Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) in primary care: Development of the IDEALearning Toolkit for primary care.

Roisin O'malley, Sinéad Lydon, Aileen Faherty, Rachel Bothwell, Paul O'connor

Keywords: General Practice; Positive deviance; Quality improvement; Team-based learning

Background:

Despite the increasingly challenging nature of delivering care in general practice, many clinicians, teams and practices continue to provide an exceptionally high standard of care. Practice teams are uniquely positioned to measure the quality of care they provide and to implement changes that improve care delivery. While many quality tools assess instances of poor care, few tools exist that harness learning from exceptional care delivery.

Research questions:

This study aimed to develop a team-based discussion toolkit for supporting learning and improvement in general practice; The Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) Discussion Tool.

Method:

A two-stage approach was employed to refine the tool. Stage 1 involved the conduct of two focus groups with key stakeholders (i.e., patients, general practitioners (GPs), practice nurses, and practice managers) to examine the appropriateness of the initial toolkit according to APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Side effects, Equity). Stage 2 collected further information on the usability, feasibility, face and content validity of the toolkit through cognitive interviews with GPs, practice nurses, and practice managers.

Results:

The IDEAL tool was received positively by patients and staff during focus groups, and several modifications were suggested and implemented. Interviews highlighted barriers to completing the toolkit in practice (e.g., comprehensibility of questions, and clarity of instructions). The final IDEAL Discussion Toolkit consists of a clinician, team and practice assessment sheet where users identify their level of capacity (i.e., Basic, Proficient or Exceptional capacity), followed by an evaluation sheet, and a section which prompts team discussion around strategies for achieving exceptional care delivery across areas they seek to improve.

Conclusions:

The IDEAL toolkit provides a valuable tool for primary care teams seeking to understand, reflect upon, and make improvements to their practice. Future research exploring the feasibility of this learning toolkit in a large sample of diverse general practices is needed.

Points for discussion:

Primary care physicians, nurses and practice managers perceptions of using a tool that emphasizes learning from exceptional care delivery.

Important facilitating factors that would improve the feasibility and acceptability of using a team discussion-based learning toolkit in practice.

Barriers that may impact the feasibility, acceptability and implementation of a team discussion-based learning tool into practice.

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