Quality improvement

The quality improvement wheel for primary care illustrates the main elements to consider in design, delivery and evaluation of a quality improvement project, acting as a guide to the stages involved. The different sections of the quality improvement wheel are explained below.

The Quality Improvement wheel for primary care

Download the Quick guide: The QI Wheel for Primary Care published by the Royal College of General Practitioners (RCGP)

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1. Culture and context

Culture and context is at the centre of the wheel as without a desire to experiment and a supportive attitude to trying something new it will be hard for change to occur or be sustained, regardless of what tools or methods you use.

Culture and context are the soil in which the intervention will germinate. The soil needs to be as favourable as possible to ensure the intervention is successful. Context is the local and national environment in which you operate.

Culture covers your practice values, attitudes and ways of working. It includes your practice team, patients and stakeholders – how you involve them and interact together on a daily basis. Your patients and stakeholders are therefore included at the heart of the quality improvement wheel.

The tools below will help you to analyse your own context and culture, which will enable you to find the best way to create a context which is supportive of the change(s) you wish to make.

RCGP quick guide: The QI Wheel for Primary Care

This RCGP quick guide explains the quality improvement wheel for primary care – a simple visual representation which illustrates the the main elements to consider in design, delivery and evaluation of a quality improvement project, acting as a guide to the stages involved.

RCGP quick guide: Context and culture

This RCGP quick guide helps practitioners to reflect on the context or environment in which a quality improvement intervention is to be introduced.

2. The quality improvement cycle

These are the implementation steps for a cycle of quality improvement. It is broken down into four steps. Consider each of the four steps as a way of framing the implementation of your quality improvement project.

Step 1: Diagnose – assess the area of your practice or organisation that requires improvement and generate some baseline data.

Step 2: Plan and test – decide the aims, methods and monitoring of your change. You can also test your intervention in a graded fashion.

Step 3: Implement and embed – make any successes part of your systems or processes.

Step 4: Sustain and spread – consider how your aims or intervention can continue to be implemented on a larger scale, if appropriate, and how the conclusions can be made more widely available.

The Quality Improvement cycle
3. Patient involvement

Patients are part of your culture and context. Involving them in our quality improvement work means we see our work through the eyes of the people who need our care. This helps us to design, implement and evaluate each individual quality improvement project.

The position of the patient involvement ring indicates it acts as scaffolding to support any quality improvement project.

The quick guide below provides ideas to harness patient input in the design and delivery of your projects and their measures of success.

RCGP quick guide: Patient involvement

This RCGP quick guide helps practitioners to ensure quality improvement work is designed to improve patients’ experience of care as well as their outcomes.

4. Engagement

Engagement represents all stakeholders relevant to your project. You will have internal stakeholders in your own practice and external stakeholders such as pharmacists, social care services, and health infrastructure bodies at the local and national level.

In a similar way to patients, your stakeholder involvement can support the different stages of your quality improvement project.

The tools below will help you to consider the who, when and how of involving your stakeholders.

RCGP quick guide: Engagement and behavioural change

This RCGP quick guide helps practitioners to think about creating the right conditions for all the individuals involved in improvement to be motivated and able to contribute to the best of their ability.

5. Improvement science

Improvement science is research to identify and demonstrate the best and most appropriate methods for improvement in the quality and safety of health services.

Improvement science is the ‘containing’ ring because it is the big picture context for your quality improvement work.

Once you have made progress on your quality improvement journey and have gained confidence using the approach explained in this guide, the improvement science section signposts you to other improvement methodologies you and your team may wish to explore.

RCGP quick guide: Improvement science

This RCGP quick guide introduces improvement science, a relatively new academic field which aims to identify the best methods for improving the quality and safety of healthcare.

RCGP quick guide: Model for improvement

The model for improvement ensures you and your team are very clear and specific about what you want to improve and how you will know if you have been successful.