About using QI to improve access to care

Using QI to improve access to care is based on the improvement journey. The key to using QI to improve access to care is understanding the current system to identify the areas for improvement. This ensures the limit 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 focus 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 small project team from the service, ensuring clinicians are at the centre of changes to their service. And understanding the system ensures clinicians see the evidence required to build strong buy-in for change and become intrinsically motivated to deliver improvements to their service.

Participants of Access QI report a greater sense of agency as using a QI approach empowers staff and builds motivation to make changes to their service, especially when data shows the measurable improves 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 reduce time from referral to diagnosis from 130 weeks to 14 weeks.
  • NHS Tayside’s Post-Menopausal bleeding pathway who reduce time from referral to diagnosis from 137 days to 34 days.
  • NHS Lothian’s Urology urgent suspected cancer pathway who reduce 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%, resulted in a reduction in the number of people waiting to access care reduce 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 a six step process:

  1. Establish a project team: Set up a project team which includes Clinicians from the service, someone with QI experience and an Analyst.
  2. Understanding you system: Analyse demand and activity data to identify key blockages in the service, map the key pathways with long waits and identify the reason for the time between each step in the pathway and engage with people who use the service to better understand their experience using the service.
  3. Develop aim and change theory: Based on the understanding of the system prioritise the areas for improvement that will have the largest impact, create a STAN aim and priorities changes to make to the service.
  4. Develop specific change ideas, test and refine: Use cycles of testing 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: Turn tested changes into the new normal way of working and spread to all relevant areas of the service.
  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.