A lesson in herding cats- Engagement for clinical audit at facility level

Grant Ramke

Clinical Nurse Consultant

Clinical Service Excellence Team

Objectives

• Overview of position

• Challenges

• Strategies for engagement

• Future development

Video

• Cat Herders

CNC Role

• To provide clinical audit expertise, coordination

and management.

• To promote and support a culture that

encourages best practice and continuous

improvement.

• To manage and assist facility Clinical Nurses

Princess Alexandra Hospital

• 600 in-patient beds

• Activity

– 88,417 admissions

– 60,658 ED presentations

– 577,136 outpatient appointments

– 18,709 operating theatre cases.

• 4882 Clinical staff

• 2,997 nurses

• 932 doctors including visiting

medical officers

• 953 health professionals

Queen Elizabeth II Jubilee Hospital

• 180 in-patient beds

• Activity

– 27,903 admissions

– 44,447 ED presentations

– 116,231 outpatient

appointments

– 5,296 elective surgeries.

• 813 clinical staff

• 534 nurses

• 195 doctors including visiting

medical officers

• 84 health professionals

Challenges

Tertiary

• Resources

– Large budget

– Large pool of people

• Time

• Relationships

– Expertise

• Established ‘Magnet’

facility

• Big brother’ syndrome

Medium Metropolitan

• Resources

– Tight budget

– Small pool of people

• Access

– Pockets of knowledge

• Beginning ‘Pathways to

Excellence’ journey

• ‘Mothership’ syndrome

Required attributes

• Resilient

• Flexible

• Data savvy

• Methodical

• Good communicator

• Knowledgeable

• Creative

Engagement - Leadership

• Hospital Executive

• Medical Directors

• Nursing Leadership

Engagement - Direct Care

• Transparency

• Accountability

• Provision of tools

• Reward & Recognition

Audit Schedule

• Negotiation with

stakeholders

– Measurement criteria

– Audit tool

– Frequency

– Reporting lines

• Publication

– Stakeholders

– Intranet

Action Plans

• The seven steps of action planning are:

• Understand your survey results.

• Communicate and discuss survey results.

• Develop focused action plans.

• Communicate action plans and deliverables.

• Implement action plans.

• Track progress and evaluate impact.

• Share what works.

Local QI Project

• Targeted Patient Satisfaction

• Staff surveys

• Service Evaluations

• Process evaluations

• Database creation

Quality Activity Register

• Develop a single registry

• Improve QI knowledge

• Promote QI mentorship

• Influence strategic direction

Herding CatsNot so difficult actually

Take Home Message

• Engagement is crucial

• Remain true to the PDSA

cycle

• Compromise, but play a

long game

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