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World Book of Family Medicine – European Edition 2015 Alexandre Gouveia, MD, GP alexandre.gouveia@me.com 76 – Drafting A Practice Professional Development Plan: A Learning Exercise Using A Continuous Quality Improvement Approach Alexandre Gouveia, MD, GP Department of Ambulatory Care and Community Medicine, Polyclinique Médicale Universitaire, Lausanne, Switzerland Primary health care services are still provided in many GP single-handed practices around the world. However, primary health care is increasingly being delivered by practices with multidisciplinary teams that include doctors, nurses, health care assistants, receptionists, physiotherapists, psychologists, and social workers, among many others. A team is, by definition, a group of people that have complementary skills and generate synergy through a coordinated effort, which allows each member to maximize their strengths and minimize their weaknesses. However, each team member has a specific set of knowledge, skills and attitudes, as well as personal values, experiences and ambitions. Teams are a highly challenging and enthusiastic environment to work in and to work with. To be able to face the daily requests of patients and challenges posed by health administrations and primary care organisations, teams need to be open to change, to be innovative, multi-skilled and efficient, well managed and popular while respected in the community. Team members can only reach this high level of performance if they concentrate efforts while being coordinated by a leading member. Leadership is nowadays recognized as an increasingly fundamental skill that needs to be developed and trained by every primary care doctor. However, only some will master the five skills defined by the Clinical Leadership Competency Framework: Demonstrating Personal Qualities Working with Others Managing Services Improving Services Setting Direction The Working Party on Quality Improvement from the World Organization of Family Doctors (WONCA) defined quality in primary care as being “the best health outcomes that are possible, given available resources, and that are consistent with patient values and preferences”. To achieve higher quality in primary care, leadership is seen as a crucial skill to help the entire team to understand the value of adopting a quality improvement approach. One of the quality improvement strategies that teams can apply is the Practice professional development plan, or PPDP, defined as follows: A Practice Professional Development Plan describes the developments planned, and the specific educational actions for individuals, groups and the whole team to enable the Practice to improve care, and which is reviewed annually. The PPDP is a team-based approach for quality improvement that relies on the assessment of needs, together with planning and implementation of a collectively owned project, which should be 234
World Book of Family Medicine – European Edition 2015 meaningful for the team, evidence-based and centred in patient care. The main purpose of the PPDP is to enable the primary health care team to focus on the objectives and priorities for future years and to identify continuing needs. Through effective leadership, teams might allocate directed efforts and protected time for the development and implementation of their PPDP. Evidence shows that PPDPs can improve patient care, although results are sometimes only seen at a later stage. Each PPDP should be structured according to the team’s needs and goals, to be owned by the team and to be perceived as a collective effort. The following draft and its components can be used as a starting point for more complex and ambitious plans. Topic Goal Strategy for improvement Assessment methodology Team members involved Deadline Colorectal cancer screening rates To audit and improve colorectal screening rates in our practice population Local protocol to be produced and implemented in January 2015 after team discussion Screening rates are assessed yearly and published in the annual practice report in each January AG, SL July – December 2014 Internal communication To develop and improve communication between team members Outdoor team-work activities and interprofessional collaboration workshops Working conditions appraisal by team members to be done at the end of each year JMC, FA January – December 2014 Prescription errors To avoid harmful drug interactions in medical prescriptions Learning activities and practical workshops One week audit of medical prescriptions AO July 2014 The Plan-do-study-act cycle is one of the approaches available for quality improvement. It’s a feasible strategy to be used in the implementation of the PPDP, although its effectiveness is quite variable. In the ‘plan’ stage a change aimed at improvement is identified, the ‘do’ stage sees this change tested, the ‘study’ stage examines the success of the change and the ‘act’ stage identifies adaptations and next steps to inform a new cycle. Although a PPDP represents an efficient and simple tool for organisational quality improvement, it has considerable obstacles in its implementation and success. Teams need to be aware that PPDPs require protected time for its design, an enduring commitment for its implementation and a rigorous assessment of the proposed outcomes. Even if the achievement of the desired objectives might not be reached, this does not represent a defeat. In sum, it’s the process itself of developing and implementing a PPDP that matters the most. Take home messages Primary care teams are made of professionals that have complementary skills and generate synergy through a coordinated effort in order to provide high quality care for their local population. Leadership is an essential skill for family doctors and fundamental in quality improvement among primary care teams. A practice professional development plan is a team-based approach for quality improvement in consensualized topics identified by all team members, through structured collective efforts that are focused on accepted outcomes. The implementation process of the practice profession development plan is by itself an important strategy for the development of better relationships among team members and will lead in the long-term to better results of the primary care team. Original abstract http://www.woncaeurope.org/content/1003-drafting-practice-professional-development-plan-learning-exercise-using-continuous 235
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