On Thursday, December 6th 2018, Quality Rounds Ontario welcomes Dr. Tara Kiran to host a presentation on using data for quality improvement. I recently had the chance to catch up with Dr. Kiran, a family physician and clinician investigator at St. Michael’s Hospital, to talk about her experience using data and listening to patients to support quality improvement initiatives in primary care.
Why is it important to use data to guide quality improvement efforts in primary care?
Don Berwick once said “all improvement requires change, but not all change is improvement”. Change is a constant in healthcare and the only way we know if the change is improving the things that matter is if we measure it -- not just before and after measurement but continuous measurement so we can monitor trends and understand whether the improvement is sustained.
Data is also crucial in helping us choose our improvement priorities. Data can help us identify areas where we are performing less well in comparison to others or to an agreed upon standard so we can use our finite improvement resources wisely.
What kind of challenges do we face in collecting and using data in primary care?
Most primary care providers are frustrated by how hard it is to pull meaningful data from our electronic medical records. It’s hard to even identify an accurate list of your patients with a specific condition let alone whether they are receiving evidence-based care. It’s particularly hard to get a nuanced picture of quality. For example, most of us are able to get data – either from our electronic medical record or from provincial sources – on what percentage of our patients have been screened for colorectal cancer. But, we know there are sometimes very legitimate reasons patients choose not to be screened and it’s much harder to get data that tells us the percentage of our patients who have had an informed discussion about screening.
I think sometimes the imperfections inherent in data and related measures really turn some people off. At our practice, we have made a point of accepting imperfection and using criticism about data as a starting point to engage people in a conversation about improvement.
How do we factor the primary care patient’s voice into our quality improvement efforts?
I’ve come to learn that there are many ways in which we can integrate the patient voice into improvement efforts. It often depends on your resources – particularly time – and also your context and the initiative itself.
We started pretty simply by launching a patient experience survey that is emailed to patients in our practice once a year during their birth month. The survey included some standard questions on timely access and patient-centredness but also some open-ended questions. We found the response to the open-ended questions to be particularly rich. They shed light on improvement opportunities that weren’t on our radar – and highlighted how appreciative some patients are.
The survey really prompted us to want to have more dialogue with patients. We’ve done this in many ways including a full-day engagement event, a shorter focus group on a defined topic, 5 minute consultations in the waiting room, and most recently through forming a patient and family advisory committee.
What advice do you have for other family physicians interested in using data to plan quality improvement initiatives?
Data is essential to quality improvement – to identify opportunities for improvement and understand whether changes actually make things better. Think broadly about what data you can use and how you can collect it. For example, consider a manual audit to gather data on a small sample. Consider both quantitative and qualitative data, including patient stories. And, try and take an equity lens to see if there are groups of people you serve who are faring less well than others.
To hear Dr. Kiran’s reflections on using data for improvement, join us this Thursday, December 6,12:00-1:00, for Quality Rounds. Attend in person at St. Michael's Hospital or join via webinar. View the event poster for more details.