The Royal New Zealand College of General Practitioners

There is growing interest in the IHI’s Triple Aim framework for quality improvement. That is: improved patient experience, better population health outcomes and more cost-effective care delivery.

This approach caught the imagination of the participants on the recent study tour of North America, described by Fiona Thomson  in her recent column in NZ Doctor. They returned enthusiastic about the possibilities, but also aware of the work ahead of us.

In some areas we have made excellent progress, and have built infrastructure that can provide rapid gains. In others, we need to do more work, particularly perhaps in understanding and improving our patient’s experience of care.

Demonstrating improvement in population health outcomes presents different challenges. We need to agree on the measures we will use, and how best to use them. A measure used for quality improvement within a reflective small group peer review session will have a different impact when used for performance judgement in a more public domain. The report from the Kings Fund  illustrates this conundrum well.

There is also a growing recognition that our ability to achieve real success with the Triple Aim is dependent on achieving integration. The current practice of care delivery in silos, is inefficient, wasteful, does not lead to the best improvement in population health outcomes or the best patient experiences of care.

In February 2012 we will showcase the College’s work on its Quality Agenda at the Quality Symposium. A key objective for this year’s symposium is to learn more about how to enable integrated care.

Since the last symposium, the College has continued to evolve its thinking on quality, which is reflected through its standards, programmes and enablers for quality. We will review the elements required for a well-functioning integrated system, at general practice and health system level, and the web of activities that need to align to support clinicians to embed coordinated care into daily practice.

At a previous College Quality Symposium, Barbara Starfield noted that primary care orientation is more likely to produce better population health outcomes, at lower cost, and with greater user satisfaction. In addition there is more pressure to produce evidence of clinical effectiveness and improved outcomes for patients. This means patient-centred and population oriented approaches must be central to any discussion on integrated care, involving clinician and patient perspectives in service planning and provision.

We are delighted to announce three keynote speakers for the 2012 RNZCGP Quality Symposium. They will help us to understand more about how an integrated system works and how this will help general practice teams to deliver improvements in care to their patients.

Keynote speaker Judith Smith from the Nuffield Trust, is a frequent visitor to New Zealand and has provided advice to the New Zealand health sector. She will summarise the recent evaluation of funding and commissioning models currently supporting integrated health care in the United Kingdom. As well as covering principles and parameters of the emerging integrated environment in the UK, she will inform us about the lessons learnt from the UK and how it relates to the regulatory and financial leverages that are needed to support primary care in New Zealand.

Our second keynote speaker, Glyn Elwyn from the University of Cardiff, has compared other international colleges and the success of their accreditation processes for improving clinical effectiveness. His work to develop the International Family Practice Maturity Matrix provides a valuable benchmarking tool for understanding where to target system improvements. We are interested in the resulting work that has followed from using the matrix. He has created approaches that support the implementation of shared decision making in the NHS. His work has created a platform for enabling patient participation by managing their care through access to decision support. Glyn has co-authored work with Stephen Buetow, who has been actively involved in the early development of Aiming for Excellence and CORNERSTONE.

The third keynote speaker is Dame Carol Black - also a frequent visitor to New Zealand via ACC. Her work has focused on reshaping combinations of primary, secondary, community and social care services. She believes understanding more about patients with long-term conditions, and being clear about what might be expected of those who advise and support them, will greatly assist patient outcomes. Her work in the rehabilitation area has provided valuable insight into the activities that primary care clinicians can use to manage complex health problems related to chronic conditions and co-morbidity.

As you’ll see with all the challenges facing the health sector on the horizon, the 2012 RNZCGP Quality Symposium should be marked on your calendar.  It runs across two days, on 10 and 11 Feb 2012, at the Museum of New Zealand Te Papa Tongarewa, Oceania Room, Wellington.  Please contact Linda Hartstonge at the College if you would like to register for this event ph: 04 550 2846 or linda.hartstonge@rnzcgp.org.nz