10/13/2015 Healthcare in Qatar Delivering BEST CARE ALWAYS: National ambition, energy, commitment Growing demand Capacity and infrastructure limits Diverse workforce Huge investment in healthcare Transformation agenda making good ideas work for patients Dr Charles H. Pain LRCP (Lond.), MRCS (Eng.), MSc, FFPH (UK), FAFPHM, FCHSM, FISQua Co-Director, Health Systems Improvement, Hamad Healthcare Quality Institute Doha, Qatar Visiting Fellow, Australian Institute of Healthcare Innovation, Macquarie University, Sydney, Australia Hamad Bin Khalifa Medical City Is healthcare getting safer? Situation The United States Agency for Healthcare Research and Quality has made important advances by adding safety indicators. In UK, rates are actually increasing in all but two of the nine indicators so far translated. 20 years of improvement effort has demonstrated that the system is stubbornly resistant to change (Leape, Berwick, Landrigan, Pronovost, Hollnagel & Braithwaite) Deaths in Healthcare Resource Groups (HRGs) appear to be decreasing significantly. The same system problems persist, as shown by inquiry after inquiry (Travaglia & Braithwaite eg. Bristol, Mid-Staffordshire, Morecambe Bay, NSW) While efforts to improve patient safety have proliferated during the past decade, progress Foreign Body Left during Procedure is also decreasing slightly, but this indicator toward improvement has been frustratingly has been found to include many cases which are not related to patient safety. slow. Luciene Leape, Don Berwick, et al. 2009, The remaining indicators appear to suggest that Transforming care is getting steadily less Healthcare: A Safety Imperative, safe BMJ Safety and Quality. 2009;18:424-428 2005 2008 2009 Prof. Rene Amalberti 1
So do we need to do something different? What does transformation look like? If you always do what you ve always done, you ll always get what you ve always got. Henry Ford (1863-1947) Albert Einstein (1879-1955) We aim to deliver the safest, most effective and most compassionate care to each and every one of our patients Best Care, Always Purpose The HHQI will design and develop evidence-based practical solutions for patients and promote access to high-quality, safe services across Qatar. - Hanan Al Kuwari, PhD [27 April 2014] HMC Health Care Quality Improvement Strategy HMC IS DOING PRIORITY IMPROVEMENT SOMETHING DIFFERENT FOUNDATION Strategy ERAS Guidelines in Medicine AMAU QEWS CCITP Leadership Development Strategy PNM Review System Conclusions 1. Our task is to find solutions to the age-old problems of healthcare 2. We should focus on the frontlines of care 3. HMC is undergoing transformation and is doing something different. 4. We are being strategic and focused not reactive and piecemeal in our approach. 5. We are focusing on improving systems, building highreliability patient care teams, developing capability, standardising practice, humanizing healthcare and changing culture. 2
Health System Transformation Model (elements of the system) Health System Facility Unit Unit CHP 2012 More on what transformation looks like? (What we are aiming for) right choice of care (appropriate) which addresses clinical needs (effective) good patient experience (acceptable) no unnecessary harm (safe) optimal resource use (efficient) consistent care standards (reliable) And more on what it looks like Appropriate Good care decisions Effective Good execution of care decisions Acceptable Compassionate and respectful care Safe Early recognition of mistakes Efficient Good coordination & no duplication of effort Reliable Good systems & commitment of staff 10 Essential Functions of High-Reliability Patient Care Teams Standard Protocols & Procedures Patient Safety & Quality Systems Team Structures & Dynamics Education, Training & Supervision Leadership & Governance Best Care Always Workforce Management Care Planning, Coordination & Delivery Patient & Family Engagement Information Management Support Services & Equipment Source: In Safe Hands, Releasing the Potential of Clinical Teams Charles H. Pain, Julie K. Johnson, René Amalberti, Jason Stein, Jeffrey Braithwaite, Clifford F. Hughes, 2012 HMC Health Care Quality Improvement Strategy PRIORITY IMPROVEMENT FOUNDATION 3
Focus on the front line and build high-reliability patient care teams ADMISSION The Patient Journey ED Ward (OR) Rehab. HOME Patient Condition ICU Time DEATH High-reliability patient care teams IN SAFE HANDS Releasing the Potential of Clinical Teams Charles H. Pain *, Julie K. Johnson, René Amalberti, Jason Stein, Jeffrey Braithwaite, Clifford F. Hughes Corresponding author: Charles H. Pain, LRCP (Lond.), MRCS (Eng.), MSc, FFPH, FAFPHM Director, Health Systems Improvement, Clinical Excellence Commission, Sydney, New South Wales, Australia. charles.pain@cec.health.nsw.gov.au Julie K. Johnson, MSPH, PhD Associate Professor of Medicine and Deputy Director, Centre for Clinical Governance Research, University of New South Wales, Sydney, Australia. René Amalberti, MD, PhD Professor & Senior Advisor Patient Safety at the Haute Autoritéde Santé, Paris, France. Jason Stein, MD, SFHM, Assistant Professor of Medicine, Emory University School of Medicine, Atlanta, USA. Jeffrey Braithwaite, MBA PhD, FAIM, FCHSE Professor & Foundation Director, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, Australia Clifford F Hughes AO, MBBS, FRACS, FACC, FACS, FCSANZ, FAAQHC, AdDipMgt Clinical Professor, Chief Executive Officer, Clinical Excellence Commission, Sydney, New South Wales, Australia. Pain, CH. Johnson, JK. Amalberti, R. Stein, J. Braithwaite, J. Hughes, CF, In Safe Hands: Releasing the Potential of Clinical Teams, presented at Patient Centred Health Care Teams: Achieving Collaboration, Communication and Care [obhc2012], Trinity College Dublin, Ireland, 15-17 April 2012 Patient Condition ADMISSION ED Ward (OR) Best Care Always Rehab. 1. Leadership and Governance 2. Team Structure and Dynamics 3. Care Planning, Coordination and Delivery 4. Standard Protocols and Procedures 5. Patient Safety and Quality Systems 6. Patient Engagement 7. Education, Training and Supervision HOME 8. Workforce Management and Development Time 9. Information Management 10. Support Services and Equipment DEATH And this is what you get And this is who we support 4
And this is who we serve...and they will deliver highreliability through: Good care decisions Good execution of care decisions Compassionate and respectful care Early recognition of mistakes Good coordination & no duplication of effort Good systems & commitment of staff What can be achieved? Orange Hospital, New South Wales (Gabriel Shannon & Sue Patterson) Reduced adverse events Improved staff satisfaction Improves patient satisfaction Improved hand hygiene The Alfred Hospital, Victoria (Harvey Newnham & Andrew Hoiles): Major improvements in global performance Improvements in perceptions of safety and teamwork Documentation of DVT prophylaxis has increased to over 70% Liverpool Hospital, England (Aftab Ahmad): halving the length of stay and doubling the number of discharges Emory, Atlanta (Jason Stein & Bryan Castle): 51% reduction in mortality Decrease of hospital acquired infections Thank you Questions? Acknowledgements Susan Whitby former Director of Nursing, Sydney West Area Health Service Professor Paul Harnett Director, Cancer Services, Western Sydney Local Health District Professor Steven Boyages Chief Executive, Sydney West Area Health Service Dr Gabriel Shannon Executive Medical Director, Western NSW LHD Associate Professor Julie Johnson Australian Institute for Health Care Innovation, UNSW Professor Cliff Hughes former Chief Executive, Clinical Excellence Commission (President Elect, ISQua) Dr Reham Negmeldin Hassan Manager, Clinical Care Improvement Training Program, HMC Dr David Vaughan Executive Director, Patient Safety, HMC Dr Adeel Butt Chief Quality Officer (I), HMC Professor Michael Richmond Chief Medical Officer, HMC Dr Hanan Al Kuwari Managing Director, HMC And many, many more... 5