A practical approach to quality improvement: the experience of the RNZCGP practice standards validation field trial

This paper describes the development, implementation and validation of general practice standards, supported by a continuous quality improvement (CQI) process that teaches practice teams how to work together to identify and enhance the quality of care they provide.

Practice standards were developed through consensus by key stakeholders in general practice, pre-tested in four practices, and refined and piloted in 20 practices throughout New Zealand during 1999. A further field trial was undertaken to validate the standards and test the process of practice assessment. During 2000-2001, 74 practices volunteered to be assessed against the standards. Sixty one general practitioners, practice nurses and practice managers, nominated from independent practitioner associations (IPAs) or primary care organisations (PCOs), were trained to undertake the assessments.

On five of 13 variables, no statistically significant differences at the 0.05 level were identified between the practices in the field trial and a random sample of practices studied by Kljakovic. The Royal New Zealand College of General Practitioners (RNZCGP) standards were found to have excellent face validity and content validity, and good construct validity. Internal consistency was fair. Lessons from the evaluation have informed an improved version of the practice assessment tool.

The validation field trial provided the RNZCGP with a framework and tool for an accreditation process based on the principles of CQI. The tool offers patients and other stakeholders a credible measure of quality and safety at the practice level through a process bridging quality control and quality improvement.