Dr Cheryl Levitt passed a tray
of chocolates around the room. "We can assess quality
in chocolate, so why not in family practice?" she asked
rhetorically. The assembled doctors nodded, diligently
munching away and rating the different chocolates' appearance,
smell and taste, on a scale from "yuck" to "fabulous."
Just as we can do for chocolate,
she said, many elements of medical care and clinic management
can, and should, be measured, quantified and analyzed
in order to achieve higher quality.
This snack was part of a presentation
of the new Quality in Family Practice program at the
College of Family Physicians of Canada's annual meeting
in Quebec City in November.
"One problem we have currently
is that we don't know how well we are doing," said Dr
Levitt. "Data is knowledge and hopefully this will allow
family doctors to fix some problems."
PAINLESS
GAINS
Dr Levitt, the president of the Ontario College of Family
Physicians, is the project leader of the Quality in
Family Practice program. The program provides a self-assessed,
voluntary model of quality assessment for family practices.
Doctors, nurses and administrators learn how to rate
themselves and their practice, decide what their priorities
are and then work with the project's advisors to make
changes.
MD
CHECK-UP
The Quality in Family Practice project — which
recently finished its first phase of pilot projects
— constitutes a significant re-thinking of quality
control in medicine.
There are several competing theories
about how to best ensure Canadian doctors are maintaining
a high standard of practice. Continuing Medical Education
(CME) and Mainpro are widely embraced by doctors and
governments alike, though they have their critics. Proposals
to implement mandatory revalidation exams have received
mixed responses and mandatory peer review systems are
loathed by some doctors.
One of the three pilot sites' lead
physicians, Dr Mel Cescon of Kitchener, Ontario, said
he believed Quality in Family Practice's system produced
far better, more useful results than either CME or peer
review.
DEVILISH
DETAILS
The program is based on a simple idea: to improve doctors'
and clinics' practice methods, you need a firm grasp
of the working conditions. Pilot project members rated
their practices on a total of over 300 aspects of a
doctor's work in about 80 different categories, with
the help of the program's assessors and advisors. (The
list of criteria are available on the project's website
at www.qualityinfamilypractice.com).
The criteria range from legal issues
— like ensuring privacy of patient records —
to "essential" matters like a documented complaints
protocol, and "desirable" qualities, such as annual
performance reviews for all staff members.
The next step is to identify the
clinic's priorities. The legal and essential requirements
must be fulfilled in a hurry if they are not up to snuff,
but the practice's doctors and administrators can choose
which of the desirable criteria they want to focus on.
"If your priorities change, you can go on to something
else that is more important to you," explained Dr Ken
Babey, the project leader at another pilot site in rural
Mount Forest, Ontario.
RATING
THE SYSTEM
The program is receiving high praise from the doctors
who participated in the year-long, three-clinic pilot
project that concluded this year.
"It shook us up in a good sense,
made us focus," said Dr Babey. His clinic focused on
a number of the screening criteria. They mined the data
from their EMR system to identify who was due for screenings
and for which conditions.
Dr Cescon's office used the assessment
tool to identify several areas where they wanted to
improve: formalizing job descriptions for all staff,
assigning a fire marshal and following proper fire codes,
and learning official procedures for receiving and storing
vaccines. "Unless you have the criteria to judge how
you are doing at those things," he said, "how do you
know what you are doing is okay?"
MOVING
FORWARD
"Canada is 15 years behind in this process compared
to other countries," laments Dr Levitt. But it will
be some time yet until this program is expanded across
the country like similar ones are in New Zealand, Australia
and the UK. Her hope is that eventually the program
will be available, with government funding, to all family
clinics and specialists in Canada. The project leaders
are currently petitioning the Ontario government for
the cash to allow them to conduct a larger, 20 to 50
practice study.
So far the project's results have
been promising: 94% of involved staff reported increased
confidence that they provided quality care and planned
to continue improving.
The results at the three clinics
are positive, said Dr Levitt. The program promises "a
better practice, happier staff, and a healthier patient
population," she said proudly.
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