GP-clusters as a successful bottom-up approach of quality improvement in Denmark

Thomas Bo Drivsholm, Christian Hollemann, Birgitte Harbo, Flemming Bro

Keywords: GP cluster quality improvement

Setting:

Inspired by GP-clusters in New Zealand and Scotland, GP-clusters were introduced in Denmark in 2018 as a replacement for accreditation.

Target group:

The GPs within 115 Danish clusters constitute of 20-30 GPs (range 11-70) in local geographical areas, aiming at a patient population of minimum 30.000.

Description of the innovative practice or project:

Mandatory cluster meetings of 2-3-hour are held 3-4 times a year, typically after clinical work. Expenses for meeting facilities are covered, but participation not financially incentivised.
Educational cluster-packages are delivered by 1) the national GP-quality institution KiAP, 2) one of the five regional quality institutions or 3) developed by the GP-clusters themselves, the choice of package taken by cluster-members themselves.
Cluster-packages from KiAP approach “plug and play” including comprehensive material including a video-introduction, a playbook, PowerPoints, a tool for developing an implementation-plan and a podcast. Packages aim at supplying data at the individual practice and patient level, enabling benchmark between cluster practices and quality improvement at the practice level and individual patients, where possible.
Even though data are central in meetings, room for reflection and exchange of knowledge and ideas between GPs as well as between general practices are believed to be of paramount value. Clusters are encouraged to revisit follow-up data after 6-12 months to enforce the overall aim of implementing a quality development culture using the PDSA-method.

Evaluation:

99 % of Danish GPs participate in clusters, 79% charactering the cluster setup as satisfying (2023).

Next Steps:

For KiAP, the ongoing development aim at 1) increasing implementation of knowledge from cluster meetings at the practice- and patient-level, and 2) document effects of the cluster approach at the level of clusters, general practices and patients.

Lessons learned:

The current cluster-approach seem to be promising as a tool to encourage Danish GPs to commit themselves in quality improvement, the bottom-up approach believed to be a key factor for the current success.

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