Quality improvement strategies used in Tayside Diabetes Managed Clinical Network, and in Scotland
| Levels16 | Examples (identified from documentary and interview data) | Used from when? |
| Strategies used by TDMCN | ||
| (Strategies not used by TDMCN in brackets) | ||
| Individual professional | ||
| Education | Single and multi-professional, varying levels, locally organised and/or using wider resources eg, Warwick Diabetes Course17 | 1998 |
| Data feedback | Routine via stand-alone regional register initially, then via DARTS/SCI-DC18 | 1996 |
| Benchmarking | Routine individual practice comparison with regional and locality averages via DARTS/SCI-DC18 | 1998 |
| Guidelines, protocol, pathway implementation | Tayside Diabetes Handbook available via MCN website is a locally modified set of national guidelines (SIGN)13 18 | 2000 |
| Leadership development | Strong central leadership with considerable delegation to task focused Tayside Diabetes Advisory Group subgroups18 | 1999 |
| (Academic detailing) | (Not explicitly used) | |
| Groups/teams of professionals | ||
| Team development | Multi-disciplinary collaborative working central to MCN ethos17 | 1998 |
| Task redesign | For example, of eye screening, education for people with newly diagnosed type 2 diabetes, care for patients starting insulin17 | 2000 |
| Clinical audits | Stand-alone regional register was designed for audit; DARTS/SCI-DC includes practice audit tools18 | 1996 |
| Guidelines, protocol, pathway implementation | Single shared guidelines and protocols for all professional groups disseminated via MCN website.18 | 2000 |
| Care pathway redesign in 2002, but implementation has been slow | 2002 | |
| (Breakthrough collaborative) | (Some Tayside practices are part of the Scottish Care Collaborative which has a diabetes arm, but not an MCN initiative) | (2003) |
| Organisation | ||
| Quality assurance | Routine data collection and audit via DARTS/SCI-DC, locally agreed but consistent with national standards13 | 1996 |
| Organisation development | Regional service redesign with creation of new care pathway, although never fully implemented19 | 2002 |
| Knowledge management/transfer | Regionally co-ordinated multidisciplinary education and training, knowledge dissemination via MCN website and newsletters18 | 2000 |
| Public disclosure | Annual reports, regional quality data and key network documents published via MCN website18 | 2000 |
| (Continuous quality improvement) | (Not explicitly used) | |
| Larger system/environment | ||
| National bodies | Scottish Intercollegiate Guidelines Network guidelines for diabetes;13 | 1996 |
| Scottish Diabetes Group and Framework4 20 | 2002 | |
| Accrediting licensing agencies | Quality Improvement Scotland review of diabetes services against national standards, and MCN accreditation15 | 2002 |
| Payment policies | 2004 General Medical Services (General Practitioner) contract21 | 2004 |
| (Evidence-based practice centres) | ||
| (Legal system) |