Volume 34 Number 3, June 2007 189 Correspondence to: slillis@wave.co.nz Practice accreditation across a network; enabling practices Steven Lillis, Denise Ward, Hayley Lord Introduction Over a 14-month period, 93 out of 97 general practices who are part of the Pinnacle General Practice Net- work completed the Cornerstone™ accreditation process. This paper will discuss key success factors from the perspective of an organised general practice network in achieving this outcome together with observation and reflection on events that had the potential to adversely affect the out- come. This paper will be the first of three reports detailing the project; the second paper will detail the ex- perience of the RNZCGP and the third will present project evaluation data. Background The Pinnacle General Practice Net- work spans five Primary Health Or- ganisations (PHOs) in the Midland region: Waikato Primary Health, Pin- nacle Taranaki PHO, Lake Taupo PHO, Turanganui PHO and Kawerau PHO. Collectively these practices encom- pass some 425 000 enrolled service users, 300 general practitioners, 350 practice nurses and 95 practice man- agers. As a management services or- ganisation, Pinnacle has, since incep- tion, maintained a strong focus on quality initiatives at the practice level. Early negotiations with the appropriate Regional Health Au- thorities (the funding body at the time) had resulted in a shared vision concerning quality initiatives in gen- eral practice and dedicated funding to support these. With the emergence of PHOs, further support was gained from these organisations for continu- ing and developing quality initia- tives. The most prominent of these quality initiatives is the annual qual- ity plan. Quality plans Historically, a Quality Committee, composed of general practitioners, practice nurses and practice manag- ers from across the network, has been charged with the responsibility of devising each quality plan. The con- cept of practice accreditation and the likely format of such a process had been discussed by the committee as early as five years ago, with the clear vision of gradually introducing those aspects of practice accreditation that would be common to any accredita- tion process. Quality Plan 5 intro- duced the concept of practice ac- creditation and sign-posted to the network that this was the direction future plans would take. An important part of the path to achieve the generic outcomes of practice accreditation was introduc- ing the concepts of clinical govern- ance to the practices. This provided a framework of responsibility for outcomes at a practice level that was shared by all members of the prac- tice team. Risk management and safety of practice are valuable con- cepts that were introduced as part of the clinical governance process. Sub- sequent quality plans, Quality Plans 6 to 8, continued this theme and in- cluded other criterion from the Aim- ing for Excellence standard in prepa- ration for the inevitability of prac- tice accreditation. Achieving Corner- Steven Lillis is Senior Lecturer in Gen- eral Practice at the Waikato Clinical School, Chair of the Board of Assess- ment for the RNZCGP and has been a Pinnacle board member for six years. He graduated from the University of Auck- land, is a Fellow of the RNZCGP and has a Masters of General Practice from Otago University. His academic interests are safety of medical care, medical edu- cation and assessment in education. Denise Ward has led Pinnacle’s quality team since October 2003. Latterly this role has encompassed managing the net- work-wide Cornerstone™ practice accredi- tation project. Previous experience in qual- ity management has included 18 months as Quality Development Leader for NZ Blood Service, and six years as Quality Manager for Hamilton Health Manage- ment Limited. Denise also has more than 10 years’ experience conducting accredi- tation surveys of health care facilities, for Quality Health New Zealand. Hayley Lord joined Pinnacle’s quality team in 2001 and currently works part- time as a Quality Facilitator. During the accreditation project she acted as Key Quality Support person for a group of 26 practices. Hayley has also played a key role in analysing evaluation data received from practices after they have achieved accreditation. Improving Performance