FRACGP Quality Assurance and Improvement 3 — Questions and Answers
Question 1: A GP practice wants to reduce the rate of patients lost to follow-up after an abnormal Pap smear result. Which QI approach is MOST appropriate as a first step?
- Immediately implement a new recall system
- Conduct a baseline audit to quantify the current problem (Correct answer)
- Survey patients about their satisfaction
- Request a practice visit from the accreditation body
Correct answer: Conduct a baseline audit to quantify the current problem
Before implementing changes, a baseline audit establishes the current rate of follow-up loss, providing a benchmark against which improvement can be measured.
Question 2: Which of the following BEST describes 'clinical governance' in general practice?
- The administrative management of practice finances
- A framework through which health organizations are accountable for continuously improving quality and safeguarding standards of care (Correct answer)
- The process of credentialing new clinical staff
- The legal framework for mandatory reporting obligations
Correct answer: A framework through which health organizations are accountable for continuously improving quality and safeguarding standards of care
Clinical governance is a system of accountability for quality and safety, encompassing leadership, culture, processes, and outcomes.
Question 3: When conducting peer review in general practice, the primary purpose is to:
- Identify underperforming practitioners for disciplinary action
- Fulfill medical indemnity requirements
- Support reflective practice and continuous professional development (Correct answer)
- Satisfy AHPRA registration requirements
Correct answer: Support reflective practice and continuous professional development
Peer review in general practice is primarily a formative, educational process aimed at supporting reflective practice and CPD, not disciplinary oversight.
Question 4: A practice implements a new electronic reminder system for cervical screening. After 6 months, screening rates have not improved. According to quality improvement principles, the NEXT step is:
- Abandon the reminder system and try a different approach
- Analyze the system to understand why the change did not produce improvement (Correct answer)
- Report the failure to the practice's accreditation body
- Increase the frequency of reminders without further analysis
Correct answer: Analyze the system to understand why the change did not produce improvement
When a PDSA cycle does not produce the expected improvement, the next step is to analyze the failure to understand the cause before adjusting the intervention.
Question 5: Which of the following is an example of a 'structure' measure in the Donabedian model of healthcare quality?
- Proportion of diabetic patients with HbA1c below 53 mmol/mol
- Time from referral to specialist appointment
- Availability of spirometry equipment in the practice (Correct answer)
- Patient-reported satisfaction with GP communication
Correct answer: Availability of spirometry equipment in the practice
In Donabedian's model, structure measures assess the resources and organizational features of care delivery, such as equipment, staff, and facilities.
Question 6: The concept of 'safety culture' in a GP practice is BEST demonstrated by:
- Zero incidents being reported over a 12-month period
- Staff feeling safe to report errors and near misses without fear of blame (Correct answer)
- The practice manager reviewing all incident reports personally
- Annual mandatory safety training for all staff
Correct answer: Staff feeling safe to report errors and near misses without fear of blame
A true safety culture is characterized by psychological safety — where staff proactively report errors and near misses, generating learning opportunities.
Question 7: In continuous quality improvement (CQI), 'special cause variation' differs from 'common cause variation' in that it:
- Is always more harmful to patient outcomes
- Represents predictable fluctuation inherent to the process
- Signals an unusual event or factor outside the normal process (Correct answer)
- Requires no action from the quality improvement team
Correct answer: Signals an unusual event or factor outside the normal process
Special cause variation arises from factors external to the normal process and signals something unusual that warrants investigation and specific action.
FRACGP Quality Assurance and Improvement 3
A GP practice wants to reduce the rate of patients lost to follow-up after an abnormal Pap smear result.
Which QI approach is MOST appropriate as a first step?