GP Pulse March 2013 Issue 21 - The Royal New Zealand College of ...
GP Pulse March 2013 Issue 21 - The Royal New Zealand College of ... GP Pulse March 2013 Issue 21 - The Royal New Zealand College of ...
College NewsPutting Improvement Scienceinto practice for child healthThe 2013 Quality SymposiumEach year, the College holds aQuality Symposium to develop ourunderstanding of quality improvementby examining an issue consideredimportant and current to generalpractice and primary care.The theme for the 2013 QualitySymposium was ‘Putting ImprovementScience into Practice for Child Health’.Child health is one of New Zealand’sleading health issues and ImprovementScience is an emerging discipline toimprove health care by addressingthe gap between what the evidencesuggests should happen and whatactually happens in practice.Our topic choice this year arose froman increasing appreciation by healthsector partners of the value of qualityinitiatives for improving child health,both for reversing poor outcomes inchildhood and the longer-term impacton adult health and morbidity.The symposium, held at our nationalmuseum, Te Papa, in Wellington on15 and 16 February, was a stimulatingand thought-provoking event forattendees.Crossing boundariesFriday kicked off with a warmWellington welcome and mihi fromDr Tane Taylor. Symposium MC andquality lead for the College, Dr JohnWellingham, then introduced theprogramme for the two days beforeinviting Associate Health Minister JoGoodhew to make the opening address.Morning tea among the exhibition standsMinister Goodhew stressed that thehealth sector needs to make theconnection between social factorsand health, especially on issues suchas obesity. She then outlined theGovernment’s recent achievementsin health within a constrained fiscalenvironment, which have a solidfoundation in primary care.She also thanked the College forits input on the White Paper forVulnerable Children and stated thatthe health sector has an importantleadership role to play in childprotection. Clinical engagementand leadership are central to theGovernment’s vision for child health,the Minister concluded, and GPs areachieving great results.Dr Wellingham reflected on theMinister’s speech and said we need tofind the barriers to improvement andremove the disincentives, and wiselypointed out that ‘All improvementis change, but not all change isimprovement.’ He then welcomed tothe stage the star attraction of thesymposium, Professor Martin Marshall.Prof Marshall has worked as a GP formore than 20 years and has played aleading role in advancing ImprovementScience at the UK’s Health Foundation.He is one of the world’s leading expertsin the field and we were very excitedto welcome him to Wellington.He started his address by describing thehistory of using medical evidence asP2 : ISSUE 21 : March 2013
College NewsThe Cafe at the End of theUniverseThe session after morning tea was called The Caféat the End of the Universe in which Professor TonyDowell talked about the big issues in child healthand what a quality menu for children might looklike.He discussed what we do well in New Zealand, aswell as what we don’t do so well – high childhoodmorbidity, lack of integration, poor illness-specificoutcomes such as for rheumatic fever, high levelsof violence against children and child poverty,traumatic brain injury in the young, youth alcoholand drug use, and child and youth obesity.Prof Dowell echoed Prof Marshall’s sentiment thatmany problems are complex, but they are all ourresponsibility. He argued that to link child healthand quality we need to take a life-course approach,use existing data, accept complexity and respond toit and think beyond the usual frame.He finished by urging GPs to run more consultationswith children in mind, practice teams to work onchild enrolment, immunisation and identifyingat-risk children, and PHOs and DHBs to conductorganised programmes and share them. And allthree must work on the ‘inedible and unpalatable’.Professor Martin MarshallChange works at thegovernment level withregulations, incentives and soon, but is needed at all threelevels – practice, organisationand government – to belasting, and each on their ownis relatively ineffective.a basis for prescription and diagnosisat the practice level and how it is nowwell entrenched within practice ITsystems.Stating that structural solutions tohealth problems rarely work at anorganisational level, Prof Marshallcited the example of the UK healthservice, which has been constantlyrestructured to little effect. He arguedthat other approaches are needed andthat they’re starting to emerge in theshape of the Triple Aim, PDSA cyclesand others.He then said change also works at thegovernment level with regulations,incentives and so on, but is needed at allthree levels – practice, organisation andgovernment – to be lasting, and each ontheir own is relatively ineffective.Complex environments need complexapproaches to change and noenvironment is more complex thanhealth. There is good organisationalevidence for how to implement changeat all levels, so why don’t we use it?,asked Prof Marshall. He blamed thetime it takes for change to happen,the norms and practices of managerialdecision-makers, the nature of thedecision-making process and the wayevidence is created.Prof Marshall then posed the question:how do we cross boundaries and thinkdifferently to take evidence into thereal world?He cited a fascinating example fromVietnam in the 1980s which wasexperiencing a famine with manymalnourished children and theacademic who found mothers who hadgone against cultural norms to ensuretheir children were well nourished.He encouraged these mothers toshare their practices and achievedan 85 percent decrease in childmalnourishment.Improvement Science likewise crossesboundaries to create positive change.It shares expertise from other sectorsto address complex problems. ProfMarshall gave several more compellingexamples of how this worked in thehealth sector through the Researcherin-Residencemodel, and by usingISSUE 21 : March 2013 : P3
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<strong>College</strong> <strong>New</strong>sPutting Improvement Scienceinto practice for child health<strong>The</strong> <strong>2013</strong> Quality SymposiumEach year, the <strong>College</strong> holds aQuality Symposium to develop ourunderstanding <strong>of</strong> quality improvementby examining an issue consideredimportant and current to generalpractice and primary care.<strong>The</strong> theme for the <strong>2013</strong> QualitySymposium was ‘Putting ImprovementScience into Practice for Child Health’.Child health is one <strong>of</strong> <strong>New</strong> <strong>Zealand</strong>’sleading health issues and ImprovementScience is an emerging discipline toimprove health care by addressingthe gap between what the evidencesuggests should happen and whatactually happens in practice.Our topic choice this year arose froman increasing appreciation by healthsector partners <strong>of</strong> the value <strong>of</strong> qualityinitiatives for improving child health,both for reversing poor outcomes inchildhood and the longer-term impacton adult health and morbidity.<strong>The</strong> symposium, held at our nationalmuseum, Te Papa, in Wellington on15 and 16 February, was a stimulatingand thought-provoking event forattendees.Crossing boundariesFriday kicked <strong>of</strong>f with a warmWellington welcome and mihi fromDr Tane Taylor. Symposium MC andquality lead for the <strong>College</strong>, Dr JohnWellingham, then introduced theprogramme for the two days beforeinviting Associate Health Minister JoGoodhew to make the opening address.Morning tea among the exhibition standsMinister Goodhew stressed that thehealth sector needs to make theconnection between social factorsand health, especially on issues suchas obesity. She then outlined theGovernment’s recent achievementsin health within a constrained fiscalenvironment, which have a solidfoundation in primary care.She also thanked the <strong>College</strong> forits input on the White Paper forVulnerable Children and stated thatthe health sector has an importantleadership role to play in childprotection. Clinical engagementand leadership are central to theGovernment’s vision for child health,the Minister concluded, and <strong>GP</strong>s areachieving great results.Dr Wellingham reflected on theMinister’s speech and said we need t<strong>of</strong>ind the barriers to improvement andremove the disincentives, and wiselypointed out that ‘All improvementis change, but not all change isimprovement.’ He then welcomed tothe stage the star attraction <strong>of</strong> thesymposium, Pr<strong>of</strong>essor Martin Marshall.Pr<strong>of</strong> Marshall has worked as a <strong>GP</strong> formore than 20 years and has played aleading role in advancing ImprovementScience at the UK’s Health Foundation.He is one <strong>of</strong> the world’s leading expertsin the field and we were very excitedto welcome him to Wellington.He started his address by describing thehistory <strong>of</strong> using medical evidence asP2 : ISSUE <strong>21</strong> : <strong>March</strong> <strong>2013</strong>
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