1 CREATE A GREAT QUALITY SYSTEM IN SIX MONTHS USING THE STRATEGIC QUALITY SYSTEM Dr Cathy Balding www.cathybalding.com
10 years after QAHCS Medical Journal of Australia Editorial: Ten years on can we confidently state that healthcare is safer for patients? There is insufficient information at a state or national level to determine whether any or all of the efforts over the past 10 years have increased safety in our hospitals (Wilson and Van Der Weyden 2005).
Since then? 12% Vic patients experience an adverse event; and AEs increase the case cost up to 7X; with $1 in every $7 spent on healthcare in Australia used to treat a healthcare-associated injury. (Ehsani J, Jackson T, Duckett S (2006) The Incidence and Cost of Adverse Events in Victorian Hospitals, 2003 04. MJA, vol 184 no 11, pp. 551 55) 27% patients experience healthcare-associated harm in the US in 2012-48% of these are preventable and up to 83% incidents are not reported. (US Office of Inspector General, 2012 study of Medicare patients in 189 hospitals) 57% of patients receive care based on best available evidence via guidelines. (Runciman WB et al. CareTrack: assessing the appropriateness of healthcare delivery in Australia. Medical Journal of Australia 2012;197(2):100-105) Mid Staffordshire inquiry 2013: high mortality rates and appalling care. Review into the quality of care and treatment provided by 14 hospital trusts in England - overview report 2013: Issues with the capability of hospital boards and leadership to use data to drive quality improvement. Some boards use data simply for reassurance, rather than the forensic, sometimes uncomfortable, pursuit of improvement.
And now the Australian line in the sand : National accreditation reform incl. The National Safety and Quality Health Service Standards (NSQHSS) 256 actions: 209 core Standard 1 Governance for Safety and Quality in Health Service Organisations Standard 2 Partnering with Consumers Standard 3 Healthcare Associated Infections Standard 10 Preventing Falls and Harm from Falls Standard 4 Medication Safety Standard 9 Recognising and Responding to Clinical Deterioration in Acute Health Care Standard 5 Patient Identification and Procedure Matching Standard 8 Preventing and Managing Pressure Injuries Standard 7 Blood and Blood Products Standard 6 Clinical Handover
5 So much activity so little impact? There s a lot of activity that goes on in healthcare (quality) that doesn t necessarily contribute to overall value. (Robert S Huckman, Professor of Business Administration, Harvard Business School, 2013)
If you aim at nothing that s probably what you ll hit, so decide exactly what Good Care is as your cornerstone 6 1. Respect for pa,ent centred values, preferences and expressed needs 2. Emo,onal support and allevia,on of fear and anxiety 3. Access to care 4. Informa,on, communica,on and educa,on on clinical status and progress 5. Coordina,on and integra,on of care 6. Physical comfort, including pain management, help with ac,vi,es of daily living and clean and comfortable surroundings 7. Involvement of family and friends 8. Con,nuity and transi,on across organisa,ons. The Picker Ins-tute, 2006. And what health professionals want: Safe, Effective, Appropriate, Efficient
We know what to do Characteristics of organisations achieving high quality health care Dissatisfaction with the current quality of care A focused, shared sense of purpose for the achieving high quality care and a culture of we can do better Relevant strategic/operational plan actions are translated into measurable quality of care objectives Priorities, objectives and measures are centralised, and the strategies for meeting them are decentralised Accountabilities for providing safe care and improving care are clear A focus on both systems redesign and human behavior to improve care. (Baker, G.R., et al. 2008. High Performing Healthcare Systems: Delivering Quality by Design. 11-26. Toronto: Longwoods Publishing.) 7
Key components of Standard 1 (Governance) Governance and QI Clinical Practice Performance and skills Incident and complaints Patient rights and engagement P&P system clinical and corporate Compliance with legislation and standards Impact on patient safety and quality of care is considered in business decision making Roles and accountabilities and corresponding support and training Mandatory and competency based training to meet the standards requirements (D) Org-wide CRM and QI system Best available evidence Early ID of high risk patients Integrated clinical record Credentialing and SOP Performance development and review system Ongoing training and development Workforce engagement with the Q system Reporting and investigation system Complaints system Open disclosure (D) Charter of rights Patients as partners in their care Confidentiality Patient feedback
If it were easy 9
10 Not easy in a complex system Ideal Care Unacceptable Care Time
So Can t do it without that relentless focus from Board to bedside, chairside to chiefs Governing Bodies: A threefold responsibility for quality: 1. Ensure that essential standards of quality and safety are met as a minimum 2. Ensure that the organisation is striving for improvement 3. Ensure that every member of staff that has contact with your consumers, or whose actions directly impact on patient care, is motivated and enabled to deliver safe and person centred care NHS: Quality Governance in the NHS, 2011
Sort out responsibility and accountability 12
Go after it, developing robust, serious, mature quality systems and skills to achieve it... Health Service Organisational Quality System Maturity Scale Maturity Level Characteristics 1. Informal Lack of systematic approach: random improvement activities based on minimal and poor data. Managerial response to quality problems largely dependent on staff trying harder. Limited staff input into identifying problems and improvements. 2. Compliance Problem based and reactive approach with minimal systematic collection or analysis of data on key issues. Focus on compliance with external/funding requirements. Doing quality is staff code for auditing and other data collection with little implementation or follow up. Lack of relationship between quality system mechanics and quality of care quality still seen as the responsibility of the quality manager. 3. Reactive Risk 4. Proactive Continuous Improvement Focus on risk management and compliance with accreditation and other external requirements.. Systematic tracking of key indicators, consumer feedback and incident reporting. Evidence of some system improvement and follow up. No agreed change and improvement model in use. Reliance on policy shifts and education as key change tools. Leaders are developed to improve safety. Quality system is a key component of clinical/quality governance system and is integrated at operational level, with plans for improvement at organisation-wide and local levels. Lack of common and uniting goals with the improvement program comprising a series of (possibly unrelated) monitoring, improvement and redesign projects. Minimum dataset reported across all quality dimensions, Data are analysed and reported through the organisational levels to the governing body, and there is evidence of effective systems improvement as a result. Strategies in place for developing leaders to engage staff and consumers in improvement across the dimensions of quality. 5. Strategic The desired quality of the consumer experience at point of care is defined with staff and consumers, and achieving it is a strategic priority. The organisational quality plan is designed and systematically implemented to create the defined quality consumer experience, through developing people and improving systems. Roles and responsibilities at all levels of the organisation for creating the quality consumer experience are described and supported. Governance systems are owned by the governing body and executive team and designed to support staff to create the quality consumer experience. A model for change and improvement is in use.
14 Create a Great Quality System In Six Months Blueprint www.cathybalding.com
15 Create a Great Quality System In Six Months Blueprint WHERE DO YOU WANT YOUR QUALITY SYSTEM TO TAKE YOU? In Month 1, you will: Engage with your staff and consumers to define the great consumer experience your organisation wants to achieve for - and with - every consumer, every time, and the behaviours, processes and governance systems required to support it. Identify the purpose, people and pillars of a great quality system.
16 Implementation WHERE ARE YOU STARTING? In Month 2, you will: Perform a quality system stocktake on your current system to see what it comprises and how it s working. Draft your quality system development plan. HOW WILL YOU GET THERE? In Month 3, you will: Develop the high level plan to achieve the great consumer experience. Develop the governance accountability system and committee structure Start developing the quality system tools for organising, coordinating and reporting on your quality plan.
17 Implementation HOW WILL YOU MAKE IT REAL FOR CONSUMERS AND STAFF? In Month 4, you will: Operationalise the plan for creating the great consumer experience. Develop the formal and informal leadership group. Develop local consumer experience plans and identify the governance supports and behaviour and ownership drivers. HOW WILL YOU GUIDE AND TRACK PROGRESS? In Month 5, you will: Develop the consumer experience plan reporting system. Link the activities of the quality system to the activities of creating a great consumer experience. Build your improvement toolkit.
18 Implementation ARE YOU READY FOR ACTION? In Month 6, you will: Finalise the consumer experience organisational and local plans for roll out. Develop the rollout program. Prepare the training and support schedule and content. Plan to celebrate and recalibrate. Plan to develop the quality systems manager role.
So, let s design our framework 19
Put it together to make your efforts purposeful (The 3PQ Model) QG Pillars Ø Goals, objectives, measures, data, risk and improvement strategies Ø Culture, leaders, support, roles, development, training Ø Evidence, standards, policy, systems, resources People Ø Empathic Ø Skilled Ø Informed Ø Proactive Ø Accountable Purpose A consumer experience that is: Responsive Integrated Safe Effective Every person, Every time
BEST CARE AT WESTERN HEALTH (adapted 3P Model) PATIENTS to receive best care FRONT LINE STAFF to provide best care MANAGERS & SENIOR CLINICIANS to lead best care EXECUTIVE & BOARD to govern best care 1. I want people to talk to me & my family and treat me with respect and understanding 2. I want help when I need it 3. I want people looking after me who know how to make me feel better 1. I will listen to patients and their families and treat them as I would like to be treated 2. I will be a team player and look for ways to do things better 3. I will be competent in what I do and motivated to do my best 1. I will put patients first when making decisions 2. I will look for ways to support staff to work efficiently & as part of a team 3. I will guide, engage and support staff to provide best practice care I will oversight the development, implementation & ongoing improvement of organisation-wide systems supporting best care 4. I want to feel safe 4. I will keep patients from harm 4. I will promote a culture of safety We will demonstrate the WH CARES Values in all that we do Compassion, Accountability, Respect, Excellence, Safety
22 For a free SUMMARY of the Create A Great Quality System Blueprint Email me @ cathyb@qualityworks.com.au Thankyou! www.cathybalding.com www.cathybalding.com