About using quality improvement (QI) to improve access to care

Access QI has been designed to mirror the quality improvement journey. The key to using QI to improve access to care is understanding the current system to identify any areas for improvement. This ensures the limited management and clinical time available for improvement is directed towards areas of the service that will have the largest impact on waiting times. Improvements are focused on making sustainable changes to reduce demand and increase activity, leading to sustainable reductions in the number of people waiting to access care.

Access QI improvement activities are clinically lead by a project team from the service, ensuring Clinicians are at the centre of decisions and changes. Understanding the system ensures Clinicians see the evidence required to build the will for change and become motivated to deliver improvements to their service.

Participants of Access QI feedback that using a QI approach empowers staff and builds motivation to make changes to their service, especially when data shows the measurable improvements they have made to the quality of their service.

Examples of using QI to improve access to care

There are numerous examples of services in Scotland who have used QI to improve access.  They include:

• NHS Dumfries & Galloway’s Neurodevelopment pathway who reduced time from referral to diagnosis from 130 weeks to 14 weeks.
• NHS Tayside’s Post-Menopausal bleeding pathway who reduced time from referral to diagnosis from 137 days to 34 days.
• NHS Lothian’s Urology urgent suspected cancer pathway who reduced time from referral to diagnosis from 50 days to 11 days.
• NHS Border’s Psychological Services who reduced the number of people waiting more than 18 weeks to access care by 49%.
• NHS Greater Glasgow and Clyde’s Podiatry service reduced the time from referral to first appointment from 13 weeks to 4 weeks.
• NHS Forth Valley’s Drug and Alcohol service reduced the number of people who do not attend appointments by 32%, resulting in a reduction in the number of people waiting to access care, reduced by 20%.

You can find more examples of services using QI to improve access to care in the Access QI improving planned care pathways toolkit.

Key steps to using QI to improve access to care

Using QI to improve access to care has six key stages:

1. Establish a project team: Set up a project team which includes Clinicians from the service, someone with QI experience and an Analyst.
2. Understand your system: Analyse demand, capacity, activity and queue data to identify key blockages in the service. Map the pathways with the longest waits and identify the reason for the time between each step in the pathway. Engage with service users to better understand their experience.
3. Develop aim and change theory: Based on your understanding of the system, prioritise the areas for improvement that will have the largest impact. Create a STAN aim and prioritise the changes you wish to make to the service.
4. Develop specific change ideas, test and refine: Use PDSA to test and refine changes that reduce demand or increase activity of the service while using outcome, process and balance measures to determine the impact of changes. 
5. Implement and sustain where tested: Make successful changes 'business as usual' to ensure that improvement is sustained.
6. Sharing learning: Share learning from the improvement project with others to enable them to use the learning to accelerate their own improvement.

You can find more detail along with tools and guidance to use QI to improve access to care in the Access QI improving planned care pathways toolkit.

Resources to implement a QI approach to improve access to care

Key resources that can help elective care services use QI to improve access to care.

• Access QI planned care toolkit: toolkit that enables quality improvement practitioners to redesign planned care pathways to sustainably improve waiting times. The toolkit aligns to the improvement journey and contains diagnostic tools, driver diagrams, change ideas and measurement plans for Access improvement projects.

• NHS Tayside specialty remobilisation, recovery and redesign toolkit: this toolkit outlines a process and key considerations for NHS boards to safely remobilise planned care services whilst ensuring people are safe and they are treated in the most appropriate environments.

• Team service planning change package: this change package enables quality improvement practitioners to use quality improvement methods to implement team service planning to contribute towards improving waiting times. The change package was developed in partnership with the Centre for Sustainable Delivery and aligns to the improvement journey and contains diagnostic tools, driver diagrams, change ideas and measurement plans for Team Service Planning implementation projects.

• GP Access Tools: This resource contains simple and easy to use data collection tools and learning summaries developed in collaboration with general practice teams from NHS Ayrshire and Arran, NHS Shetland and NHS Tayside.