business case for change - together · 2020-01-16 · 16/01/2020 page 4 of 15 business case for...

Business Case for Change

Patient Safety and Quality Unit

January 2020

Service: Medical Services

Division: Patient Safety and Quality Unit

Date Submitted: 13 January 2020

Prepared by: Erin Finn, Director Patient Safety and Quality

Approved by: Associate Professor Deepak Doshi, Chief Medical Officer

16/01/2020 of 15 Business Case for Change: Patient Safety and Quality Unit

Contents

Contents ............................................................................................................................................................................ 2

Introduction ........................................................................................................................................................................ 3

1.0 Purpose ......................................................................................................................................................... 3

Background ....................................................................................................................................................................... 3

Commitment to employment security ................................................................................................................................ 3

Reason for change ............................................................................................................................................................ 3

Change particulars ............................................................................................................................................................ 4

2.0 Option one .................................................................................................................................................... 4

3.0 Option two ..................................................................................................................................................... 5

4.0 Option three .................................................................................................................................................. 5

5.0 Net cost of proposed structure ...................................................................................................................... 6

5.1 Option 1: ........................................................................................................................................ 6

5.2 Option 2: ........................................................................................................................................ 6

5.3 Option 3: ........................................................................................................................................ 6

6.0 Positions impacted ........................................................................................................................................ 6

7.0 Proposed role particulars .............................................................................................................................. 7

8.0 Strategic alignment ....................................................................................................................................... 8

9.0 Supporting our employees through change .................................................................................................. 8

Recommendation .............................................................................................................................................................. 9

Next steps .......................................................................................................................................................................... 9

10.0 Implementation plan ...................................................................................................................... 9

11.0 Consultation and engagement plan............................................................................................... 9

Feedback contacts .......................................................................................................................................................... 10

Attachments ..................................................................................................................................................................... 11

Attachment A - Proposed organisational chart (option 1) ..................................................................................... 11

Attachment B - Proposed organisational chart (option 2) ..................................................................................... 12

Attachment C - Current organisational chart ......................................................................................................... 13

Attachment D – Affected positions spreadsheet (Options 1 and 2) ...................................................................... 14


Introduction

1.0 Purpose

This business case outlines a proposal for a revised structure for the existing Patient Safety and Quality Unit (PSQ) to

better support the clinical service delivery divisions of West Moreton Health through a re-focused business partnership

model.

This business case provides the opportunity for employees, unions and relevant stakeholders to comment on the

proposed reorganisation of the PSQ.

Background

In 2017, a new executive structure for West Moreton and new divisional structure for Ipswich Hospital was

implemented to support West Moreton respond to current and future challenges in meeting the health needs of the

West Moreton community. The structure was further refined via an executive realignment in June 2019 that introduced

a Chief Operating Officer to provide strategic oversight and accountability for the clinical provider arm of the business,

while the Executive Directors of Ipswich Hospital, Community and Rural Service, and Mental Health and Specialised

Services retain a focus on clinical services and operations.

Having completed this executive realignment and confirmation of operational leadership of clinical services, there is a

need to ensure that safety and quality support services operate effectively and efficiently to support the provider arm to

achieve their performance goals and clinical governance accountabilities. The ultimate goal is for the provider and

support arms to work together to deliver safe, high quality, person-centred care.

Commitment to employment security

West Moreton is committed to the Queensland Government’s Employment Security Policy 2015 which commits to

maximum employment security for permanent government employees.

To achieve the proposed structure, it will be necessary for some positions to change in terms of scope of responsibility

along with changes to reporting lines and in some cases changes to titles. There is no proposed reduction in

permanent positions.

Reason for change

The current structure of the Patient Safety and Quality Unit is made up of four (4) functional areas and two overarching

support areas which independently concentrate on specific safety and quality domains namely:

– patient safety

– quality improvement

– consumer feedback

– independent patient rights advice, and

– support from data analysis and administration areas.

West Moreton Health is facing significant challenges and opportunities as it strives to meet the health needs of the

community now and into the future, including significant population growth, in a fiscally restrained environment.

Investment in support services is essential to ensure appropriate expertise is available to meet the legal and regulatory

requirements of the organisation but must also represent value in supporting the clinical divisions. Support services,

including PSQ, must continually seek the most effective and efficient models for supporting the provider arm to deliver

safe, high-quality, person-centred care.


Change particulars

This Business Case proposes three options for consideration and feedback from staff and the unions.

2.0 Option one

Option one addresses the re-alignment of patient safety and quality improvement functions in a “Business Partner”

model that promotes clearer points of accountability associated with provider arm Services’ KPI’s. Retaining several

centralised coordination functions will provide support to the business partners and promote standardisation of

reporting and accreditation coordination across all provider arm services.

Option one would deliver multiple benefits for PSQ staff, the provider arm of the business and, ultimately, patients. The

benefits of establishing a contemporary unit structure include:

• Alignment of primary PSQ safety and quality support services with provider arm divisions to embed the core pillars of quality and safety into the culture of each division and reduce ambiguity for staff of PSQ regarding business partner arrangements

• Enhanced integration of clinical governance functionality by combining the expertise of patient safety and quality improvement to provide dedicated support to provider arm business units through

o Improved consistency of a holistic safety and quality culture with appropriate expert advice and support

o Increased efficiency through closer working relationships between PSQ business partners and divisional leaders

• Improved capacity for alignment of teams and peer support within PSQ.

• Alignment of senior clinical roles within PSQ.

• Career progression pathway for non-clinical experts in safety and quality.

Current Proposed Change Rationale

PSQ is currently split into functional teams:

• Patient Safety

• Quality Improvement

• Consumer Liaison

• Independent Patient Rights Advisers

• Data analysis

• Administration support

The Quality function has a team leader, while the staff in the remaining functions all report directly to the Director.

Consumer Liaison team, Independent Patient Rights Advisers, Administration support – see below.

Reorganise the Patient Safety, Quality Improvement and Data Analysis functions into:

- A team of business partners

- A team of core support functions to meeting organisational regulatory and reporting requirements and facilitate standardisation across the business partners

Enable a business partnership model to better support the Provider Arm of the business. A primary safety and quality business partner will be dedicated to one or two clinical divisions. The allocation of portfolios will be negotiated between the Director Patient Safety and Quality and the Executive Directors but within existing resources there is notionally capacity for:

- IH – 2 business partners - MHSS – 2 business partners - CARS – 1 business partner

Enhanced integration of safety and quality functions to support the clinical divisions to deliver good quality, safe, patient-centred care.

Increased visibility of safety and quality business partners who are familiar with the day-to-day operations and staff of their designated division/s. All business partners will be CNCs to bring a clinical focus and expertise to supporting safety and quality in the clinical divisions.

A dedicated focus on key organisation-wide regulatory and


reporting requirements (such as accreditation and ELC/Board reporting. Centralised coordination functions to facilitate standardisation of key processes and reporting across the business partners.

Consumer Liaison Team No change proposed to the current arrangements.

Continued Consumer Liaison function within PSQ.

Administration support No change proposed to the current arrangements.

Continued administration support to the Director and the unit.

A proposed unit structure for option 1 is provided at Attachment A.

An affected positions spreadsheet for options 1 and 2 is provided at Attachment D.

3.0 Option two

Option two proposes a re-alignment of patient safety and quality improvement functions in a “Business Partner” model,

as per option one, with a transfer of CLO resources to the provider arm for improved operational management of

consumer feedback closer to the frontline.

Option two would deliver the benefits of option one along with:

• Closer relationships with frontline managers and quicker escalation of issues and delays through being embedded in the operational leadership structures.

• Improved clarity of accountability for complaints resolution with the Chief Operating Officer (COO) and Executive Directors of clinical services, together with enhanced visibility of complaint issues and resolutions for the COO Executive Directors.

Current Proposed Change Rationale

Consumer Liaison Team supports the management of complaints received about services provided by the clinical divisions, reporting to the Director Patient Safety and Quality.

Change of direct reporting lines and transfer of budget to the clinical business, in a way to be determined by further consultation. Options include:

- Transfer 3 CLO positions to the Office of the COO

- Transfer 1-2 CLO staff to Executive Director of Ipswich Hospital and 1-2 CLO staff to the Executive Director of Mental Health and Specialised Services, with either or both services to support Community and Rural Services.

The delivery of patient-centred care occurs in the clinical divisions. The management of complaints about care is an integral component of patient-centred care and is best managed as close to the frontline as possible. Leadership is critical to supporting a culture that values consumer feedback and uses that feedback to improve care delivery.

The CLO team represents an investment of organisational resources to support clinical managers to resolve complaints and could be more effective if embedded within operational structures.

A proposed unit structure for option 2 is provided at Attachment B.

An affected positions spreadsheet for options 1 and 2 is provided at Attachment D.

4.0 Option three

Option three would see the current structure remaining in place with no change and no additional benefits to staff,

patients or services provided by West Moreton. The risks associated with not progressing with the proposed changes

include:


• Failure to achieve best value for the budget available for PSQ.

• Failure to change the current siloing and separation of the teams within the PSQ will limit West Moreton Health’s ability to provide an integrated and embedded culture for safety and quality.

• Failure to address the issues caused by insufficient alignment with the provider arm Services of the business will result in the potential for continued miscommunication and misalignment of expectations.

The current unit structure is provided at Attachment C.

5.0 Net cost of proposed structure

5.1 Option 1:

The proposed structure for option 1 has been calculated to be cost neutral according to the 2019/20 labour budget for

PSQ.

5.2 Option 2:

The proposed structure for option 2 has been calculated to be cost neutral according to the 2019/20 labour budget for

PSQ.

5.3 Option 3:

Cost neutral – no change proposed.

6.0 Positions impacted

The proposal for option 1 will impact the following roles:

Position title Current team Current reporting line Impact

Patient Safety Officer (NG7)

Patient Safety Director Patient Safety and Quality

Change of scope

Change of title

(NB. Revised role description subject to evaluation)

Clinical Nurse Consultant (Quality Improvement) (NG7)

Quality Quality Team Leader

Change of scope

Change of title

Change of reporting line


Quality Improvement Coordinator (AO6)

Quality Quality Team Leader

Change of scope

Change of title



Quality Team Leader (AO7)

Quality Director Patient Safety and Quality

Change of scope

Change of title

Create as multi-disciplinary position

Data Analyst (AO7) N/A Director Patient Safety and Quality



The proposal for option 1 will not impact the following roles:

Position title Current reporting line

Administration Support Officer (AO3) Director Patient Safety and Quality

Consumer Liaison Manager (AO7) Director Patient Safety and Quality

Consumer Liaison Officer (AO5) Consumer Liaison Manager (AO7)

Independent Patient Rights Adviser (AO7) Director Patient Safety and Quality

The proposal for option 2 will have the same role impacts as option 1 except:

Position title Current team Current reporting line Impact

Consumer Liaison Manager (AO7)

Consumer Liaison

Director Patient Safety and Quality


Consumer Liaison Officer (AO5)

Consumer Liaison

Consumer Liaison Manager


7.0 Proposed role particulars

For options one and two It is proposed to transition the current CNC Patient Safety Officer and CNC Quality

Improvement Coordinator roles to the new CNC (Safety & Quality) role. It is intended that these roles classified in the

nursing stream with mandatory nursing qualifications. The key functions of the proposed new role are:

• Act as the primary safety and quality business partner for one or more clinical divisions reporting to the Director Patient Safety and Quality but working largely within the clinical division/s.

• Provide expert advice and clinical leadership skills to support the clinical division’s leadership team meet their clinical governance responsibilities and ensure that safety and quality KPIs are met, including:

o Clinical incident management o Implementing the organisation’s audit program, together with local clinical audits relevant to each

division o Implementing recommendations from clinical incidents, audits, quality improvements and other

sources o Implementation and maintenance of policies and procedures o Embedding the National Safety and Quality Health Service (NSQHS) Standards into everyday

business o Readiness for accreditation o Promoting evidence-based practice and implementation of Clinical Care Standards

• Work closely with other CNCs (Quality Improvement) to promote consistency in the management of safety and quality issues and the application of safety and quality standards across clinical services.

• Support HHS-wide safety and quality committees to ensure implementation, evaluation and continuous improvement of NSQHS Standards.

• Conduct SAC1 analyses.

• Implement safety and quality education and in-service within the clinical division/s.

It is proposed to revise the current Quality Team Leader role to a Team Leader (Safety & Quality Systems) role. It is

intended that this role will be classified in both the administrative and nursing streams, to ensure a future recruitment


pool of expertise from a range of backgrounds, both clinical and non-clinical. The key functions of the proposed

revised role are:

• Assist the Director Patient Safety and Quality to: o implement, monitor and manage the organisation’s safety and quality audit program, incorporating

NSQHS Standards compliance audits and other clinical audits o coordinate HHS-wide reports pertaining to safety and quality indicators to inform the Clinical Safety

and Quality Council, Executive Leadership Committee, Board and Board Safety and Quality Committee, including analysis of any variance or quality outcomes that require escalation

o coordinate the development of reports, self-assessment surveys and other relevant documents in preparation for accreditation

• Coordinate HHS-wide safety and quality improvements

• Coordinate implementation and evaluation of the HHS Safety and Quality Training Framework

• Support other organisational priorities and outcomes relating to patient safety and quality, as required.

It is proposed to transition one of the current Quality Improvement Coordinator (AO6) roles to the new National

Standards Coordinator role. The key functions of the proposed new role are:

• Assist the Team Leader (Safety & Quality Systems) to: o facilitate and coordinate HHS-wide quality management systems and processes, to ensure

compliance with National Standards and accreditation requirements o coordinate HHS-wide safety and quality improvements o support other organisational priorities and outcomes relating to patient safety and quality, as required.

• Support the CNCs (Safety & Quality) to meet the requirements of HHS-wide quality systems and processes at divisional level.

It is proposed to transition one of the current Quality Improvement Coordinator (AO6) roles to the new Safety and

Quality Reporting Coordinator role. The key functions of the proposed new role are:

• Assist the Team Leader (Safety & Quality Systems) to: o coordinate and monitor the planning, collection, analysis, preparation and distribution of safety and

quality data across all levels of the organisation o coordinate HHS-wide safety and quality improvements o support other organisational priorities and outcomes relating to patient safety and quality, as required.

• Support the CNCs (Safety & Quality) to promote consistency in the analysis and reporting of safety and quality data at divisional level.

All new roles will be subject to consultative development of role descriptions and work value evaluation in accordance with relevant HR policies and procedures.

8.0 Strategic alignment

A strengthened safety and quality team structure is critical to West Moreton’s purpose “to meet the health needs of the

diverse and growing community now and in the future”. West Moreton recognises quality and safety as a key priority

and integrated clinical governance as a key enabler to delivery our strategic plan. The proposed enhancements of the

Patient Safety and Quality Unit will support clinical services to meet their safety and quality obligations and

continuously improve standards of care.

9.0 Supporting our employees through change

West Moreton recognises that workplace change can cause concerns amongst staff. Critical to the success of any

change process will be the provision of support and access to information that our staff have during this proposed

period of change. The following support activities will be offered:

• Access to information through individual and team meetings with staff. Union representatives will be invited to attend team meetings and impacted staff are invited to bring their union representatives to individual meetings should they wish.

• Availability of leaders to support staff: o Erin Finn, Director Patient Safety and Quality o Assoc Professor Deepak Doshi, Chief Medical Officer


• Encouragement to contact the Employee Assistance Service (EAS) on 1800 604 640 (24/7). This confidential service can be accessed through self-referral to Lifeworks-OPTUM, the external EAP service provider. Services are available 24 hours a day, seven days a week, and 365 days a year, at no cost. Counselling services are available face to face or by telephone. Additional information available at: http://qheps.health.qld.gov.au/eap/

• Additional training and support for staff who transition to a role with a changed scope.

Recommendation

Subject to consultation, it is recommended that Option one or two be implemented. Option one will provide West

Moreton with the ability to progress the safety and quality support function to a business partnership model, while

maintaining direct reporting lines to a Director of Patient Safety and Quality. Holistic and dedicated support by senior

clinical business partners within PSQ will strengthen safety and quality leadership in clinical services, emphasising

West Moreton’s commitment to safe, high quality care. Option two offers the potential to strengthen patient-centred

care by embedding the consumer feedback function within clinical services.

Next steps

10.0 Implementation plan

The following implementation plan to support the proposed change process has been developed to ensure that we

meet our industrial obligations whilst moving promptly to embed changes that are designed to improved safety and

quality support services that will ultimately benefit our patients.

We have incorporated a two-stage consultation process into our plan to ensure that our staff and relevant unions have

the opportunity to provide feedback regarding the proposed changes to West Moreton’s organisational structure.

Activity January February March April

Release Business Case for Change X

Pre-decision consultation with staff and stakeholders

X

Consider feedback X

Announce decision X

Post-decision consultation X

Consider feedback X

Final decision made X

Implementation X X X

Embed X

A detailed implementation plan setting out the planned approach to fill the new roles will be developed and provided

during the Post Decision Consultation period.

11.0 Consultation and engagement plan

Staff and unions will be provided with this Business Case for Change in writing, with a two-week period to provide

feedback. A team meeting will be held during that period to provide an opportunity for staff to discuss the options, ask

questions and provide feedback in person. Staff will also be provided with the opportunity to provide feedback in one-

on-meetings and/or in writing.

http://qheps.health.qld.gov.au/eap/


Feedback contacts

West Moreton strongly encourages all employees and relevant unions to review the supporting materials to provide

feedback on the proposed changes. Feedback can be provided to:

• Erin Finn, Director Patient Safety and Quality, at [email protected], or

• Tanya Rhea, HR Business Partner, at [email protected]

A representative of the management team and the Human Resources team will be present at all formal discussions

regarding the proposed changes. Staff wishing to provide feedback at these forums can do so verbally or in writing to

either representative during the discussions.

mailto:[email protected]

mailto:[email protected]


Attachments

Attachment A - Proposed organisational chart (option 1)

Director Patient Safety and Quality (DSO2)

CNC Safety & Quality (NG7*) x 5

Team Leader Safety and Quality Systems (AO7/NG7*)

National Standards Coordinator (AO6*)


Consumer Liaison Officer (AO5) x 2

Safety & Quality Data Analyst (AO7)

Independent Patient Rights Advisors (AO7) x 2

Chief Medical Officer

Administrative Officer (AO3)

OPTION 1: PROPOSED ORGANISATION STRUCTURE FOR PATIENT SAFETY AND QUALITY UNIT

Safety & Quality Reporting Coordinator

(AO6*)

* = new role description, classification subject to evaluation

Consumer Liaison TeamS&Q Business Partner

TeamS&Q Systems Team Patient Rights Team


Attachment B - Proposed organisational chart (option 2)


CNC Safety & Quality (NG7*) x 5

Team Leader Safety and Quality Systems (AO7/NG7*)

National Standards Coordinator (AO6*)

Consumer Liaison Manager (AO7) & Consumer Liaison

Officers (x2) transferred to clinical services

Safety & Quality Data Analyst (AO7)

Independent Patient Rights Advisors (AO7) x 2



OPTION 2: PROPOSED ORGANISATION STRUCTURE FOR PATIENT SAFETY AND QUALITY UNIT

Safety & Quality Reporting Coordinator

(AO6*)

* = new role description, classification subject to evaluation

S&Q Business Partner Team S&Q Systems Team Patient Rights Team


Attachment C - Current organisational chart


Patient Safety Officer (NG7) x 3

Quality Team Leader (AO7)

Quality Improvement Coordinator (NG7) x 2


Consumer Liaison Officer (AO5) x 2

Data Analyst (AO7)Independent Patient

Rights Advisors (AO7) x 2



PATIENT SAFETY AND QUALITY UNIT CURRENT ORGANISATION STRUCTURE

Quality Improvement Coordinator (AO6) x 2


Attachment D – Affected positions spreadsheet (Options 1 and 2)

Position Title Position Number Organisational Unit Work Location Classification FTE

NIL

Original Role Position Number Organisational Unit Work Location Classification New Role Comments

Patient Safety Officer 3047750 PSQ Ipswich Hospital NG7 CNC (Safety & Quality) NG7 3 positions - options 1 & 2

CNC (Quality Improvement) TBA PSQ Ipswich Hospital NG7 CNC (Safety & Quality) NG7 2 positions - options 1 & 2

Quality Improvement Coordinator 32015016

PSQ

Ipswich Hospital

AO6 National Standards

Coordinator

AO6

Quality Improvement Coordinator 32015016

PSQ

Ipswich Hospital

AO6 Safety & Quality Reporting

Coordinator

AO6

Team Leader (Quality) 32018685 PSQ Ipswich Hospital AO7

Team Leader (Safety &

Quality Systems)

AO7/NG7 1 position - options 1 & 2

Position Title Position Number Organisational Unit Work Location Classification Existing or New Position Comments

NIL

Position Title Position Number Organisational Unit Work Location Classification Recruitment Strategy New Position

NIL

Position Title Position Number Organisational Unit Work Location Classification

Consumer Liaison Manager

PSQ Ipswich Hospital AO7 TBD

Consumer Liaison Officer

PSQ Ipswich Hospital AO6 TBD Option 2 only - dependent on further

consultation if option 2 is the preferred

option

TRANSFER OF BUSINESS

ABOLISHED / RELOCATED POSITIONS

2 positions - Options 1 & 2

Initial allocation by staff preference

of 2 x existing AO6 staff,

proceeding to limited pool

suitability assessment for

allocation if required

Affected Positions spreadsheet:

Receiving Area Comments

Option 2 only - dependent on further

consultation if option 2 is the preferred

option

Patient Safety and Quality Unit,

Medical Services, West Moreton

Hospital and Health Service

OPEN MERIT

LIMITED POOL SUITABILITY ASSESSMENT

Comments

Applicant Pool

Classification

DIRECT MATCH

Comments


Direct Matching (At Level)

Direct match may be used when an employee is being matched to a role of their current employment status and classification within the work unit/branch/division. Direct matched roles often have similar skills or functions and may be more specialised.

Eg. Generalist HR role matched to Conduct and Performance. Direct matching requires the provision of an evaluated job description of the intended matched role along with any developmental or training requirements to undertake the matched role.

Transfer at Level

Employee is transferred to a suitable role of the same status and classification level at another work unit or location. (Requires consideration of employee’s circumstances).

Limited Applicant Pool Suitability Assessment (At Level)

Where the number and/or nature of ongoing roles change, the unit may adopt a limited applicant pool suitability assessment process to appoint employees to the new structure.

This often occurs where there are:

• mismatched numbers of staff to positions; or

• the role has changed such that it requires different skills; or

• employees may be considered for a suitable role within the revised structure.

New roles may require additional training and support for the employee. Any developmental or training requirements to undertake the new roles should also be outlined.

Voluntary Redundancy Offer

Alternate placement options including transfer, redeployment, secondment or priority transfer within health or other public service roles must be explored prior to redundancy packages being offered. (Dir 04/18 Cl. 10.1)

In the event the employee declines the VR offer, that employee will then be required to participate in the priority transfer process as per clause 11.4 of Directive No. 17/16.

Priority Transfers

Where management is unable to facilitate the placement of the employee into a suitable alternative role, the employee is to be registered for a priority transfer . A priority transfer employee will be required to actively participate

in the placement process including retraining or development to secure a [#transfer/ or consensual redeployment] opportunities.

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