Everyday work as quality improvement: Practical steps for busy practices

Quality improvement (QI) has long been part of how general practices operate. Every day, teams adjust workflows, respond to feedback, refine systems and solve problems in ways that improve care for patients and support how the practice runs.

Under the current RACGP Standards, QI is broadly defined as activities undertaken to monitor, evaluate or improve the quality of healthcare delivered, reinforcing that routine practice activity informed by data and feedback can be meaningful improvement when approached deliberately.

With the RACGP Standards 6th edition in final development, the draft versions continue to position continuous QI as a core practice capability. While the overall principles are likely to remain consistent across these editions, what the draft 6 edition Standards indicate is the likelihood of an enhanced focus on ongoing monitoring, systematic evaluation and emerging themes such as environmental sustainability. This highlights the role of continuous improvement within daily practice and its contribution to delivering safe, effective and sustainable care over time.

Most teams are already constantly refining systems, responding to feedback, adjusting workflows and solving daily challenges. A common issue for many practices going through the accreditation process is not in regards to the undertaking or implementation of QI activities, it’s in regards to how they demonstrate, record or monitor these initiatives when submitting evidence as part of the accreditation process.

As expectations around continuous QI continue to evolve, the focus is shifting away from isolated activities completed for accreditation, and towards building practice capability and consistency over time. Everyday work at the practice, when approached with intent, already contains the foundations of continuous QI.

This article intends to explore how practices can recognise, capture and build on what they are already doing, to turn routine activities into documented improvement that supports patient care, team wellbeing and sustainability.

The quality improvement lens

QI can begin with the work practices are already doing every day. Many routine activities are already embedded and contribute to QI such as:

• Responding to patient feedback
• Adjusting appointment scheduling
• Communication initiatives between clinical and administrative staff
• Reviewing incidents
• Incorporating new digital tools or workflows

Routine practice activity becomes QI when it is undertaken with clear intent and followed by reflection. Being able to describe the rationale for change, the intended outcome, and the insights gained enables practices to demonstrate meaningful QI.

Viewing everyday work through the QI lens can help practices move away from seeing it as an additional or separate activity and instead recognise it as a structured way of making current initiatives visible and valued.

Recognising and documenting existing QI activity

Practices often undertake a wide range of improvement activities and could benefit from approaches that help them clearly communicate and document this work. Effective QI documentation does not need to be long and complicated, and can focus on four key elements:

1. Reason for change
   What is prompting the change? Are there issues that need to be addressed? What risk, opportunity or enhancement has been identified?
2. Action taken
   What was actions were changed, tried or introduced?
3. Outcome or learning
   What was the result? What worked, what didn’t, what was learned?
4. Next steps
   Is the change being embedded in everyday activities? Will it be adjusted or reviewed in the near future?

Certain planned approaches such as Plan–Do–Study–Act (PDSA) cycles and SMART goals can be valuable for practices as they provide a clear and structured way to highlight improvement activities with your team. These tools are not limited to clinical assessments and can be applied to administrative processes, workforce, patient experience improvements and sustainability efforts.

It’s important to focus on documenting any initiative with clarity as it makes it easier to track and maintain, and it also makes it more useful for internal teams and external reviews.

Sustaining continuous QI over time

At times in the lead-up to the accreditation assessment reviewing and reporting on QI can become a key activity, and that is not always maintained with the same consistency once the assessment is complete. Sustainable improvement is best supported through a consistent and ongoing approach.

Some ideas for practices to embed QI into everyday operations can include:

• Setting aside time throughout the year to reflect on data, feedback and risks
• Using routine meetings to discuss what is working well and what could improve
• Revising previous improvement activities to assess whether changes have been sustained
• Encouraging small, manageable improvements rather than large, one-off projects

This type of approach encourages a shift from an activity-focused view of QI to one centred on ongoing improvement. Over time, it builds confidence and supports a clearer path of continuous development.

Preparing for assessment effectively

Assessment preparation can be viewed as time consuming and sometimes even reactive, especially when documentation of QI activities has been inconsistent. Understanding what assessors are generally looking for can help practices focus their efforts more effectively. Assessors will seek evidence that the practice has:

• Identified areas for improvement based on information or feedback
• Taken action in response
• Reflected the outcome and consistent steps

Practices are not expected to showcase perfect results and are encouraged to acknowledge the challenges and mixed outcomes. Review and reflection often strengthen the credibility of QI activities, as it shows that learning has occurred and informed future decisions.

Every practice can use information they have at hand, for example data from clinical systems, patient feedback tools, incident logs and team discussions that make preparation for assessment more manageable.

Fostering team engagement and capability

QI is most effective when it is a shared team responsibility. While having a nominated team member to drive activities and provide structure is a helpful initiative, sustainable QI relies on shared understanding and participation across the whole team.

To build capability in a practical way, it’s important to involve staff in identifying improvement opportunities, sharing updates on changes and learnings to encourage reflection and recognising contributions from both clinical and non-clinical team members.

Embedding quality improvement into routine practice

As expectations around continuous QI continue to evolve, practices are being encouraged to demonstrate how real improvement is approached, documented and sustained. Preparing for accreditation can give organisation the chance to embed QI into the practice’s identity.

By applying simple structures, capturing learning and engaging the whole team, practices can turn what they already do into evidence of thoughtful, ongoing improvement. When QI is integrated into the practice culture, the benefits go far beyond accreditation, building better systems, supporting teams, and care that continues to evolve in response to patient and community needs.

Over time, this approach builds confidence, consistency and capability, ensuring that QI remains a practical and valuable part of everyday practice, well beyond the accreditation cycle.