February 2010 IMPORTANT
We are asking for your clinical help in producing ideas and examples of changes made in your locality that have made a difference.
If you could tell us of changes that have improved patient care and produced greater efficiency we would be very grateful. We know there are examples in community based management of chronic obstructive pulmonary disease, oxygen services, lung cancer etc. Some of these changes may be quite small and would never get published but actually do make a real difference to the way medicine is delivered. We really want to hear about all examples whether big or small. Please reply in freehand or you may find the box below helpful (download form below). For instance if the problem has been giving IV antibiotics to patients with mild pneumonia this is a problem of overuse, this could be ticked. List the adverse events that come from this and then your solution. On the other hand if the problem is using inappropriate antibiotics or antibiotics for severe pneumonia this would be under-use and then offer your solution. If the problem is shadows being missed on chest x-rays and your solution is that all abnormal x-ray reports are reviewed by a Chest Consultant this would be another example. There may be others as well which you could include.
Action
Please do what you can to complete the box, or answer the question in freehand (download form below); we will try to fill in any gaps and/or contact you to follow up if necessary. We will ensure all members receive a copy of the publication that will be ready in time for the conference on 11 May.
Send your response to the IMPRESS Project Manager, Siân Williams [email protected] by Monday 29 March.
Thank you,
Professor Tony Davison and Dr Steve Holmes, co-Chairs.
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Problem arising from: |
Leading to adverse events |
Leading to poor quality |
Solution – include any comment on timeframe – short term or 3-5 years and comment on cost of implementation* |
Overuse, misuse, underuse, under co-ordination
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Over-use
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Under-use |
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Misuse |
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Under co-ordination
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Other |
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Based on Dr John Ovretveit Does improving quality save money? A review of the evidence of which improvements to quality reduce costs to health service providers. Sept 2009 For Health Foundation
Download the form here
Background
The form draws on the report by Dr John Ovretveit Does improving quality save money? A review of the evidence of which improvements to quality reduce costs to health service providers. Sept 2009 For Health Foundation. This categorises opportunities to improve quality in terms of the overuse, underuse, misuse of effective interventions, leading either to poor quality or adverse events. He also adds a further dimension of under-coordination that he claims is the most common cause of poor quality. Examples he gives are: overuse of antibiotics leading to adverse events, overuse of investigations leading to poor quality, misuse of prescriptions, leading to adverse events, underuse of vaccinations leading to adverse events, underuse of effective communication leading to poor quality, and under-coordination of information between providers leading to poor quality. He also argues that many of the examples of improvement in the literature do not give sufficient information about the costs of implementation. He suggests that a successful improvement requires
Evidence of effective change + supportive environment + effective implementation = improvement
Our question also aims to find examples of the two related concepts of efficiency:
Doing thing right (as efficiently as possible, as safely as possible, as effectively as possible), also known as technical efficiency, and
Doing the right things the ones that add most value to the population; also known as allocative efficiency - and the issue for which commissioners are primarily responsible