Kupu Taurangi Hauora o Aotearoa
The Commission Supporting the health and disability sector to deliver safe and quality health care to all New Zealanders
The Commission Works with clinicians, health providers and consumers to: improve the quality and safety of services increase consumer engagement and participation
It s about Shining a light on important quality and safety issues through public reporting Lending a hand through making expert advice, guidance and tools available Doing the right thing, and doing it right, first time
Our Board Professor Alan Merry (Chair), Head of Auckland School of Medicine Mrs Shelley Frost (Deputy Chair), Chair and Executive Director (Nursing) of General Practice New Zealand
Our Board Dr Bev O Keefe, General Practitioner, Martinborough Ms Heather Shotter, Executive Director at Committee for Auckland. Mr Bob Henderson, Air New Zealand pilot and instructor and retired RNZAF Officer.
Our Board Dr Dale Bramley, Executive Officer of Waitemata DHB Dame Alison Paterson, Independent Director of Vector Ltd Ms Gwen Tepania-Palmer, Chairperson of the Ngāti Hine Health Trust, board member of Manaia Health, member of Waitemata and Auckland DHBs
Roopu Māori Roopu Māori provides advice to the Board and Chief Executive. Members are: Mr Tuwhakairiora (Tu) Williams, Chair Ms Leanne Te Karu Dr Denise Wilson Dr George Laking Ms Marama Parore Dr Janice Wilson Ms Kayleen Katene
Māori Caucus Māori Caucus provides support to the Māori members of the mortality review committees. Members are: Dr Jonathan Koea Dr Sue Crengle Ms Ngaroma Grant Assoc Prof Denise Wilson Maria Baker
The New Zealand Triple Aim Sector quality and safety outcomes
Our focus Reducing harm from: falls healthcare associated infections medication surgery Information, analysis and evaluation
We know what works Evidence tells us that with the right interventions: patient falls that result in fractures can be reduced by up to 30 percent CLAB rates can be reduced to fewer than one per 1000 line days surgical complications can be reduced by about a third potentially adverse drug events can be reduced by a quarter
Measuring harm
Mortality Review Committees Review particular deaths, or the deaths of particular people to learn how to best prevent these deaths Family Violence Death Review Committee Chair: Associate Professor Julia Tolmie Perioperative Mortality Review Committee Chair: Dr Leona Wilson Child and Youth Mortality Review Committee Chair: Dr Felicity Dumble Perinatal and Maternal Mortality Review Committee Chair: Dr Sue Belgrave Suicide Mortality Review Committee (time-limited committee) Chair: Professor Rob Kydd
Medication Safety Medication safety is about making sure the right patient gets the right medicine in the right dose at the right time and by the right route Our focus is on: prescribing and administration safety of transitions of care electronic medicines management in hospitals high-risk medicines and situations measurement and evaluation
Infection Prevention and Control Up to 10 percent of patients admitted to hospitals in the developed world acquire one or more infections Our focus is on: health care workers using 5 moments for hand hygiene (partnership with Auckland DHB) reducing patient risk of infection by greater use of central line insertion and maintenance bundles (partnership with Counties Manukau DHB) reducing the harm and cost related to surgical site infection
Reportable Events The Commission reports annually on the serious and sentinel events that occur in our hospitals 489 events in 2012/13 Falls were 52 percent of SSEs reported in 2012/13 No other significant changes in the pattern of SSE reporting Adverse events reporting policy agreed Moving to reporting in primary care and other settings
Patient Safety Campaign Open for better care, a campaign to reduce patient harm, launched in May 2013. Led and coordinated nationally by the Commission, and led and implemented locally by the sector Focuses on reducing harm from: falls healthcare associated infections surgery medication
Improvement starts with knowledge and clarity Well designed measures collect the right data, in the right parts of the system, at the right time They help you understand what parts of the system to change and how
Three key roles of measurement For UNDERSTANDING: to know how a system works and how it might be improve For PERFORMANCE: monitoring if and how a system is performing to an agreed improvement/performance/managerial state or level For ACCOUNTABILITY: allowing us to hold ourselves up to patients, the government and public to be openly scrutinised
Why measure? Stimulation of improvement Evaluation of what worked (or didn t) Judgement of overall quality Prompting the important questions
Health Quality Evaluation Quality and Safety Indicators (QSI) National set of Quality and Safety Markers (QSM), process and outcome measures, include the four focus areas (falls, healthcare associated infections, surgery, medication) Atlas of Healthcare Variation Quality Accounts
Rationale: QSI Cancellation of elective surgery by the hospital Provides insight into how close the system is running to capacity It is a measure of patient experience that is shown in other systems to be of importance to patients
Process markers Example QSM set for falls Percentage of patients aged 75 and over that are given a falls risk assessment and implementation of appropriate falls prevention. - proposed national threshold 95% Percentage assessments that result in a positive intervention to manage the risk of fall. (a subset used to contextualise the primary marker no national threshold) Outcome measures In hospital Fractured Neck of Femur (FNOF) per 1,000 admissions (age/sex standardised). Mortality following in-hospital FNOF (actual lives lost and rate per 1,000 admissions). Additional occupied bed days (OBDs) and associated cost following in hospital FNOF (actual OBDs and $s).
Measuring Consumer Experience
Lowest scoring questions 70% 60% nationally 58% 59% 50% 49% 40% 30% 20% 10% 0% 1 2 3 Did a member of staff tell you about medication side effects to watch for when you went home? Did the hospital staff include your family/whānau or someone close to you in discussions about your care? Do you feel you received enough information from the hospital on how to manage your condition after your discharge? Data taken from results of November 2015 quarterly patient experience survey
Safe Surgery Supporting the adoption of the Surgical Safety Checklist through the Reducing Perioperative Harm programme. The checklist is a tool to improve the safety of operations and reduce unnecessary death and complications by: reinforcing accepted safety practices fostering better teamwork and communication briefing and debriefing in operating theatre Our goal is - Every theatre, every case.
Global Trigger Tools A work programme to help implement the Global Trigger Tools programme in New Zealand Global Trigger Tools is a quality improvement initiative being used internationally to reduce patient harm Analyses random samples of patient records looking for triggers which may indicate harm has occurred Information gained is used to improve the quality and safety of services
Reducing Harm from Falls Reducing harm from falls aims to reduce harm associated with preventable falls The initial focus is on in-patients and aged residential care
Reductions in harm from falls and value for money In-hospital falls data indicates the programme has prevented falls and saved costs since July 2012 67 FNOFs were prevented 2140 bed days from falls were saved No significant change in community-based falls resulting in hospital admission from 2009/10 to Dec 2015 $3.1m associated costs saved $2.8m ARC costs saved (estimated)
Conducting risk assessments for older patients has increased 92% of older patients were assessed for their risk of falling in 2015 quarter 4-15% higher than 2013 quarter 1 (77%) 14 DHBs achieved the threshold of assessing over 90% of their older patients at risk of falling 6 DHBs assessed 80% - 89% of older patients for risk of falling 1 DHB assessed less than 75% of older patients for risk of falling
Individualised care planning for older patients has increased 92% of older patients at risk of falling had an individualised care plan in a hospital setting in 2015 quarter 4-12% higher than 2013 quarter 1 (80%) 14 DHBs achieved the threshold of developing individualised care plans for over 90% of their older patients at risk of falling 5 DHBs developed care plans for 77-80% of older patients 2 DHBs developed care plans for less than 75% of older patients
Leadership and Capability Building 47 IA s completed one year course From Knowledge to Action International speaker series Annual Quality Improvement Scientific Symposium
Consumer Engagement
Consumers, patients, family, whānau the largest untapped resource in health
Deteriorating Patient Programme 2016-2021 Board approval for five-year quality improvement programme Aims to: Improve the recognition of and timely, patientspecific responses to clinical deterioration for all adult inpatients in NZ
Primary care programme Establishing EAG Whakakotahi primary care quality improvement challenge Priority areas Equity Consumer engagement Integration http://www.hqsc.govt.nz/our- programmes/othertopics/news-and-events/news/2566/
Driving quality improvement Building capability Supporting clinical leadership Building on the success of existing initiatives Sharing success stories
Engagement across the sector
What we don t do Handle individual consumer cases or complaints Enforce regulations or legislation Quality assurance or compliance auditing e.g. for certification Credentialing or registration of individual clinicians Fund health and disability services
Questions?
Our website: www.hqsc.govt.nz Register for our newsletter and fortnightly email updates Contact us: info@hqsc.govt.nz
Kupu Taurangi Hauora o Aotearoa