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http://www.union.org 1

By: Mrs Fan WongQuality Assurance Manager

Union Hospital

Quality Improvement Quality Improvement Project –Project –Patient Safety Patient Safety WalkRoundsWalkRounds

QUALITY QUALITY IMPROVEMENT IMPROVEMENT

AND AND PATIENT SAFETYPATIENT SAFETY

http://www.union.org


Session Session OutlineOutline

1.1. Background of Union Background of Union Hospital Hospital

2.2. Development StagesDevelopment Stages

3.3. Project ObjectivesProject Objectives

4.4. ImplementationImplementation

5.5. Findings and ResultsFindings and Results

6.6. LimitationLimitation

7.7. Way ForwardWay Forward

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1. Background of UH1. Background of UH

• Opened in July 1995

• 1996: 110 beds

• 2013 : 433 beds



• Comprehensive private hospital with 433 beds Registered Comprehensive private hospital with 433 beds Registered with Department of Health in 1994with Department of Health in 1994

• Newest private hospital in Hong Kong Newest private hospital in Hong Kong

• Staffing above 1500 Full Time plus 100 Part Time Staffing above 1500 Full Time plus 100 Part Time

• 2012 Service volume 2012 Service volume o EMC (ER) attendance: 85,238

o Specialist OPD: 95,664

o Admissions: 36,438

o Operations: 24,798

o Deliveries: 7,393

o Occupancy rate (midnight census): 68.9%

o Bed utilization rate: 101.46%



Value, Mission, Vision Value, Mission, Vision

Professional, Reliable, Efficient, Friendly, Ethical and Resourceful



Management SystemManagement System

• 1999 to now : ISO Quality Management System (QMS) 9000 1999 to now : ISO Quality Management System (QMS) 9000 series series

• 1999 to 2010 : UK Trent Accreditation Scheme (TAS)1999 to 2010 : UK Trent Accreditation Scheme (TAS)

• Staff : SHS : General and work related Staff : SHS : General and work related OSH Ambassador WalkRounds : IOD OSH Ambassador WalkRounds : IOD

• Incident : Risk Management Committee Incident : Risk Management Committee

• Client Feedback : Hospital-wide SQSClient Feedback : Hospital-wide SQS : Departmental SQS : Departmental SQS

• Overall Review : Half yearly Management Review and Risk Overall Review : Half yearly Management Review and Risk Prevention (MR&RP)Prevention (MR&RP)


The development of Patient Safety Walk The development of Patient Safety Walk Round…Round…

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2. Development Stages2. Development Stages


3. Project Objectives3. Project Objectives


Support from Senior Management and Support from Senior Management and the Multidisciplinary Team…the Multidisciplinary Team…

Team Leader: Risk Manager / Chairperson of Risk

Management Committee

Members: Deputy Medical Director

Quality Assurance Manager

Departmental Clinicians (By invitation)

Senior Nursing Officer (In-patient)

Senior Nursing Officer (Out-patient)

Estate Manager

Occupational Safety and Health Team Leader

Infection Control Team Leader

Clinical Leaders from Allied Health Team

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4. Implementation4. Implementation


4. Implementation4. Implementation

1st Month ------------------------------------ 2nd Month ---------------------------------------------------------------------- 3rd Month ------------------------------- 4th Month ------- 6th Month ------ 9th Month -----

4-6 weeks prior to Walk

Round

3 days prior to Walk

Round

1 hour Walk Round

1-2 weeks post Walk Round

4-6 weeks post Walk Round

6-monthly (3-mth before MR & RP

Meeting)

6-monthly

Confirm date & time

Pre-view of self-assessment

Site visit / interview

Members’ assessment/

feedback

Consolidate recommendation/

assessment results

Follow-up plans

Implement Follow-up

actions Risk Management Committee

Management Review & Risk Prevention

Committee

Data

Registry Data

Analysis Data

Review Issue

Identification

The Workflow and Logistic…The Workflow and Logistic…


Mth Jul Aug Sep Oct Oct Nov Nov Dec Dec Jan Jan Feb Feb Feb Feb Feb Mar Mar

Dept RMCUNEEMC ICU RDC CSSD OPT OFC EDC W09 W07 TDC TMEI TRMC TDHI THMC W10 W11 TotalKey

Improvement 3 1 5 3 5 1 5 7 3 3 2 3 1 4 1 3 4 3 57

Potential hazards/

Risks 10 2 3 3 2 3 4 0 3 4 2 2 2 1 1 3 1 3 49Recent Incident 1 1 2 0 0 1 5 0 2 1 11 0 0 1 0 1 88 1 35Plan for

Improvement 3 4 2 1 2 1 4 1 2 3 2 1 2 2 1 2 4 4 41

Total 17 8 12 7 9 6 18 8 10 11 17 7 5 8 3 9 1717 11 182

1) Number of Items raised in Preview Form: Self Assessment 1) Number of Items raised in Preview Form: Self Assessment

5. Findings and Results5. Findings and Results


2. Distribution of domains with recommendations raised by PSWR Team :2. Distribution of domains with recommendations raised by PSWR Team :



0

2

4

6

8

10

12

Dept

No

of In

cide

nt

Fire incident

Infection Control related

Environment

Medication error

Machine & Facility

Patient related

Fall of patient

Injury on duty case

Fire incident 1

Infection Control related 1

Environment 1

Medication error 2

Machine & Facility 2

Patient related 2 2 1

Fall of patient 1 7 8

Injury on duty case 1 2 2 1 1

RMC UNE EMC ICU RDC CSSD OPT OFC EDC W09 W07 TDC TMEI TRMC TDHI THMC W10 W11


3. Distribution and nature of Incident reported in the Part I: Preview Form3. Distribution and nature of Incident reported in the Part I: Preview Form

1

1

1

2

2

5

16

7

Total: 35 cases



4. Distribution of Component in Part II: Preview Form 4. Distribution of Component in Part II: Preview Form

Areas for Improvement Remarks

Organisational and Management Factor Components

2 W07 : Re-design Paed Ward

EDC : Re-design

Work Environment Components

8 ICU, EDC, TST and TMEI : Staff Toilet

EDC : Medical grada fridge, Storage space, Waiting area, security of DD, patient privacy, storage of DD too far from clinical work

Team Components 0

Individual (Staff) Components

1 EDC : Care Pathway

Task Components 1 EDC : Power Failure Drill

Patient Components 0


5. Risk Registry Summary of PSWR Jul 2012 – Mar 2013 as at 15 May 2013:5. Risk Registry Summary of PSWR Jul 2012 – Mar 2013 as at 15 May 2013:



Tasks Completed In ProgressWorksite Setting Adjustment / Improvement 20 7

Reference Guide / SWG Development 11 5Competency Assessment/Training 10 1Safety Device Installation 6 -Workflow / Practice Amendment 4 -Security Device Installation 4 -Review / Audit 5 1Reinforced Communication / Dissemination of Information

3 -

Sourcing/Purchase New Device 2 1Reinforced SWG 3 -Drill Exercise 3 10ITS Development - 6Renovation Plan - 4Manpower Arrangement - 1Contingency Plan - 1Total * 71 37

6. The Task Type for completed and In-progress status as at 15 May 2013:6. The Task Type for completed and In-progress status as at 15 May 2013:


* 4 pending review


Dept RMC UNE EMC ICU RDCCSS

D OPT OFC EDC W09 W07 TDC TMEITRM

C TDHITHM

C W10 W11 Total

Self Risk 10 2 3 3 2 3 4 0 3 4 2 2 2 1 1 3 1 3 49Total Issued concluded 9 11 11 9 8 9 6 7 7 4 7 5 4 2 6 4 3 112

Different -1 9 8 4 5 5 6 4 3 2 5 3 3 1 3 3 0

7. Number of self assessment risk issues and PSWR raised issues :7. Number of self assessment risk issues and PSWR raised issues :



8. Interview : Question mostly asked or mentioned : As indicated by 8. Interview : Question mostly asked or mentioned : As indicated by PSWR PSWR members, the following were asked most from the scribe’s report members, the following were asked most from the scribe’s report


The other 9 were not asked at all.

Nos Question

18 When you observe the environment, what aspects of the environment do you think are likely to lead to patient harm?

18 Is there any recent incidents (eg sentinel events, medication errors) incurred in the department that lead to patient harm?

18 Have there been any near misses that could have been prevented?

18 What do you think the likelihood of occurrence / recurrence of the incident could be?

18 Is there anything we can do to prevent that incident? (eg alterations in the teamwork / environment / workflow)

18 When you make an error, do you always report it?

18 If you make or report an error, are you concerned about personal consequences?

6 Do you know what happens to the information that you report?

6 What do you think this department could do on a regular basis to improve patient safety?

6 Can you think of a way in which the system/environment fail you on a consistent basis?(eg information availability/clarity)


9. Quantitative Data :9. Quantitative Data :


Mth Jul Aug Sep Oct Oct Nov Nov Dec Dec Jan Jan Feb Feb Feb Feb Feb Mar Mar

Dept RMC UNEEMC ICU RDC CSSD OPT OFC EDC W09 W07 TDC TMEI TRMC TDHI THMC W10 W11 TotalNo of

persons participates 15 22 9 10 10 9 8 9 9 7 7 9 9 9 9 9 10 10 180

Dept Staff interviewed 5 4 7 3 3 4 4 3 3 4 2 2 3 1 3 1 4 4 60Time spent

per WalkRounds

(mins) 120 85 60 40 40 75 75 60 50 60 45 30 30 20 40 15 3535 30 910

Total Time spent 2400 2210 960 520 520 975 900 720 600 660 405 330 360 200 440 150 490 420

13,260(221 hrs)

For the VisitFor the Visit

• Department Department : : 1818

• WalkRounds Team WalkRounds Team :: 180180

• Department StaffDepartment Staff :: 6060

• Total Time / hoursTotal Time / hours :: 221 221

Pre & Post WalkRounds among Pre & Post WalkRounds among

Staff in similar magnitudeStaff in similar magnitude

Commitment from Commitment from Management is very StrongManagement is very Strong


10. Qualitative Data :10. Qualitative Data :


• Facilitate communicate to build open culture Facilitate communicate to build open culture

• Assist staff to focus on patient safety and staff safety Assist staff to focus on patient safety and staff safety

• Willingless of staff and department head to discuss department issues Willingless of staff and department head to discuss department issues enhanced enhanced

• Timing control Timing control

• No cancellation of any planned WalkRoundsNo cancellation of any planned WalkRounds

• Raised issues entered as Risk Registry for close monitoring Raised issues entered as Risk Registry for close monitoring

• Specific environmental issues were included in new building plans Specific environmental issues were included in new building plans


11. System Environment and Facilities Issues :11. System Environment and Facilities Issues :


• Examples on Self Assessment Examples on Self Assessment

• Care and concerns onCare and concerns on : :

Patient Patient :: Privacy issue due to limited space Privacy issue due to limited space StaffStaff :: staff toilet, medical grade refrigerator, storage space, staff toilet, medical grade refrigerator, storage space, security of DD security of DD System System :: Power Failure DrillPower Failure Drill

• Concerns on environmentConcerns on environment : :

Paediatric Ward : re-design Paediatric Ward : re-design EDCEDC : re-design : re-design


Commented by Hospital Chief Commented by Hospital Chief Executive Executive


AchievementsAchievements……



6. Limitations6. Limitations

1)

2)

3)


6. Limitations6. Limitations

4)

5)


7. Way Forward7. Way Forward

Leadership Commitment : Leadership Commitment : Bennis et al remarked that: Major progress requires a multifaceted Bennis et al remarked that: Major progress requires a multifaceted leadership approach, implemented and revisited over time, and leadership approach, implemented and revisited over time, and includes activities, such as assessing a culture for safety, responding includes activities, such as assessing a culture for safety, responding to data, striving for high reliability, requiring transparency, foster to data, striving for high reliability, requiring transparency, foster communication and teamwork, setting meaningful goals and sharing communication and teamwork, setting meaningful goals and sharing outcomeoutcome


7. Way Forward7. Way Forward

2)

1)

3)


ReferenceReference

1. Kirkman-Liff B 2004 The structure, processes, and outcomes of Banner Health’s corporate-wide strategy to improve health care quality. Quality Management in Health Care 13(4):264-78

2. Frankel A.S., et al.: Patient Safety Leadership WalkRounds Guide.2004 Institute of Health Improvement3. Frankel A., Haraden C.: Shuttling toward a safety culture: Healthcare can learn from probe panel’s findings

on the Columbia disaster. Mod Healthc 34:21, Jan. 20044. Frankel A, et al 2009 The Essential Guide for Patient Safety Officer, Joint Commission resources, Illinois 5. Building a safer NHS for patients 2001. UK Department of Health website:

http://www.doh.gov.uk/buildsafenhs/ch6.htm6. Joint Commission Resources 2008 Patient Safety Rounds: A How-To Workbook, USA7. Leape L. Can we make health care safe? In: Reducing medical errors and improving patient safety. A

report of the National Coalition on Health Care and the Institute for Healthcare Improvement. Available at: http://www.qualityhealthcare.org/ihi/uploads/medical_errorsACT.pdf. Boston: ACT:2000 Feb

8. Peter C, Aly H 2009 Patient Safety First : Leadership for Safety: Supplement 1 : Patient Safety Walkrounds, UK

9. Hospital Authority (2012). Hong Kong Hospital Authority Clinical Governance Review Report. Available :http://www.ha.org.hk/haho/ho/pad/clinical_governance_review_en.pdf

10. Australian Health Care Facilities. The Australian Council on Health Care Standards, Sydney11. Connor M., et al.: Creating a fair and just culture: One institution’s path toward organizational change. Jt

Comm J Qual Patient Saf 33:617-624, Oct 200712. Institute of Medicine: To Err Is Human: Building a Safer Health System Washington, DC National Academy

Press, 200013. Joint Commission Resources 2012 Even More Mock Tracers, USA14. International Patient Safety Goals, Joint Commission Resources 15. Agency for Healthcare Research and Quality: 30 Safe Practices for Better Health Care.

http://www.ahrq.gov/QUAL/30safe.htm (accessed Jun. 15, 2008).16. Hospital Authority. (2012). Hospital Authority Strategic Plan 2012-2017. Available:

http://www.ha.org.hk/upload/publication_29/359.pdf


Thank You!Thank You!

Patient’s SafetyPatient’s SafetyIt’s in our handsIt’s in our hands

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Q & AQ & A

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Contact : Contact : [email protected]

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