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How can digital health solutions play a role in the improvement of primary care practice? How do you see this role changing over the next 5-10 years?
Whether it's getting more to be seen out of hours, over the phone, or by nurses, then the data is key. As you make changes, you need to profile how these changes are playing out actual practice and outcomes. If it's quality improvement, then it's got to have patient outcomes at the heart of it.
You can make changes to improve the lives of your staff better, but it's only quality improvement if this makes a difference to the patients. Having better processes for staff to follow makes for happier staff and therefore you get happier patients.
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You spent time teaching the principles of auditing in Gondar, Ethiopia. Can you tell us more about this experience and how it informed your approach to clinical audit once you returned to the UK?
It wasn't an extreme version of medical software, but still, I saw so much in terms of aspirational activity that was going on. Both clinicians and patients were involved in doing what they could with the limited resources they had. There was still an ethos of everything being for the patient, but there was a lot more of a "can do" attitude.
They were very keen to learn, and they didn't have any baggage or preconceived ideas of what you were trying to teach. They were very grateful that you were there in the first place and keen to modernise their approach in line with what we do in the UK.
In your opinion, what are the most common mistakes made by healthcare practitioners who are trying to improve their practice
I recently gave a talk where I was trying to tell people that they often do things on auto-pilot, and they don't know why they're doing something. Understanding the "why" is very key.
I imagine it's the same in primary care as you've still got to take a team-based approach, saying that "we're all in this together and we need to know how we're doing".
We need regular feedback, and that's where measurement and data come in.
Successful medical practices often have a fair amount in common. Given your frequent contact with different kinds of healthcare professionals, is there anything in particular that you have seen that sets the best practices apart from the rest?
It’s down to leadership, culture and infrastructure in terms of what kinds of data you’ve got. You need to have a strong leader within a culture that says everyone’s got a role to play and it’s alright to challenge and bring forward ideas. Everyone’s got ideas, and I like Don Berwick’s quote where he says, “Do your job and improve your job”. Those Trusts that do well are those who allow people to have a mindset of asking whether tasks can be done better and then trying to make it happen.
Which professional media outlets and organisations aside from your own would you recommend for clinicians interested in digital health and clinical auditing?
The Health Quality Improvement Partnership (HQIP) runs the National Clinical Audit and Patient Outcomes Programme. There’s a lot of rich data coming from there in terms of national audits, and they’re trying to make bitesize summaries of what this data is telling clinicians. Keep an eye out for the publications coming from there. Now, we’re trying to make sure that the national audits are auditing across the pathway from start to finish. That’s a resource that people need to keep their eye on.
The other one that jumps to mind is the BMJ, which has the Open Quality improvement journal for publishing what auditors have done. It’s not just about successes as they also encourage people to publish their failures. In terms of quality improvement, it’s okay to fail as you want to let other people know not to do the same. If we tell them what we did, they won’t fall down because of the same pitfalls and mistakes.
Do you have a favourite quote you would like to share with our readers?
I often say we shouldn’t be surprised by a given result as it’s a result that the system we designed has produced. Individuals involved in that system are sometimes inappropriately blamed, and there should be a mentality that it’s not an individual failure, but a system failure. Life is messy, and there is variation in the delivery of healthcare. You’ve got to look at it over time and see what the trends are.
What digital tools do you and your colleagues use in the course of your work?
The essential one is Excel. You can do so much with it these days, from run-time charts to p-values if you need them to see whether there are any outliers around your confidence intervals. You can do a basic analysis in terms of compliance calculations.
What we increasingly find is that you need a good platform to share your data. I’m not in a position to name names, but I think it’s essential that you’ve got either a decent intranet or another place where you can keep your data, and then everyone can access it.
Integration is important, but when you work in a large Trust, a lot of data can become compartmentalised. You need to be able to see the whole picture and not just the risks, clinical audit compliance or the patient satisfaction levels and complaints. You need to put the data together.
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