Quality improvement

The Brisbane South PHN quality improvement (QI) support team are here to assist you in delivering the best quality of care for your patients. There are 3 main sections on this page, please refer to the content list below. If you are unable to find what you are looking for, please contact the QI support team.

On this page:

All about QI

What is quality improvement

The Royal Australian College of General Practitioners (RACGP) defines quality improvement (QI) as an ongoing activity undertaken within a general practice with its purpose being to monitor, evaluate or improve the quality of health care services provided to patients.

We are committed to working with the primary care sector to deliver best practice, person-centred care through a range of QI activities that range from QI toolkits to structured person-centred care programs.


Our Primary Care team works with general practices to provide practical advice and resources to help them plan, implement, and review their QI activities. Outcomes of QI are best summarised by the quadruple aim.

Quality improvement in general practice

We offer a range of QI support for general practices in our region. Support includes self-paced, online learning modules and structured programs developed and delivered in conjunction with industry experts.

Our QI programs and activities align with the quadruple aim, and many support practices to meet the requirements of RACGP accreditation and the Practice Incentive Program for Quality Improvement (PIP QI).

Practice Incentive Program for Quality Improvement

The Federal Government’s Practice Incentive Program (PIP) encourages general practices to provide quality care, build and enhance their clinical capacity and improve accessibility and health outcomes for patients through a range of incentives.

The PIP Quality Improvement (PIP QI) incentive is a quarterly payment given to practices to undertake and provide evidence of continuous QI by:

  • providing the PIP Eligible Data Set (de-identified data) to their Primary Health Network (PHN)
  • participate in QI activities provided by their PHN that address any of the 10 specified improvement measures or directly meet the needs of their practice population.


PIP QI measures

The 10 improvement measures for the PIP QI have been identified to support understanding of chronic disease management in areas of high need. They facilitate a common data baseline and data analysis to observe improvements within general practice.

There are no prescribed targets associated with any of the improvement measures. Practices may choose to focus their QI activities on the specified measures or alternatively, focus on any other areas informed by their clinical information system data.

The 10 improvement measures:

  1. proportion of patients with diabetes with a current HbA1c result
  2. proportion of patients with a smoking status
  3. proportion of patients with a weight classification
  4. proportion of patients aged 65 and over who were immunised against influenza
  5. proportion of patients with diabetes who were immunised against influenza
  6. proportion of patients with COPD who were immunised against influenza
  7. proportion of patients with an alcohol consumption status
  8. proportion of patients with the necessary risk factors assessed to enable CVD assessment
  9. proportion of female patients with an up-to-date cervical screening
  10. proportion of patients with diabetes with a blood pressure result.

These measures may be altered to reflect emerging high-need areas regionally and nationally. The Quality Improvement Toolkit: PIP QI Ten Measures guides you through how to implement these 10 improvement measures.

Practice readiness for PIP QI

To get ready for PIP QI, you need to register via your Provider Digital Access (PRODA). Step-by-step instructions are available on the Services Australia website.

Practice PIP QI checklist

  • hold current Practice Accreditation Certificate
  • arrange data-sharing with Brisbane South PHN
  • train your team to use Pen CS CAT4 and Topbar tools
  • register for PIP for QI via PRODA
  • register for Monthly Benchmark Reports
  • start planning and actioning QI activities using our QI Toolkits and Resources
  • maintain a record of QI activities and progress using your online practice plan.

Providing de-identified data

  • We provide practices with free access to the Pen CS CAT4 software suite to enable secure encryption, de-identification, and transmission of data from practices back to us. 
  • Read our Pen CS CAT4 software suite Data Sharing Agreement Fact Sheet.

More information on how to apply for PIP QI can be found here.

Primary Health Insights

All PHN’s have started using Primary Health Insights, a secure storage and analytics platform designed to house the de-identified practice data collected under our data sharing agreement. 

Primary Health Insights allows PHNs to increase our data analytic capabilities, privacy protection, data security and data governance competences. Primary Health Insights enhances data analytic capabilities to support PHNs to identify needs and planning services.

More information can be found on the Primary Health Insights website.

QI programs available for your practice

We can provide general practices with QI coaching and support to:

  • analyse monthly benchmarking and trend reports
  • identify opportunities for QI in your practice
  • use QI resources (i.e. toolkits, etc)
  • assist with PIP QI, including the registration, guidelines, and improvement measures.

QI support tiers

Our General Practice Quality Improvement Coordinators offer a variety of access tier levels, to offer catered support for your individual practice’s needs. It is up to decide which access tier level would be most appropriate for your practice team to engage with.

Annual QI support cycle with general practice

Our General Practice Quality Improvement Coordinators will determine opportunity areas for your practice, through the annual Practice Partnership Planning Discussion (PPPD). Within this meeting, your QI coordinator will discuss:

  • the current key focus for the practice
  • what is working well and what could be better
  • areas of interest
  • top population and health priorities
  • person-centred medical home development blocks
  • your chosen support level.

Annual QI support flow chart

My Health for Life QI program

The Queensland Government’s My Health For Life (MH4L) program is a free behaviour change program designed for people at high risk of developing a chronic disease. It is designed to support participants to make small lifestyle changes that can have significant, long-term health benefits.
The program supports the primary health care network through the extension of advice given by health professionals.

The program includes 6 coaching sessions (either phone or group sessions) for participants over 6 months by qualified health professionals and MH4L facilitators, there is also an ongoing maintenance program.

Person-centred care

We work with heath care providers to support their journey towards enhanced person-centred care.

We offer a range of programs and activities that are designed by General Practitioners (GP) and subject matter experts to support practices to build their team, enhance the sustainability of their practice and improve patient experiences and outcomes.

QI tools and resources

Data analysis tools

We provide several tools to help practices collect, analyse and improve the quality of their data. The Pen CS Suite, including CAT4 and Topbar, are provided by Brisbane South PHN to the practice at no cost and offers a number of benefits including:

  • automatic data extraction to meet PIP for QI requirements
  • monthly data to identify opportunities for QI
  • streamlined internal processes
  • improved patient-centred care.

Monthly benchmark and trend reports

Each month, we will produce a benchmark and trend report for your practice using your data. This report will help you identify key priority areas and quality improvement opportunities for your practice.

For assistance in accessing or interpreting your reports, please contact the Brisbane South PHN practice support team.

Quality improvement tools

Model for Improvement

The Model for Improvement (MFI) uses the Plan-Do-Study-Act (PDSA) cycle, a tried and tested approach that will achieve successful change and offers the following benefits:

  • it is a simple approach to change management that anyone can use
  • it reduces risk by testing small changes before wider implementation
  • iIt minimises resistance to change by starting with small changes
  • it helps foster team unity by creating shared goals
  • it encourages individual creativity and ideas from team members.

How to use the MFI

For a step by step approach and detailed instructions on how to use the MFI, download and read the e Quality Improvement Toolkit: Overview.

Each QI toolkit also has recommendations on how to use the MFI and PDSA cycle to achieve the QI activities in the toolkits.

RACGP QI & CPD points available for completing PDSA

GPs may be eligible for 40 RACGP accredited activity CPD points when 2 PDSA cycles are completed. GPs can log into their RACGP account, scan the QR code on the front of the template and read the guidelines in the MFI/PDSA RACGP template for more information.

Here are 2 completed examples of a MFI/PDSA RACGP

MFI and PDSA examples

Quality improvement toolkits

Brisbane South PHN has developed 34 quality improvement toolkits for general practices, covering a range of topics:

  1. general quality improvement
  2. specific conditions
  3. mental health
  4. prevention
  5. patient populations
  6. quality records and business
  7. Disaster & pandemic planning & management.

Modules included in these toolkits are designed to support practices to achieve the PIP QI requirements.

As practice teams complete the activities within the toolkits, they are shown how to analyse practice data to develop comprehensive knowledge about their patient population and the care pathways being provided in their practice. Reflections from completion of these activities and the related data may support the identification of improvement opportunities that can be actioned using the MFI.

Activities can be planned and documented in a practice’s online Practice Plan, accessible through DiscoverPHN, ensuring QI activity can be planned, tracked and saved for future accreditation and PIP QI reporting requirements.

QI toolkit activity workbooks

Activity workbooks are available in DiscoverPHN for some of the QI toolkits. The workbooks have been created as a PDF fillable document which allows you to complete the workbooks on your computer. These workbooks are also able to be shared amongst team members to allow a team approach to completion. For more support, email the Brisbane South PHN practice support team.

*Instruction document included. The first page of this document can be printed as a blank template or completed online then printed.

**This document can be printed as a blank template or partially completed online then printed.

DiscoverPHN: Self-paced online learning portal

DiscoverPHN is Brisbane South PHN’s learning and collaboration portal that provides self-paced online education modules, resources and support to primary health professionals in the Brisbane south region. More specifically, DiscoverPHN has useful modules surrounding topics such as digital health technologies, resources to assist in meeting the RACGP accreditation standards and QI courses and resources.

These include:

Courses

  • quality improvement using clinical software
  • improving data quality using Pen CS CAT4 (coming soon)
  • how to guide: quality improvement in general practice (coming soon)

Resources

  • Practice plan (coming soon)

Train IT

  • Brisbane South PHN has a library of webinars and resources from Train IT that guide a practice through QI activities using clinical software. Access to this library is available to our region via DiscoverPHN.

Contact QI support team

To request further practice support, please don’t hesitate to contact the quality improvement team at support@bsphn.org.au.  

Our team is dedicated to providing the best possible support for your practice.