Leading the Safety and Quality Leading the Safety and Quality AgendaAgenda
in Australian Health Carein Australian Health Care
Coalition of National Nursing OrganisationsCoalition of National Nursing Organisations
Chris BaggoleyChris Baggoley
2 May 20082 May 2008
Quality in Australian Health Care StudyQuality in Australian Health Care Study
“A furore erupted in mid-1995 when a former Federal Minister for Health, Dr Carmen Lawrence, released preliminary results of a study estimating that 14,00 people died in Australian hospitals each year as a results of complications in their health care. The public was alarmed, and doctors were furious.”
Sydney Morning Herald: 2/12/1997
ACSQHCACSQHC
The Australian Commission on Safety and Quality in Health Care
- Established by Health Ministers in 2005, commenced in 2006
- Reports to Health Ministers
- Commissioners diversity and strength
- Committee structure: IJC, PHSC, PCC, ISC
Enactors
- Stakeholders / Colleagues include: Consumers
Professional organisations
Health Service Executives
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Our Priority Programs1. Patient Charter of Rights
2. Open Disclosure
3. Basic Care Issues- Hygiene- Patient Identification- Medication Safety- Handover-Patient at risk-Falls
4. Tools- Accreditation and credentialing- Quantitative & Benchmark Measures- Harnessing IT & Communication
DRAFT: Australian Charter of Health RightsDRAFT: Australian Charter of Health Rights
What can I expect from the health system?MY RIGHTS WHAT THIS MEANS
1. SAFETY: I have a right to safe and high quality care
•Safe and high quality health services provided to me with professional care, skill and competence
2. RESPECT: I have a right to respect, dignity and consideration
• Care that respects me and my culture, beliefs, values and personal characteristics
3. COMMUNICATION: I have a right to be informed about services, treatment, options and costs in a clear and open way
• Open, timely and appropriate communication about my health care provided in a way I can understand
4. PARTICIPATION: I have a right to be included in decisions about my care
• I may participate in making decisions about my care and about health service planning
5. PRIVACY: I have a right to privacy and confidentiality of my personal information
• My personal privacy is maintained and proper handling of my personal health and other information is assured
6. COMMENT: I have a right to comment on my care and to have my concerns addressed
• I can comment on or complain about my care and have my concerns dealt with properly and in a timely way
7. ACCESS: I have a right to health care • I can access services to address my health care needs
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PATIENT CHARTER
I have a right to safe and high quality care
I have a right:
-To be free of being infected by my hospital or health worker
-To be free of medication mishap
-To be assessed for the risk of VTE
-To have the correct procedure, operation, test, x-ray
-To be rescued if my condition unexpectedly deteriorates
Evidence based risk assessment for VTEEvidence based risk assessment for VTE
Evidence based risk assessment for DVT is disappointing despite national and international research.
Mortality due to DVT after hospital admission is 10 times greater than after MRSA.
Responsibility for assessment and prescription of prophylaxis are often confused.
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PATIENT CHARTER
I have a right to clear communication throughout the period of care
I have a right:
- For my health information to be passed accurately between settings and shifts of care
- To be told what happened when things go wrong
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PATIENT CHARTER
Patient rights
ACSQHC response
By this time next year we will have…
Open DisclosureOpen Disclosure
This time next year, we will have:
- The open disclosure standard endorsed
- Provided tools to assist jurisdictions and private sector implement the standard
Legal consistency
Patient stories
Patient support material
Implementation guide for health care facilities
- Published open disclosure evaluation in the peer reviewed literature
Health Care Associated InfectionHealth Care Associated Infection
This time next year, we will have:
- Infection Control Guidelines updated and disseminated
- Nationally agreed standards for:Surveillance of hospital infections
Monitoring resistance to antibiotics
Use of antibiotics
- Empowered Infection Control Practitioners to effect change in their facilities
Patient IdentificationPatient Identification
This time next year, we will have:
- An agreed national standard for patients ID
- Spread the 3Cs nationally to other areas, such as:Radiology
Radiotherapy
Dental care
- Disseminated learnings from patient ID adverse events
Clinical HandoverClinical Handover
This time next year, we will have:
- Completed national projects covering 4 areas:Specific handover processes
Electronic tools
Communication and team training
Tools for observation, monitoring and evaluation and handover
- Commenced national spread
- Advised international community
- Disseminated learning from clinical handover adverse events
Medication SafetyMedication Safety
This time next year, we will have:- Spread the National Inpatient Medication Chart to the
following areas:Paediatrics
Long stay
Specialist areas (eg insulin administration)
- Audited the effectiveness of the NIMC in jurisdictions
- Spread the VTE prophylaxis program to the private sector
- Assisted GPs manage warfarin medication
- Described and started to address other key medication safety gaps
AccreditationAccreditation
This time next year, we will have:
- An alternative model for accreditation
- A preliminary set of Australian Health Standards
- Reviewed surveyor participation
- Conducted research into patient journeys and unannounced surveys
- Defined a process of national coordination of accreditation
Information StrategyInformation Strategy
This time next year, we will have:
- Developed operating and technical standards for Australian Clinical Quality Registries
- Developed national indicators for safety and quality
- Recommended to Ministers national data sets for safety and quality
- An understanding of the economic costs of patient injury
Not only but alsoNot only but also
This time next year, we will have:
- The 2008 National Report
- Led and coordinated a national approach to credentialing
- Commenced a national approach to detection and response to the patient at risk
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PATIENT CHARTER
Patient rights
ACSQHC response
But how will this make a difference?
To Consumers To Clinicians
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Consumers
Patients
Citizens
Experience, wisdom, knowledge and views
Health Ministers
Actions to make health care more patient centred, to improve safety and quality
States and Territories, and their public hospitals
State/ Territory Safety and Quality Organisations
Private Sector
Primary Care Sector
Health Care Complaints Commissioners
Regulators
Australian Commission on Safety and Quality in Health Care
Consumer Engagement
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SAFETY: Safe and high quality carePatients, consumers and health care providers are entitled to a safe, secure and supportive health care environment. Patients and consumers have the right to expect that safe care and treatment will be provided in every encounter with the health system.
Some of the ways you can contribute to the provision of safe and high quality care are by:
Tell staff if you think that an error might have occurred or something has been missed in your care
Tell staff if you think that an error might have occurred or something has been missed in your care
Patient or ConsumerPatient or Consumer
Provide health care services with professional skill, care and competence Provide health care services that are informed and where possible, evidence based Participate in patient safety systems established by the health service organisations in which you work
Provide health care services with professional skill, care and competence Provide health care services that are informed and where possible, evidence based Participate in patient safety systems established by the health service organisations in which you work
Health Care ProvidersHealth Care Providers
Ensure that health care providers are appropriately qualified, competent and experienced, and that facilities and procedures meet industry standardsEnsure that health care providers have the resources to allow them to provide safe, effective and appropriate health careEnsure that systems are in place that promote patient safety and that instructions to patients and consumers are clear and well communicated
Ensure that health care providers are appropriately qualified, competent and experienced, and that facilities and procedures meet industry standardsEnsure that health care providers have the resources to allow them to provide safe, effective and appropriate health careEnsure that systems are in place that promote patient safety and that instructions to patients and consumers are clear and well communicated
Health Service OrganisationHealth Service Organisation
LiteratureLiterature
On the Trail of Safety and Quality in HealthcareRichard Grol, Donald Berwick, Michael Wensing BMJ 336 (2008) 74-76
Major problems persist to improve the quality and safety of healthcare
Factors include:
- Resistance to change among health professionals
- Organisational structures that block improvements
- Dysfunctional financial incentives
Research agenda topics suggested
LiteratureLiterature
On the Trail of Safety and Quality in Healthcare
Richard Grol, Donald Berwick, Michael Wensing BMJ 336 (2008) 74-76
Research agenda topics suggested include: - How to achieve sustained change in normal care
- How to guide clinicians towards scientifically correct and safe practice
- How to provide new evidence at the point of care
- How to create a culture of change and continuous improvement in the ward or practice
Organisational FactorsOrganisational Factors
“There is growing evidence base of rigorous evaluations of organisational strategies, but the evidence underlying some strategies is limited and for no strategies can the effects
be predicted with high certainty.”
Wensing M, Wollersheim H & Grol R Implementation Science, 2006
www.implementationscience.com/content/1/1/2
Organisational intervention to improvement in patient care : a structured review of reviews
Organisational FactorsOrganisational Factors
Organisational interventions to improvement in patient care : a structured review of reviewsRevision of professional roles
Focus Main results
Nurse practitioners in primary care ( 13 trials)
Improved: laboratory testing, resolution of pathology conditions, patient satisfaction
No change: quality of care, prescribing functional status, consultation rates, use of emergency service
Nurse practitioners in primary care ( 13 trials)
Improved: patient satisfaction
Increased: consultation length, investigations
No change: health status
Mental health workers in primary care (38 trials)
Replacement role: did not consistently change psychotropic prescribing, consultation rates or mental health referrals
Enlargement of the role of the public pharmacist (16 trials)
Changed: use of health care services, improved patient outcomes
No change: quality of life
Outreach nursing for COPD
(4 trials)
Increased: hospital service use
No change: mortality, lung function, health related quality of life
Organisational FactorsOrganisational Factors
Organisational interventions to improvement in patient care : a structured review of reviews
Integrated care services
Focus Main results
Stroke Units (19 trials)Reduced: mortality, dependency, institutionalisation, length of hospital stay
In-hospital pathways for stroke (10 trials)
Fewer: UTIs, readmissions
More: CT brain scans, carotid duplex
Reduced: patient satisfaction, quality of life
No change: mortality, dependency, discharge destination
Disease management for heart failure in patients discharged from hospital (11 trials)
Decreased: hospital use, costs
No change: all-cause mortality
Organisational FactorsOrganisational Factors
Organisational interventions to improvement in patient care : a structured review of reviews
Knowledge management
Focus Main results
Computerized information services in different settings
Improved: test ordering/prevention in A, B & C
Improved: drug prescription in D
Improved: patient knowledge in E
A. Provider prompt
B. Provider feedback
C. Computerized medical record
D. Assisted treatment planning
E. Computerized patient education
(100 trials)
Nursing record systems
(8 trials)
No change: patient care, patient outcomes
Some: administrative benefits
Sun Herald – ‘simple jab’Sun Herald – ‘simple jab’
Effecting ChangeEffecting Change
Commission
Private Hospital Sector Committee Information Strategy Committee
Primary Care Committee
IJCSafety and Quality
Bodies
Staff
Clinical Quality Registries Committee
CHF
Consumer engagemen
t
Community
AHMC
AHMAC
AIHW TGA CPMC NHMRC NICS NeHTA
Nursing Orgs ACHSE Allied Health OrgsUniversity
Sector
Prime Minister COAG
National Health and Hospitals Reform CommissionAMA
Media
Private Sector
Advisory Committees Working Parties
Research Sector