Table 3

Quality improvement strategies used in Tayside Diabetes Managed Clinical Network, and in Scotland

Levels16Examples (identified from documentary and interview data)Used from when?
Strategies used by TDMCN
(Strategies not used by TDMCN in brackets)
Individual professional
EducationSingle and multi-professional, varying levels, locally organised and/or using wider resources eg, Warwick Diabetes Course171998
Data feedbackRoutine via stand-alone regional register initially, then via DARTS/SCI-DC181996
BenchmarkingRoutine individual practice comparison with regional and locality averages via DARTS/SCI-DC181998
Guidelines, protocol, pathway implementationTayside Diabetes Handbook available via MCN website is a locally modified set of national guidelines (SIGN)13 182000
Leadership developmentStrong central leadership with considerable delegation to task focused Tayside Diabetes Advisory Group subgroups181999
(Academic detailing)(Not explicitly used)
Groups/teams of professionals
Team developmentMulti-disciplinary collaborative working central to MCN ethos171998
Task redesignFor example, of eye screening, education for people with newly diagnosed type 2 diabetes, care for patients starting insulin172000
Clinical auditsStand-alone regional register was designed for audit; DARTS/SCI-DC includes practice audit tools181996
Guidelines, protocol, pathway implementationSingle shared guidelines and protocols for all professional groups disseminated via MCN website.182000
Care pathway redesign in 2002, but implementation has been slow2002
(Breakthrough collaborative)(Some Tayside practices are part of the Scottish Care Collaborative which has a diabetes arm, but not an MCN initiative)(2003)
Quality assuranceRoutine data collection and audit via DARTS/SCI-DC, locally agreed but consistent with national standards131996
Organisation developmentRegional service redesign with creation of new care pathway, although never fully implemented192002
Knowledge management/transferRegionally co-ordinated multidisciplinary education and training, knowledge dissemination via MCN website and newsletters182000
Public disclosureAnnual reports, regional quality data and key network documents published via MCN website182000
(Continuous quality improvement)(Not explicitly used)
Larger system/environment
National bodiesScottish Intercollegiate Guidelines Network guidelines for diabetes;131996
Scottish Diabetes Group and Framework4 202002
Accrediting licensing agenciesQuality Improvement Scotland review of diabetes services against national standards, and MCN accreditation152002
Payment policies2004 General Medical Services (General Practitioner) contract212004
(Evidence-based practice centres)
(Legal system)