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Evidence and magic
How to transform Quality in NZ?
Wellington Feb 2009
Bruce Arroll,
Department of General Practice & Primary Health Care
Faculty of Medical & Health Science
University of Auckland, Auckland, New Zealand
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Acknowledge
Prof John Buchannan “grand” father of quality in Auckland Kept the interest in the topic when we were flagging
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Disclaimer
Fresh eyes on what is happening
At a global level I am happy with the health system
I work at the University 70% of my time and 30% I
work in a clinic in Manurewa, which I partly own,
one of the most disadvantaged suburbs in New
Zealand
No concerns about waiting lists – a side show
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Story
Story of 6 year old girl
She is having chemotherapy for a blood cancer
She is bald
All her class mates are laughing at her
Her teacher considers
Her teacher does something outrageous →
Problem solved
This is magic or transformation – a step change
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Rod Jackson
Health is all about quality and cost and nothing else
Perceptions are generally wrong –you need to audit
and compare – we overestimate
We need a step improvement in quality
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Shave our heads for quality
Make quality the centre of the health system If we can grow moustaches for prostate cancer
surely we can shave our heads for quality
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My contribution to quality
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What would quality look like
The computer system would have audit functions
made user friendly as well as for clinical stuff
The current systems are really designed to make
clinical work more effective with audit as a
secondary consideration
Press a button and get an audit
We should know how we are doing as a nation
Each clinic would have a “quality person”
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What would quality look like
Diana North and Drinfo –press a button and find out
how you are doing and selects those who need to
be called in to get their management improved
Ensure that practitioners know how to use their
computers
Enter the data in to data base not in as text
A robust method of evaluating performance
UK make figures public- audit police
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Are the decks burning #1
2007-2008 gout audit
38% of patients with gout with uric acid levels <
0.36 mmol/l
Practice in same suburb 43%
After intervention 45%
How does this rate nationally
No one knows
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Are the decks burning #2
Auckland 2001 81% of patients on ACE
inhibitors/CHF
UK 2007 80% of patients on ACE inhibitors with
CHF
Auckland 2005 70% of patients on ACE inhibitors
Personal communication V Andersen 2009
Does this matter => hospitalisations, QoL, death
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Are the decks burning #3
Immunisation DTP NZ 2004-5 79.3% coverage
DTP UK 2003-4 94%
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NZ vs UK
We don’t know Echocardiogram for patients with CHF 92.5% in the
UK in an Auckland population 58% NZ most likely no better than the UK on any
measured parameter in the QoF and probably worse on most if not all
Perhaps we should measure what’s happening here as a starting point
UK system unlikely to go backwards
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What is needed
A transformation i.e a step change in attitude towards quality
Consider a systemic approach Pegasus with CME and audit synchronised
There are plenty of criticisms but the UK is probably as good as or better than us on every indicator that they use -they are the bench mark
A national system
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What’s missing ?
Political devolution of responsibility to DHB/PHOs
means nobody is in charge
Problem with transferring electronic detail from one
clinic to another using Medtech software.
Eg adverse drug reaction info is lost
Computers do this well humans do not
Some one will die or get sick
No single person can change this situation other
than perhaps the minister of health
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Summary
Gary Sinclair
Aims for the best not just better health care
If we want the best we need a transformation.
Waiting for change to happen spontaneously is
wishing for magic
We need to embrace quality
We need to measure how we are doing-QoF nz
survey
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Summary
We need to consider a system that works for NZ
without the downside of QoF
The UK may not have the Rugby world cup but they do have the world cup on quality
Somebody needs to be in charge
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