kupu taurangi hauora o aotearoa. quality and safety are at the heart of clinical practice “first...
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Kupu Taurangi Hauora o Aotearoa
Quality and Safety are at the Heart of Clinical Practice
“First Do No Harm”
“To Err is Human” – Institute of Medicine Report USA (1999)
Peter Davis NZ (2002) – 12.9% medical error, though many minor
Australia (1995) - 16.6%
Britain (2001) - 10.8%
Key Questions• How can you tell you are delivering a quality
service, and a safe service?• What information do you use?• How does a “system” answer the same
questions?• How do you and/or the system change if you
need to?
Why has health quality and safety become an “industry”?
tools, methodologies, body of knowledge/evidence, training modules, monitoring etc
How can this become an automatic part of every day work for individuals and systems?
The Commission
• Formally established under the New Zealand Public Health and Disability Act 2000 in November 2010
• Crown Agency under the Crown Entities Act 2004• Has picked up many of the programmes of the
former Quality Improvement Committee
Our role (in legislation)
• Provide advice to the Minister of Health to drive improvement in quality and safety in health and disability services
• Lead and coordinate improvements in safety and quality in health care
• Identify data sets and key indicators to inform improvements in safety and quality
• Report publicly on the state of safety and quality, including performance against national indicators
• Disseminate knowledge on and advocating for safety and quality
Best value for publichealth system resources
QUALITY
IMPROVEMENT
The New Zealand Triple Aim
SYSTEM
We do need to do things right, first time
But we also need to do the right things
And only the right things
Doing the right thing
Overarching Focus :
Building an Improvement Culture
Key elements of quality
Information
QUALITY
IMPROVEMENT
1. Clinical leadership (underpinned by good management
infrastructure)
Support for training in tools, improvement methods and innovation, based on specific programmes or priorities
Support and maintain “networks”
2. Consumer engagement and participation
• Stock take of existing consumer organisations; • Develop and support a ‘national network’ of consumers;• Supporting and developing appropriate health literacy
3. Information
• National measures of quality and safety; • Report or “Atlas” of healthcare variation; • Quality “Accounts”• Sharing knowledge on quality and safety – e.g. active
website
“…success… …requires credible measurement. The measurements need not be of research quality, but they must be honest, obtainable with as little disruption and added cost as possible, consistent across hospitals so they can be analyzed in the aggregate, and transparent”
Also true in primary care and across primary and hospital care
Measurement
Berwick et al JAMA 2008
Measurement EffectsThe outcome of any recommended action to improve safety should be measured because:
• it may not be effective•‘revenge effects’ may occur.
Improving safety in an established and highly functioning health care system is not easy and the detail matters
The dimensions of quality and organisational layers of
healthcare
Runciman B Merry A Walton M Safety and Ethics In Healthcare Ashgate 2007
www.dartmouthatlas
Geographic variations in Medicare resource use across practice intensity
Dartmouth Health Care Atlas(John Wennberg)
Our initial focus
• Ensuring current programmes in public hospitals work
Next areas of focus (3 years) include:
Programmes extending to -• primary health• private providers• services for older people• maternity services• mental health services• people with disabilities• children and young people
Mortality Review Committees
• Child and Youth Mortality Review CommitteeDr Nick Baker
• Perinatal and Maternal Mortality Review Committee Prof Cynthia Farquhar• Family Violence Death Review Committee
Wendy Davis• Perioperative Mortality Review Committee
Prof Iain Martin
The Way We Work• Facilitate & support
implementation of projects/programmes in all parts of the sector
• Work with clinicians, other providers and consumers to assist with improvements and innovations that will make our health system safer
• Work in partnerships with other agencies – no duplication
• Draw on overseas experience and innovation, adapting it for New Zealand’s circumstances.
It’s about….…. supporting others to put in place systems and processes to ensure the safest and highest quality care
….supporting services to learn from mistakes so they don’t happen to others.
(reducing harm and variation)
Current work programme (to 2012)1. Medication Safety
Working towards the introduction of electronic prescribing, dispensing and monitoring of medication – firstly by:
– national introduction of standardised (initially adult) medication chart and reconciliation of medicines process
– demonstration sites of e-prescribing and e- medicine reconciliation
2. Reducing hospital-acquired infections(hand hygiene, IV line/catheter, surgical sites, etc)
3. Learning from other preventable adverse events (e.g. reducing falls)
4. Reviewing implementation of the surgical checklist
5. Reducing falls which cause harm
Surgical Site Infections (SSI)• Savings per SSI avoided estimated* at:
– $21,000 for knee & hip joint replacements– $20,000 for coronary artery bypass grafts– $4500 for caesareans
• A surveillance system could avoid 421 SSI each year• Total savings after first 10 years estimated at $18.8
million approx, and then $4.4 million a year ongoing
* Sapere Research Group publication, May 2011
CLAB Reduction Savings – one DHB
2008 2009 2010
Number of CLAB cases 14 4 1
Median days between CLAB cases
28.1 75.1 N/A
CLAB / 1000 line days 6.8 3.0 0.9
Cost of CLAB cases $280,000 $80,000 $20,000
Berwick et al JAMA 2008
• Obtaining the evidence• Evaluating the evidence• Promulgating the evidence• Persuading practitioners to
adopt the evidence and practice according to it, sustainably
Challenges to changing practice
Diffusion of knowledge and information
• Networks – local, regional, national and international
• Website and associated social media• Publications – journals, magazines• Media -- look for the opportunity
• Posters, hand-outs etc• Conferences, teaching sessions
What we don’t do• Handle individual consumer cases
or complaints (providers, HDC)• Enforce regulations or legislation
(MOH, HDC, registration bodies)• Quality assurance or compliance
auditing – e.g. for certification (MOH, registration bodies)
• Credentialing of individual clinicians (DHBs & other providers)
Our BoardProfessor Alan Merry (Chair), Head of Department for Anaesthesiology at the University of Auckland’s School of Medicine
Dr Peter Foley, Chief Medical Officer - Primary Care, Hawkes Bay DHB
Mrs Shelley Frost, Deputy Chair and Executive Director (Nursing) of General Practice New Zealand
Our BoardDr David Galler, intensive care specialist at Middlemore Hospital
Dr Peter Jansen, Senior Medical Advisor to ACC
Mr Geraint Martin, Chief Executive Officer of Counties Manukau DHB.
Mrs Anthea Penny, Director of R H Penny Ltd, Australasia
What do you think we should be doing?
• Contact us on: info@hqsc.govt.nz
• Our website: www.hqsc.org.nz – please register!
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