%20Lipp%20Haussen_PDCA_Presentation.pdf