Authors (including presenting author) :
Ko SH(1), Li WS(1), Leung SH(1), Chen XR(1), Li YC(1)
Affiliation :
(1) Department of Family Medicine & General Out-patient Clinics, Kowloon Central Cluster
Introduction :
Upon re-delineation of cluster boundary of KCC and KWC in April, 2017, the Department of FM&GOPC of KCC has doubled its size, both in terms of number of clinics and the target deliverable of primary care attendance. In view of the different management culture and operational workflow in different clinics, it is essential for the management team to align the service across all GOPCs in KCC. Under this context, Peer visit round (PVR) has been launched out to all GOPCs of KCC after cluster boundary delineation and it has provided an essential platform to align the practice and operational issues in the department.
Objectives :
- To adopt a bottom-up participatory approach for checking quality and safety issues involving both clinical and non-clinical areas
- To allows cross-learning and ideas sharing among clinics
- To follow up any arising issues upon monitoring of risk register during the risk reduction exercise in departmental Q&S subcommittee.
Methodology :
- The PVR team is composed of COS, DOM, one PVR coordinator doctor from exKCC clinics and exKWC clinics. Other members include one representative of each rank of staff, such as clinic Dr in charge, Ward Manager, APN, Nurse and Shroff staffs.
- 2 to 3 PVRs have been conducted annually.
- PVR Themes was set according to risk registry of Department of KCC FM&GOPC.
- A report on achievements and gaps after each PVR will be issued for review and follow up actions by individual clinic.
- Improvement and alignment strategies had been thoroughly discussed at Dept. Quality and Safety meeting regularly.
- Important message would be shared among all staff with formal platform (e.g. clinic meeting, email)
Result & Outcome :
- 7 PVRs had been conducted since 2017
- Important themes inspected with follow up actions:
1. Investigation report handling: Important principle of handling of investigation reports were aligned with “Work instruction on investigation report handling” revised.
2. Consultation quota add/reduce mechanism: Important principle and logbook for record aligned.
3. Later comer management: definition of “later comer” was clarified and aligned.
4. Procedures on blood taking, specimen handling and transportation: Practice was aligned with revision of relevant controlled document. Workflow implementation progress was checked during subsequent PVR.
5. Injury on duty prevention – Manual handling operation related injury: Reality check on knowledge of frontline staff and hardware enhancement was suggested.
6. IT breakdown contingency workflow: Reporting criteria for Advance Incident Reporting System was standardized. Hardware including IT breakdown log sheet and CMS downtime kit were aligned. Sick leave certificate for downtime was enhanced.
Conclusions:
PVR acted as a platform for cross learning for different GOPCs in KCC FM&GOPC. It helped to fill gaps and maintain achievements. Continuous quality improvement was achieved by fulfilling the “Check” and “Act” in the PDCA cycle, aiming at alignment of best practice at various GOPCs.
