‘Collaborative method’ benefits all

“Plunging into the abyss was a steep learning curve and as we replaced ignorance with knowledge we began to realise the task was achievable. We recognise that the quality improvement tool [the Collaborative method] has even broader applications than we previously thought and that the process can be extrapolated to other areas of general practice.”
Michael Pelmore, Meadows Medical Centre, Mullumbimby,

“We all aim to provide a high quality standard of care, but often get caught up just coping with each day as it happens. I saw the collaborative as a way to help organise our practice to look at the bigger picture. When there are a large number of practices working towards the same targets there is the possibility to produce dramatic improvements in health outcomes. The results from the UK regarding reduction in coronary deaths are stunning, 50% reduction over 5 years.”
Lynne Davies, Tintenbar Medical Centre

“What a great opportunity to be involved in something that will actually make a difference to the lives of patients, GPs and practice staff. Having now attended the first training workshop I am so excited by the prospect of sharing the journey with such a fantastic team. What a great bunch of courageous people!”
Sandi Hill, Collaboratives Program Manager

“The most stimulating aspect of working with the Collobarative program is sharing ideas and solving problems with other practices. All practices seem to face similar issues. The collobarative process derives its power from working together ‘to turn the possible into the usual’.”
Tony Lembke, Alstonville Clinic

“It's an opportunity to look at medical practice more holistically as a system and ensure that the web of care is a little more integrated. Finally we get paid to look at the big picture!”
Jacqueline Boustany, Nimbin Medical Centre

Collaborative collaboration
There is often confusion between the Collaborative method and collaboration in general. The Collaborative method has a specific approach, which is user friendly and simple. It works because of the simplicity, support and framework, which allows for protected time for participants to spend together solving problems as a team.

The Collaborative approach is a tried and tested method, developed in the USA, which has been applied to a range of management challenges, including health care systems in Australia, the USA and Sweden, and most recently and effectively through the National Primary Care Development Team in the UK.

How it works
A Collaborative is a time-limited method for spreading and adapting existing knowledge to multiple sites to achieve a common aim. It consists of a series of learning workshops interspersed with action periods during which measures common to the participating sites are used to track progress. Practical ideas that have resulted in improved systems form the basis for the workshops, together with teaching on the techniques of implementation.

The model for improvement
1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
3. What changes can we make that will result in improvement?

Plan Do Study Act
PDSA stands for Plan, Do, Study, Act. It’s a model for testing ideas that you think may create an improvement. It can be used to test ideas for improvement quickly and easily based on existing ideas, research, feedback, theory, review, audit, etc or practical ideas that have been proven to work elsewhere.

EXAMPLE
Objective
To improve BP control for patients with CHD

Plan
Practice manager to identify 5 CHD patients from the CHD register with BP greater than 140/85 by a certain date. Receptionists to contact patients by telephone to offer appointments with the practice nurse. Measure date of last attendance, BP, medication compliance.

Do
Plan is carried out.

Study

Two additional patients were seen opportunistically.
Six patients seen and one did not attend.
All patients had been seen in previous 4 months.
Control of BP had been difficult:
4 patients were overweight, 1 obese.
All patients did very little or no physical exercise.
All patients except one reported that they comply with medication.

Act

Medication compliance is difficult to assess: arrange meeting with doctors to discuss alternative methods of compliance.
Patients to be followed up more frequently by practice nurse.
Exercise program aimed at this group to be considered.
Doctors to review medication again at the next follow-up visit.

PDSA tips and hints

Keep it simple and very specific.
Keep it small and manageable to start with. Massive projects can be broken down into a number of small, quick PDSA cycles.
Cycles should happen quickly - think in terms of a week not a month.
There is no wrong answer, if you find something that works - use it.
Copy and adapt other people’s ideas if you think they might be useful.
Many make the error of filling in the ‘Plan - Do - Study – Act’ columns at the outset. You can of course only complete Plan and DO until the cycle has run.

Information for this article was taken with permission from the NPCC website and handbook. www.npcc.org.au