How did you first get involved in improvement, and what has been your journey since then?

My interest in Quality Improvement began when I was a GP trainee; our training involved completing a clinical audit. I found it interesting thinking about data and how you move from performing in a way that you’re not happy with to something better. As a result, I started to do a lot of clinical audits when I became a fully-fledged GP and I became both the audit and quality lead, initially for just our practice. Because of my interest in audit, I was invited to teach clinical audit to GP trainees and to audit facilitators and off the back of that was asked by the PCT to take up the post of ‘Lead for Clinical Audit’, particularly linking in with the local hospital trust. If I’m being honest, I didn’t like the title when I was appointed, so I asked if I could be the ‘Clinical Lead for Quality Improvement’ instead. (Interestingly, this was when I probably didn’t know what Quality Improvement meant, but they agreed!) Soon after starting the role, the Health Foundation advertised for the GenerationQ programme, specifically looking for leaders who were interested in learning more about Quality Improvement. I thought, ‘oh that’s probably for me,’ applied and was accepted onto the programme. Most of my grounding in QI and what it means in a complex healthcare environment comes from GenerationQ and I’ve been applying the learning ever since.

Most of my grounding in QI and what it means in a complex healthcare environment comes from GenerationQ and I’ve been applying the learning ever since.

After starting GenerationQ at the beginning of 2014, I used the programme to explore both my own skills and attitudes, as well as applying them to my practice and the wider environment where I work. That’s really taken me on a fantastic journey; I became a clinical support fellow at the Royal College of General Practioners looking at QI, soon after that I became a clinical lead and along with a colleague we designed the Quality Improvement Guide for General Practice, which applied what I’d learnt on GenerationQ to frontline general practice and my real working environment. I was then able to train GPs, practice managers and teams in using those tools to improve their working lives and their patient care, which we did with some support from the Health Foundation, as well as the National Diabetes Audit and Cancer Research UK looking at how QI can be used in general practice to achieve earlier diagnosis of cancer.

Just over a year ago, I was appointed to direct the GP Excellence Programme in Greater Manchester, a much bigger system approach to supporting improving general practice with a big QI component. I’ve got a vision of building QI capability and passion across the whole of Greater Manchester!

What most inspires you professionally?

I had a lot of thoughts about this! I decided that it’s the belief that all the people I encounter working in the health sector are really genuine in their desire to deliver great care for their patients, but are sometimes held back by their inflexible, inefficient systems and processes. Some of these processes are imposed on them, but many are ones that they’ve designed themselves that become habits. So the fact that what all people really want is to do things right by their patients and their staff is inspirational – and the thought that I can help and support them to do that is really motivating.

Joining the Q community was a natural follow on from being a GenerationQ fellow. There’s always a fear when you’ve completed something like GenerationQ that you might lose touch with the ‘magic’ – magic being the energy you get from being surrounded by people who have similar passions and are doing similar things.

What change could we make that would do most to embed continuous improvement in health and care?

Over the years in my world of general practice, GPs and their teams have been continuously trained to jump through hoops by being financially incentivised to achieve certain things. I believe that encourages them to lose sight of purpose and vision a bit. Personally, I think that there must be a better way of encouraging people to do a right or better thing without falling back on financial incentives.

Why did you join Q?

Joining the Q community was a natural follow on from being a GenerationQ fellow. There’s always a fear when you’ve completed something like GenerationQ that you might lose touch with the ‘magic’ – magic being the energy you get from being surrounded by people who have similar passions and are doing similar things. Although I’m fortunate enough to still be part of my action learning set from GenerationQ, being part of the Q community just expands that even further. Although I’m yet to invest as much time to Q as I’d like, the fact that it’s there when I need it is a really positive thing.

What new connections have you made as a result of joining the Q community – and what have you learnt so far?

I’ve made some really good connections with the Primary Care SIG; we held an event at the Health Foundation in November where we screened a video from Donald Berwick and I was able to share my experience of the GP Excellence Programme.

A personal video from Don Berwick to the Q Primary Care SIG @TheQcommunity @tracypsc ⁦@WessexAHSN⁩ pic.twitter.com/vzElSeyO6m

— Lesley Mackenzie (@LesleyPSC) November 30, 2018

It can be hard to pinpoint specific learning from the Q community because it happens in such an emergent way. You often don’t know where you’ve picked something up, but you know that you feel something differently, that you test something new out. Having said that, I went to the UK-wide Q community event last year, where I was introduced to some of the techniques from the Liberating Structures book. As a result, I bought the book and I’ve since used them. The power of experiencing a new way of participative techniques within a group setting to gather and to share learning more effectively was wonderful.

Can you tell us about something you’re currently working on that Q members might be able to get involved with?

I do improvement work at three different levels of organisations, so I’ve thought about it from those perspectives.

It can be hard to pinpoint specific learning from the Q community because it happens in such an emergent way. You often don’t know where you’ve picked something up, but you know that you feel something differently, that you test something new out.

The first is practice level; I still work as a GP for the majority of my week and at the practice we’re working on a number of improvement projects. One project is trying to reduce the number of telephone calls into the practice by helping people find alternative ways of accessing information. Another is tackling opioid prescribing; that’s been escalating nationally and we are looking for interventions to improve that. Finally, we’re looking at how we can better support our patients – so we’re helping those with diabetes to reach their target HbA1c and are working to quickly recognise people who might be in the final stage of their life to enable us to offer better support and planning.

At the next level up, I do some QI work across the CCG; we’ve been helping practices learn a bit more about the model for improvement by applying it to two QI projects of their choice over the last two years. This project comes to an end in March with the submission of final reports. There have been a whole range of projects, however one of the real highlights is that many practices chose to manage their mail differently – they are trialling having trained administrative staff manage the mail so fewer letters need to be read by GPs.

Finally, there’s the Greater Manchester level; that’s more of a systems convening role, so although there’s QI capability building within it, I’m learning more about how I can join up a system better and how the other components within that system can support the work we do in general practice.

If any Q community members have experience in any of these areas or would like to find out more, please get in touch!