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Discussion paper:

A framework for quality improvement and patient safety capability and leadership-building for

the New Zealand health system

July 2015

Content

s

Executive summary..............................................................................................................................4

Introduction..........................................................................................................................................6

Background..........................................................................................................................................7

Defining quality and safety...................................................................................................................8

Benefits of developing health quality and safety capability and leadership.........................................9

Developing a New Zealand capability framework..............................................................................10

The framework...................................................................................................................................11

1 Capabilities of consumers.......................................................................................................14

2 Capabilities of everyone engaged in the health and disability workforce................................16

3 Capabilities of operational, clinical and team leaders, and other change agents...................20

4 Capabilities of senior organisational leaders...........................................................................26

5 Capabilities of quality and safety experts................................................................................32

6 Capabilities of governance/boards..........................................................................................38

July 2015 Draft Capability Framework

Executive summary

The Health Quality & Safety Commission (the Commission) has a national mandate to develop and support capability and leadership in quality improvement and patient safety to ensure that the delivery of health care is consistent with its overarching framework, the Triple Aim. Building capability is identified as one of the Commission’s strategic priorities to assist the sector to effect change.

This document describes a high level framework to guide the development of quality and safety capability across all levels in the health care sector, including consumers. It has been developed at the request of the sector and informed by an expert advisory group.

The framework is intended to provide the basis for a common understanding of the expected knowledge, skills and underpinning values required to achieve better quality and safer patient centred health care.

Articulating this for each of the broad roles within health care provides a benchmark against which organisations and individuals can gauge their current knowledge and identify future requirements for learning and development. It also serves to clarify and deepen understanding of the responsibilities associated with each role to enable more effective and consistent delivery of quality and safety expectations for patient care.

Currently, the quality improvement capability of the health sector in New Zealand is reflected in uneven system performance, with a few centres of excellence and islands of good practice as well as an over-reliance on the commitment and expertise of individuals to drive the quality and safety agenda. There is a compliance orientation towards quality and a lack of confidence in the sustainability of gains.

The serious failures in the Mid-Staffordshire National Health Services Foundation Trust demonstrate the consequences of not having quality and safety as a central consideration within the systems of their organisation. One of Berwick’s nine groups of recommendations in response focused on education, training and capacity building (National Advisory Group on the Safety of Patients in England 2013) which has also been recognised by many other international health systems.

To date the Commission’s focus on building capacity has been on quality improvement advisor scholarships, sponsored course attendances, supporting visits by international speakers, and building capability and leadership as part of all campaigns and collaboratives. The Commission believes there now needs to be a broader and more integrated approach to address the complex change challenge involved in achieving and enhancing system wide quality and safety.

Such a strategy needs to include addressing existing workforce needs, sustainably building the quality improvement capability of the future workforce; developing specialist roles in quality improvement science; supporting consumer participation; ensuring decision-making based on data and evidence; and supporting boards to provide leadership that encourages a quality improvement and patient safety focus throughout the sector.

This capability and leadership framework will provide the basis for a common understanding of the knowledge, skills and underpinning values required to achieve better quality and safer patient centred health care, and provides overall direction to the health sector. For each of the groups


identified in the framework, we define who typically belongs within these broad categories, and outline the quality and safety knowledge and actions that could reasonably be expected within the roles in each group.

The framework also recognises that most health care is delivered within the context of teams and within services. Quality and safety capability and leadership within and between multidisciplinary teams and networks is required for the seamless and safe care of patients, as part of the systems of care within an organisation.

Ultimately, embedding quality improvement and safety within all roles will result in organisations demonstrating a more mature quality and safety culture, and having in place the requisite systems and structures to enhance the delivery of better patient outcomes. Making explicit the expected knowledge, skills and behaviours required across broad roles within health care will enhance system capability.


Introduction

Safer and better quality care occurs when those in governance and management, health practitioners, non-clinical staff and consumers all work together at all levels of the health system with a common purpose. This common purpose been expressed through the New Zealand Triple Aim.

The Triple Aim identifies three dimensions that together mean:

providing effective, evidence-based treatments that meet the values and needs of individuals

ensuring there is improved health and equity for all populations in New Zealand avoiding harm and waste by doing the right thing first time.

Achieving the Triple Aim requires more than technical knowledge and skills. It requires a capable workforce that can adapt to meet the changing needs of the complex health care environment (Bodenheimer and Sinsky 2014). This can only occur in a system where consumer1 safety and their experience of care is a top priority. Compassionate care, underpinned by openness and transparency, to engender mutual trust and respect is fundamental to enable consumers and the health care workforce to work effectively together to co-design a more resilient health care system.

The Health Quality & Safety Commission (the Commission) has a national mandate to develop and support capability and leadership in quality improvement and patient safety to ensure that the delivery of health care is consistent with its overarching framework, the Triple Aim (Health Quality & Safety Commission 2014). The Commission clearly identifies building sector capability as one of its strategic priorities to assist the sector to effect change (Health Quality & Safety Commission 2014).

This document describes a high level framework to guide the development of quality and safety capability across all levels in the health care sector, including consumers. It has been developed at the request of the sector and informed by an expert advisory group. http://www.hqsc.govt.nz/assets/General-PR-files-images/EAG-representative-Aug-2015.pdf

1 In this document the words ‘consumer’ and ‘patient’ are considered interchangeable. It is assumed that these terms embody the broader concept of individuals and/or their whanau/families as applicable.


http://www.hqsc.govt.nz/assets/General-PR-files-images/EAG-representative-Aug-2015.pdf

Background

Currently, the quality improvement capability of the health sector in New Zealand is reflected in uneven system performance, with a few centres of excellence and islands of good practice as well as an over-reliance on the commitment and expertise of individuals to drive the quality and safety agenda. There is a compliance orientation towards quality and a lack of confidence in the sustainability of gains.

The serious failures in the Mid Staffordshire National Health Services Foundation Trust in 2005–08 demonstrate the consequences of not having quality and safety as central to the systems of an organisation. One of Berwick’s nine groups of recommendations in response to the Francis Report (Robert Francis 2013) focused on education, training and capacity building (National Advisory Group on the Safety of Patients in England 2013), which has also has been recognised by many international jurisdictions (Lachman 2013, Went 2013, Wales 2014).

The Commission has embarked on building capability as a key strategy for improving health care quality and safety. To date the focus has been on quality improvement advisor scholarships, sponsored course attendances, supporting visits by international speakers, and building capability and leadership as part of all campaigns and collaboratives. The Commission believes there now needs to be a broader and more integrated approach to address the complex change challenge involved in achieving system wide quality and safety.

Such a strategy needs to include addressing existing workforce needs, sustainably building the quality improvement capability of the future workforce, developing specialist roles in quality improvement science, supporting consumer participation, ensuring decision-making based on data and evidence, and supporting boards to provide leadership that encourages a quality improvement and patient safety focus throughout the sector.


Defining quality and safety

In 2003 in ‘Improving Quality: A systems approach for the New Zealand Health and Disability Sector’ (Minister of Health 2003) quality was defined as follows:

‘Within a systems approach, quality can be defined as the degree to which the services for individuals or populations increase the likelihood of desired health outcomes, and/or increase the participation and independence of people with a disability, and are consistent with current professional knowledge (adapted from Lohr (1990)). Quality is the cumulative result of the interactions of people, individuals, teams, organisations and systems.’

The key dimensions of quality include the following:

1. Safe: avoiding harm to patients from the care that is intended to help them. 2. Effective: providing services based on scientific knowledge to all who could benefit, and

refraining from providing services to those not likely to benefit. 3. Patient-centred: providing care that is respectful of and responsive to individual patient

preferences, needs, and values, and ensuring that patient values guide all clinical decisions. 4. Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy. 5. Accessible and equitable: providing care that does not vary in quality because of personal

characteristics such as gender, age, ethnicity, geographic location, and socioeconomic status.

In this paper we do not specify timeliness as a separate dimension as we see this as a component of other dimensions of effectiveness, accessibility and efficiency. The dimensions above are underpinned by the foundations of the partnership, participation and protection principles of the Treaty of Waitangi (Te Tiriti).

While safety is considered a dimension of quality, the inherently hazardous nature of health care and the high numbers of reported adverse events means safety demands additional consideration.

As defined above, safety is essentially about avoiding harm caused by the process of health care. To date there has been a strong emphasis on improving safety by learning from past harm. The causes of patient harm from health care however are seldom simple. In an increasingly complex health care system, safety needs to be addressed as a system property:

‘Safety does not reside in a person; device or department. Improving safety depends on learning how safety emerges from the interaction of components’(Cooper, Gaba et al. 2000).

Improving safety requires a focus on what goes right as much as what goes wrong. This strengthens our understanding of how the system works and how to build system resilience by ensuring that things go in the right direction (Hollnagel 2014).


Benefits of developing health quality and safety capability and leadership

Developing workforce capability and leadership offers an important platform for better health care quality and safety outcomes, and a more systematic and predictable quality and safety response across the health and disability sector, with the following envisaged medium- and long-term benefits (Rimmer 2012).

Envisaged medium-term benefits include:

a transparent quality and safety agenda in which everyone has an opportunity to participate a critical mass of the (technical and leadership) skills and knowledge in quality and safety to

facilitate system-wide spread and change more consistent application nationally of quality and safety knowledge, tools and techniques,

demonstrated by active projects and improved performance on key quality and safety priorities

wider engagement and participation by patients/communities in their health and disability services.

Envisaged long-term benefits include:

a health culture where ‘quality and safety is inherent in everything we do’ a health system that is responsive to patient needs and preferences through effective

partnerships across all levels of health care reduced harm, waste and unwarranted variation across the system with quality and safety

outcomes matching or better than comparable health systems.


Developing a New Zealand capability framework

Developing a New Zealand capability framework is important for a number of reasons:

It will provide the basis for a common understanding of the knowledge, skills and underpinning values required to achieve better quality and safer patient-centred health care.

It provides overall direction to planning and development for capability building across all levels of the health sector, including consumers.

It is intended to articulate clearly specific leadership expectations for quality and safety at each level of the health system from all frontline clinical and non-clinical staff to senior executive teams and Board members.

It will also inform the development of a range of training and education programmes to meet the needs of the sector, so that there is a coherent approach to building quality and safety capability in New Zealand.

Ongoing lifelong learning in quality and safety should be supported by a range of education delivery strategies that are easily accessible to all health care workers throughout their careers, to advance knowledge and skills, including:

postgraduate pathways in quality and safety that will support a New Zealand evidence base for quality and safety

a coordinated education programme, using a variety of delivery models and providers with recognised levels of attainment through New Zealand Qualifications Authority certification, that will support ongoing education and training for health care workers

the development of a New Zealand College/Association that will support specialist roles in quality and safety, and provide the necessary leadership to support and sustain excellence in quality and safety in the New Zealand health care system.

Sustaining a knowledgeable and skilled workforce in quality and safety can only occur in the context of:

a culture across all levels within the health and disability sector where quality and patient safety are the central foci

consumer partnership across all levels in the health and disability sector to inform quality and safety improvement initiatives

effective governance and leadership, both clinical and managerial, across all levels within the health and disability sector to improve quality and safety

an infrastructure being in place to support and sustain capability in quality and safety across the sector.


The framework The New Zealand framework builds on other frameworks previously described by leading

health care organisations, including NHS Scotland, Kaiser Permanente, (NHS Scotland , Scrimshaw and Parisi 2013). Appendix 1: http://www.hqsc.govt.nz/assets/General-PR-files-images/Sector-full-discussion-paper-appendix-1-Aug-2015.docx

The New Zealand framework has been chosen to describe capabilities rather than competencies. While both competence and capability are required for the ongoing improvement of the quality and safety of health care, capability reflects a perspective that builds on competence, to include the ability to adapt to change and generate new ideas and knowledge. It is about staying curious and open-minded, attributes that are essential for a 21st century workforce (Fraser and Greenhalgh 2001).

The New Zealand Framework takes a whole of system approach as described in the following definition (Batalden and Davidoff 2007):

‘the combined unceasing efforts of everyone – healthcare professionals, patients and their families, researchers, payers, planners and educators – to make changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning).’

It is unique in describing consumer capabilities. Consumers have an important role to play not only with respect to managing their own health, but also by being actively engaged in the planning and design of care to improve quality and safety.

The framework also recognises that most health care is delivered within the context of teams and within services. Quality and safety capability and leadership within and between multidisciplinary teams and networks is required for the seamless and safe care of patients, as part of the systems of care within an organisation.

Organisations express capability not only through their systems and structures, but more importantly through their culture, values and behaviours. Exemplary organisations are those where quality and safety practices and values are embedded as part of routine practice, resulting in measurable improvements in the patient experience of care and patient outcomes.

Ultimately, embedding quality and safety within all roles will result in organisations demonstrating a more mature quality and safety culture, and having in place the requisite systems and structures to enhance the delivery of better patient outcomes. Making explicit the expected knowledge, skills and behaviours required across broad roles within health care will enhance system capability.

For our quality and safety framework nine domains have been identified and defined as follows:


http://www.hqsc.govt.nz/assets/General-PR-files-images/Sector-full-discussion-paper-appendix-1-Aug-2015.docx


Domain Description

1. Partnerships with patients/consumers and their whānau/families

Establishes meaningful engagement with each patient/consumer and their whānau/family as the central participant of the health care team

2. Quality and safety culture Contributes to and models a culture that values and promotes quality and safety as top priorities

3. Leadership Doing what is right and setting an example so that others follow. In the context of a defined leadership role, leadership carries the responsibility of setting the direction for improving quality and safety consistent with organisational and national goals

4. Systems thinking Optimises system performance by being aware that a system is an interdependent group of items, people or processes, with a common purpose, and working with others to avoid unintended consequences

5. Teamwork and communication Works with others across professional and organisational boundaries to facilitate achieving shared quality and safety goals.

6. Improvement is evidence-based and data-driven

Decisions are made on evidence rather than beliefs and perceptions

7. Quality improvement knowledge and skills

Applies appropriate tools and methods to improve the quality of care

8. Patient safety knowledge and skills

Applies appropriate tools and methods to ensure the delivery of safe care

9. Managing change Knows and uses principles of change management to support effective implementation and sustainability of quality and safety improvements

In developing domains and grouping knowledge and actions within these domains, we have taken account of the literature that describes generic capabilities as well as drawing on a number of sources of information specifically related to competencies in quality and safety. Appendix 2: http://www.hqsc.govt.nz/assets/General-PR-files-images/Sector-full-discussion-paper-appendix-2-Aug-2015.docx

The New Zealand framework has chosen to identify capabilities by health care groups. These apply equally across the primary, secondary and aged care sectors. Health care groups have been broadly classified as follows:

1. Consumers 2. Everyone engaged in the health and disability workforce3. Operational, clinical and team leaders and other change agents 4. Senior organisational leaders5. Quality and safety experts 6. Boards




For each of the groups identified in the framework, we define who typically belongs within these broad categories, and outline the quality and safety knowledge and actions that could reasonably be expected as part of that role. We have taken a slightly different approach with the role of consumers and have not specified domains but summarised the key capabilities more generically.


1 Capabilities of consumers

The consumer group includes everyone who accesses the health care system, either for their own purposes, or on behalf of another person (for example, as parents or caregivers). Enabling consumers to become equal partners in care requires support that builds consumers’ self-efficacy, self-awareness, confidence and coping skills (refer http://www.eu-patient.eu/campaign/PatientsprescribE/).

Consumers may participate within all levels of the health care system, not only to achieve outcomes for themselves and their whānau/families, but also to participate in advisory roles in the planning, design and delivery of health care services. The increasing focus on building consumer engagement and partnerships (Carmen, Maurer et al 2013) requires a level of health literacy that enables consumers to achieve health outcomes as individuals and for the population as a whole.

Consumers need to feel empowered to ask questions, so they can find, interpret and use information and health services to make effective decisions about their own and/or their whanau/family’s health and wellbeing, in partnership with their health care providers.

Consumer engagement also facilitates consumer participation in advisory roles, where consumers are able to share their experiences and contribute to discussions about planning and designing care for improved quality and safety.

Consumers need an awareness that they can access information about their rights under the under the Code of Health and Disability Services Consumers’ Rights Act (1996) and be able to make a complaint to the provider/health care organisation or the Health and Disability Commissioner in the event they feel their rights have been breached.

1.1 Consumers interact with healthcare providers in a way that helps them achieve their desired outcomes

KNOWLEDGE OF ACTIONS

1.1.1 the concept of partnership and what that means for consumers with respect to their own health and that of their whānau/family

1.1.2 how to formulate questions relevant to their needs

1.1.3 where to find information and services relevant to their needs

1.1.4 how to read and interpret the information

1.1.5 how to communicate with their health care provider to express their needs and preferences

1.1.6 the safety risks that may be

1.1.9 apply skills to ask questions, find, interpret and use information and health services to maximise their own health and well-being, or that of their whānau/family

1.1.10 participate in their care by expressing their preferences and asking questions to ensure their needs are met and health care goals are achieved

1.1.11 communicate concerns about any quality and safety where appropriate,

1.1.12 participate in advisory roles by sharing their experience and contributing to discussions about planning and designing care for improved quality and safety

1.1.13 work with staff to help redesign care to


associated with receiving health care

1.1.7 the importance of expressing concerns to health care providers and the mechanisms for giving feedback in their experience of care

1.1.8 the Health and Disability Code of Rights & Complaints process

address safety or quality issues for the future

1.1.14 raise concerns with the provider, health care organisation or the Health and Disability Commissioner in the event they feel their rights have been breached


2 Capabilities of everyone engaged in the health and disability workforce

At this ‘foundation’ level, everyone requires a basic understanding about the importance of improving quality and safety in health care by reducing harm, waste and variation.

To do this, they need an appreciation of health care as a process with patients as the central focus. Berwick cited in (Evans 2014)), described ‘constant curiosity’ as a property of a systems thinker. In this way, individuals bring their own ‘lens’ to spot ways to make things better and safer for patients at all levels in the organisation.

There needs to be willingness by every person employed in health care organisations to engage in quality and safety improvement efforts appropriate to their role and their sphere of work. Simple quality and safety tools should therefore be part of everyone’s skill set in health care. For some this can be as simple as identifying and reducing waste, standardising an aspect of care or testing a small change.

Working collaboratively with others in teams is everyday practice in health care. Relationship skills are therefore essential. With the move to more network-based care involving multidisciplinary teams both within and between organisations, effective communication, mutual respect and shared values are basic competencies that enable teams to achieve optimal outcomes for patients.

Managing information is a critical competency for health care workers in the 21st century. This means individuals must be able integrate, analyse and critically appraise information in real time so they can adapt and respond to changing demands. This may include the need at times to innovate and broaden their scope.

2.1 Partnerships with patients/consumers and their whānau/familiesEstablish meaningful engagement and partnerships with patients/consumers and their whānau/families as the central participants of the health care team


2.1.1 the core values associated with patient centred care

2.1.2 the concept of patient engagement and patient partnership across the spectrum of health care as a key strategy for improving health outcomes

2.1.3 the principles of health literacy and cultural competency

2.1.4 applies the principles of patient centred care as part of their everyday practice

2.1.5 partners with the patient/consumer and their whānau/family so that their care is tailored to meet their expressed needs and preferences

2.1.6 identifies the health literacy of their patients and adapts communication style to ensure the patient/consumer and their whānau/family understand key information and are supported to ask questions


2.2 Quality and safety cultureContribute to and model a culture that values and promotes quality and safety as top priorities


2.1.1 what a good quality and safety culture is and the links with better patient outcomes

2.1.2 the value of openness and transparency in health care and the implications for quality and safety

2.1.3 the importance of reporting and the mechanisms for reporting in their own organisation

2.1.4 fosters a quality and safety culture within their own work environment

2.1.5 is open and transparent in words and actions

2.1.6 recognises and reports quality and safety concerns

2.3 LeadershipDoing what is right and setting an example so that others follow. In the context of a defined leadership role, leadership carries the responsibility of setting the direction for improving quality and safety consistent with organisational and national goals


2.3.1 the broad principles of leadership and the implications for their own role within the team

2.3.2 demonstrates leadership appropriate to their role

2.3.3 models doing the right thing in both words and actions

2.3.4 motivates and leads others to do the right thing in words and actions

2.3.5 delivers safe and effective care every time for the right patient in the right place at the right time

2.4 Systems thinkingOptimise system performance by being aware that a system is an interdependent group of items, people or processes with a common purpose; and work with others to avoid unintended consequences


2.4.1 the New Zealand health care context- both the structure and function of national, regional and local organisations

2.4.2 health care as a complex system

2.4.4 demonstrates an awareness of where their role fits in the context of the wider system

2.4.5 works within their team or department and ensures that actions taken don’t have unintended consequences for other areas


2.4.3 local systems and processes

2.5 Teamwork and communicationWork with others across professional, organisational and cultural boundaries to facilitate achieving shared quality and safety goals


the basic principles of:

2.5.1 effective communication skills including active listening

2.5.2 team building skills including individual member traits and how they contribute to team functioning

2.5.3 conflict management and resolution

2.5.4 giving and receiving constructive feedback

2.5.5 demonstrates understanding of the purpose of the team

2.5.6 demonstrates understanding of their roles, strengths and responsibilities as well as that of each team member

2.5.7 ensures written and verbal communications to exchange information are clear, respectful and logical\

2.5.8 plans and manages time and responsibilities to achieve team objectives

2.5.9 adapts and adjusts own behaviour and strategies to meet team objectives

2.5.10 shows trust and respect for others in the workplace

2.5.11 applies active listening and effective conflict management skills

2.5.12 gives, receives and acts on constructive feedback in the context of an open team culture

2.6 Improvement is evidence-based and data-drivenDecisions are made on evidence rather than on beliefs and perceptions


2.6.1 how to source evidence

2.6.2 simple measurement concepts to establish the facts

2.6.3 uses best practice evidence to inform their own practice

2.6.4 uses facts rather than beliefs and perceptions to substantiate decisions and identify opportunities for improvement


2.7 Quality improvement knowledge and skillsApply appropriate tools and methods to improve the quality of care


2.7.1 the history and current context of health care improvement

2.7.2 the key drivers of poor quality care: harm, waste and variation

2.7.3 the principles of improvement

2.7.4 how to apply simple Quality Improvement tools

2.7.5 participates in quality improvement projects in their local environment

2.7.6 identifies and defines problems, especially in relation to harm, waste and variation

2.7.7 sets a simple goal for improvement

2.7.8 is able to develop a simple measure to evaluate an aspect of care or service delivery

2.7.9 applies simple tools for improvement

2.7.10 knows where to ask for help

2.8 Patient safety knowledge and skillsApply appropriate knowledge, tools and methods to ensure the delivery of safe care


2.8.1 the nature and extent of patient harm

2.8.2 the basic principles of human factors including human error

2.8.3 how to report and learn from adverse events and near misses

2.8.4 the importance of openness and transparency and the principles of open disclosure

2.8.5 complies with organisational safety practices

2.8.6 is risk aware

2.8.7 reports safety concerns

2.8.8 anticipates future threats and take steps to minimise risk

2.8.9 participates in adverse event reviews when required

2.9 Managing changeKnow and use principles of change management to be supportive of the effective implementation and sustainability of quality and safety improvements


2.9.1 how change can impact on self and others

2.9.2 the importance and value of implementing sustainable quality and safety improvements

2.9.3 participates in and supports change processes

2.9.4 adapts own behaviour and attitudes to accommodate change

2.9.5 empowers change within the local work team


2.9.6 actively communicates successful change


3 Capabilities of operational, clinical and team leaders, and other change agents

Operational and clinical leaders are in positions that require them to facilitate and lead change within teams and services. This identifies them as champions for quality and safety with a responsibility to foster innovative practices and creativity within team and service areas in order to bring about changes to improve the quality and safety of care.

As ‘middle managers’, operational and clinical leaders are the ‘bridge’ between the senior leadership and the frontline. Ensuring organisational objectives are actioned at the front line requires strategic thinking and planning skills and a degree of organisational awareness to create an environment for change.

To effect change, leaders need a sound working knowledge of improvement science and safety science methods, including an understanding of measurement for improvement to monitor the quality and safety aspects of patient care and to identify problems. In developing solutions, they need to use an evidence-based approach to inform decision-making and then test, evaluate and refine the impact of selected interventions.

Leaders also need to be able to lead and work with teams and consumer groups in the co-design and redesign of care. By modelling desirable behaviours and their ability to communicate effectively, they should be able to create a culture that has a focus on improving the quality and safety of care for patients. Leadership and management skills at this level will enable them to execute a number of portfolios effectively.

Team leaders, nurse educators, and intern supervisors may also lead local quality and safety projects at a unit or service level. Providing learning opportunities for staff on both a formal and informal basis not only improves knowledge and skills, but creates the momentum that keeps staff engaged and curious about how they can ‘take the next step’ to improve quality and safety.

Anyone in health care can be a ‘change agent’, however some have formal roles in leading service and organisational change to improve the quality and safety of health care. Other change agents in the organisation include those who are not in formal leadership roles, but who also cause a change in the way things are done or the way ideas are viewed. These are not the formal change agents such as quality improvement advisors who are ‘experts’.


3.1 Partnerships with patients/consumers and their whānau/familiesEstablish meaningful engagement and partnerships with patients/consumers and their whānau/families as the central participant of the health care team





3.1.4 the concept of co-design in health care as a way of involving patients in co-producing health at the individual, organisational and policy levels to improve the experience of care for patients

3.1.5 model and ensure that staff apply the principles of patient centred care as part of their everyday practice

3.1.6 model and ensure that staff adapt their communication style to ensure patient/consumer and their whānau/family understand key information and are supported to ask questions

3.1.7 facilitate active participation by consumers of healthcare in the co-design of care across all levels of health care



3.2.1 what an ideal quality and safety culture is and the links with better patient outcomes

3.2.2 the value of openness and transparency in healthcare and the implications for quality and safety

3.2.3 how to measure the safety culture

3.2.4 balancing system versus individual accountabilities and approaches to improving the safety and reliability of healthcare

3.2.5 champion an ideal quality and safety culture within their own work environment

3.2.6 ensure their words and actions model and uphold the values of openness and transparency

3.2.7 measure safety culture and use the results to inform improvement

3.2.8 receive and act on quality and safety concerns raised and escalate where appropriate

3.2.9 manage safety risks using a systems-based approach




3.3.1 transformational leadership theory and practice

3.3.2 the application of organisational theory and management in health care (including strategic planning)

3.3.3 methods and tools for clinical and operational risk assessment and management


3.3.5 set and lead the strategic direction for quality improvement in collaboration with the senior executive team and board

3.3.6 chair or participate in organisational committees that have a key influence on quality and safety within the organisation

3.3.7 lead continuous quality improvement by working with key stakeholders and across boundaries to create effective strategies for organisational change to reduce waste, improve capacity and flow, streamline processes and enhance the patient experience of care

3.3.8 lead, motivate and support teams in the design of patient centred care and manage organisational implementation and spread

3.3.9 coach and mentor to improve capability in quality and safety leadership

3.4 Systems thinkingOptimise system performance by being aware that a system is an interdependent group of items, people or processes with a common purpose, and work with others to avoid unintended consequences


3.4.1 the New Zealand health care context including both the structure and function of national, regional and local organisations

3.4.2 the New Zealand Triple Aim and managing resources appropriately to achieve best value outcomes for individuals and population

3.4.3 health care as a complex adaptive system

3.4.4 quality as a systems feature

3.4.5 the application of systems theory and operational management in health

3.4.7 demonstrate an awareness of the various roles they undertake and/or manage in the context of the wider system

3.4.8 demonstrate awareness about the complex interplay between patients, health care workers and the work environment, and can explain the implications for the quality and safety of care

3.4.9 use a multidisciplinary approach to analyse system quality and safety gaps and prioritise strategies for actions

3.4.10 coordinate quality and safety improvement locally and across service and organisational boundaries to ensure the integrity of the


care

3.4.6 systems and processes in key services and organisations they interact with

system

3.4.11 build capability to improve team and system resilience




3.5.1 effective team work and impact on patient outcomes




3.5.5 negotiation skills


3.5.7 foster a team culture that supports quality and safety

3.5.8 model communication that is clear, respectful and logical

3.5.9 model trust and respect for others in the workplace

3.5.10 demonstrates understanding of their roles, strengths and responsibilities as well as that of each team member

3.5.11 adapt and adjust their own behaviour and strategies to meet team objectives

3.5.12 use active listening, effective conflict management and negotiation skills for quality and patient safety

3.5.13 give and receive constructive feedback in the context of an open team culture



3.6.1 evidence-based practice methods and tools

3.6.2 types of data, sampling methodologies, data collection and management

3.6.3 the reliability validity and limitations of metrics for measurement

3.6.4 the role of quantitative and qualitative data for improving system performance

3.6.5 data analysis, interpretation and

3.6.8 use evidence and industry benchmarks to set performance standards and inform continuous performance improvement to get the best value for health care resources at population and individual levels

3.6.9 access and appraise evidence to identify best practice

3.6.10 use valid and reliable measures to evaluate aspects of service delivery, drive improvement and inform change and sustainability

3.6.11 use multiple data sources and a broad range


presentation to communicate results

3.6.6 the requirement for a broad range of metrics to understand system performance and reliability

3.6.7 measurement strategies for system improvement

of metrics to assess system performance and reliability and to identify areas for improvement

3.6.12 measure and act on patient/consumer experience of care and monitor clinical outcomes




3.7.2 the concepts of harm, waste and variation in health care

3.7.3 improvement methodologies and tools

3.7.4 measurement strategies for improvement

3.7.5 implementing and sustaining improvements

3.7.6 successful improvements in other organisations nationally and internationally

3.7.7 identify and define problems especially in relation to harm, waste and variation

3.7.8 set goals for improvement that are specific, measurable, achievable, realistic and time bound (SMART)

3.7.9 work with quality improvement experts to select appropriate methodology and tools for improvement

3.7.10 use effective measurements to baseline current practice and track improvements

3.7.11 identify potential solutions and conduct sequential tests of change

3.7.12 implement interventions and monitor to ensure sustainability

3.7.13 support creativity and innovative practice in system change

3.7.14 coach and mentor others to build capability in quality improvement

3.8 Patient safety knowledge and skillsApply appropriate tools and methods to improve the reliability of delivering safe care


3.8.1 patient safety concepts and frameworks


3.8.3 the principles of ‘human factors’ including human error

3.8.4 approaches to managing safety risks at the individual and organisational levels

3.8.9 ensure that an effective clinical governance structure is in place

3.8.10 use and model appropriate safety practices to manage risk and increase the reliability of safe care locally and across the system

3.8.11 is risk aware (clinically and operationally) and reports safety concerns

3.8.12 is proactive in anticipating future threats and


3.8.5 a systems approach to analyse and learn from systems failures to improve patient safety (incident investigation and analysis)

3.8.6 the principles of open disclosure including understanding the impact on others

3.8.7 the role of incident management systems for organisational reporting and learning

3.8.8 barriers and enablers for reporting and learning from system failures

takes steps to minimise risk

3.8.13 use a systems approach in responding to and mitigating the consequences of human error

3.8.14 apply human factors knowledge to increase the safety of system performance

3.8.15 participate in adverse event reviews to identify and address system vulnerabilities

3.8.16 model openness by sharing learning from failures and successes and encourage conversations about safety risks

3.8.17 coach and mentor others to build capability in patient safety

3.8.18 work with senior leaders to ensure that systems and processes are in place to support patients, whanau/families and staff after adverse events

3.9 Managing changeKnow and use principles of change management to support effective implementation and sustainability of quality and safety improvements


3.9.1 change management theory and practice


3.9.3 facilitation tools and techniques for leading change


3.9.5 basic understanding of social movement concepts

3.9.6 communicate the vision for change in collaboration with the senior executive team and build a compelling story

3.9.7 help create the imperative for change

3.9.8 assess the readiness for change

3.9.9 lead and support service change processes

3.9.10 build good relationships and networks across service and organisational boundaries to influence and engage others for change

3.9.11 empower change within their team and service areas

3.9.12 actively communicate successful change


4 Capabilities of senior organisational leaders

A commitment to improving quality and safety starts with the Board and is operationalised and led by senior organisational leaders. Together, the Board and senior leaders set the organisational strategic quality direction and goals, aligned with the national priorities for improvement. They uphold and model the organisational values for staff and consumers.

The senior organisational leaders need to ensure flexible and responsive governance structures that enable and support teams and the organisation to adapt to a constantly changing and challenging health care environment, and ensure that effective clinical governance systems are in place.

Clear expectations and a compelling story need to be communicated by senior leaders in a way that supports an organisational culture for learning, and helps create the imperative and leverage for changes that make care safer and more effective. This group doesn’t necessarily need to have an in-depth knowledge of quality and safety methodologies, but they do need at least foundation level knowledge. Understanding the concept of variation and being able to interpret data means they will know what questions to ask to keep the organisation on track to meet its objectives for improvement.

Working with quality improvement experts, they will select and prioritise portfolios that align with the organisational quality and safety objectives, to ensure a cohesive and systematic approach to quality and safety improvement work.

4.1 Partnership with patients/consumers and their whānau/familyEstablish meaningful engagement and partnership with patient/consumer and their whānau/family as the central participant of the health care team





4.1.4 the concept of co-design in health care as a way of involving patients in co-producing health at the individual, organisational, and policy levels to improve the experience of care for patients

4.1.5 ensure and enable consumer participation in decision-making about health and disability services at every level including governance, planning, policy, setting priorities, and highlighting quality improvement opportunities

4.1.6 facilitate the co-design of care across all levels of health care

4.1.7 apply patient centred care principles to organisational decision-making

4.1.8 ensure that staff are enabled to apply the principles of patient centred care and facilitate patient empowerment as part of their everyday practice

4.2 Quality and safety culture


Contribute to and model a culture that values and promotes quality and safety as top priorities




4.2.3 how to measure the safety culture

4.2.4 balancing system versus individual accountabilities and approaches to improving the safety and consistent quality of health care

4.2.5 champion an ideal quality and safety culture within their own work environment

4.2.6 ensure their words and actions model and uphold the values of openness and transparency

4.2.7 ensure safety culture measurement is undertaken and the results used to inform improvement

4.2.8 receive and act on quality and safety concerns raised and escalate where appropriate

4.2.9 takes a lead in ensuring clinical and operational risk management systems are current, effective and given equal consideration






4.3.4 the value of giving and receiving constructive feedback

4.3.5 set and lead the organisational strategic direction for quality improvement in collaboration with the board

4.3.6 ensure that each member of the team sponsors, chairs or participates in organisational committees that have a key influence on quality and safety within the organisation

4.3.7 ensure continuous quality improvement with key stakeholders and across boundaries, to create effective strategies for organisational change to reduce waste, improve capacity and flow, streamline processes and enhance the patient experience of care

4.3.8 motivate and support organisational and clinical leaders in the design of patient centred health care

4.3.9 ensure organisational implementation and spread of effective quality and safety


initiatives

4.3.10 ensure structures and processes are in place to support emerging leaders

4.3.11 coach and mentor to improve capability in quality and safety leadership

4.3.12 acknowledge and celebrate successful quality improvements

4.4 Systems and process thinkingOptimise system performance by being aware that a system is an interdependent group of items, people or processes with a common purpose and work with others to avoid unintended consequences


4.4.1 the New Zealand health care context including the structure and function of national, regional and local organisations

4.4.2 the New Zealand Triple Aim and managing resources appropriately to achieve best value outcomes for individuals and the population

4.4.3 the systems and processes in key organisations, and agencies they interact with


4.4.5 quality as a systems feature

4.4.6 the application of systems theory and operational management in health care

4.4.7 demonstrate awareness about the complex interplay between patients, health care workers and the work environment, and can explain the implications for the quality and safety of care

4.4.8 draw on multidisciplinary input and use quality improvement advisors to analyse system quality and safety gaps and prioritise strategies for action

4.4.9 ensure that quality and safety improvement is coordinated locally and across organisational boundaries

4.4.10 build organisational quality and safety capability and capacity to improve system resilience





4.5.2 team building skills including


4.5.8 model communications that are clear, respectful and logical


individual member traits and how they contribute to team functioning






4.5.10 demonstrates understanding of their roles, strengths and responsibilities as well as that of each team member clarifying their roles in quality and safety

4.5.11 build organisational team capability by providing adequate resources including time, to ensure teams are effective in supporting quality and safety

4.5.12 adapt and adjust own behaviour and strategies to meet executive team objectives

4.5.13 model effective strategies for conflict management and negotiation to enhance quality and safety




4.6.1 evidence-based practice methods and tools


4.6.3 measurement strategies for system improvement


4.6.5 the reliability, validity and limitations of metrics for measurement

4.6.6 data analysis, interpretation and presentation to communicate results

4.6.7 use evidence and industry benchmarks to set organisational performance standards and take decisions to get the best value for health care resources at population and individual levels

4.6.8 use valid and reliable measures to evaluate aspects of service delivery, drive improvement and inform change and sustainability

4.6.9 ensure services use evidence-based practice

4.6.10 receive and act on information from multiple sources to drive organisational quality and safety improvement

4.6.11 measure and act on patient/consumer experience of care and monitor clinical outcomes









4.7.6 successful improvements in other organisations nationally and internationally

4.7.7 use an effective set of measures to monitor quality performance of services and foster openness and transparency with the results

4.7.8 ensure resources are appropriately allocated to achieve quality and patient safety goals

4.7.9 ensure patient participation in quality improvement

4.7.10 ensure and resource adequate quality improvement expertise to meet current and future demand and build capability in quality improvement

4.7.11 encourage creativity and innovative practice in system change

4.7.12 encourage the sharing of learning through coaching, mentoring, and presentations to enable cross pollination of ideas and lessons





4.8.3 the principles of ‘human factors’ including human error

4.8.4 approaches to managing safety risks at the individual and organisational levels

4.8.5 a systems approach to analyse and learn from systems failures to improve patient safety (Incident investigation and analysis)


4.8.7 the role of incident management systems for organisational reporting

4.8.9 ensure and operationalise an effective organisational patient safety framework to manage current and future safety risks

4.8.10 ensure and resource an effective clinical governance structure

4.8.11 ensure and resource adequate patient safety expertise to meet current and future demand, and build capability and capacity

4.8.12 use an effective set of measures to understand and monitor system safety and reliability

4.8.13 demonstrate openness and transparency, and share learnings by communicating the results about system successes and failures, escalating as appropriate

4.8.14 ensure staff use appropriate safety practices to manage risk and increase the reliability of safe care across the system


and learning

4.8.8 the barriers and enablers for reporting and learning from system failures

4.8.15 ensure all staff and patients are encouraged to report operational and clinical safety concerns

4.8.16 champion and take part in safety walk-arounds

4.8.17 ensure a systems approach and human factor knowledge is used in adverse event reviews

4.8.18 ensure and resource systems to support patients, whanau/families and staff after adverse events

4.9 Managing changeKnow and use principles of change to support effective implementation and sustainability of quality and safety improvements







4.9.6 communicate the organisational vision for change and build a compelling story

4.9.7 help create the imperative for change

4.9.8 assess the readiness for organisational change

4.9.9 champion and support organisational change processes

4.9.10 build good relationships and networks across organisational and agency boundaries to influence and engage others for change

4.9.11 empower collaborative change within their organisation

4.9.12 actively communicate successful change


5 Capabilities of quality and safety experts

Experts are those who have advanced expertise in the application of quality and safety methodologies and tools, and operate within organisations in a high level advisory capacity, working both in dedicated quality improvement roles and in other capacities. This means they need to have an overview of the system’s capabilities and the ability to critically analyse, design, manage and facilitate quality and safety improvement projects. Their roles may vary depending on the size of organisation they are working in and the other staff working in this area.

Experts work closely with the executive leadership team to influence strategy and policy. For this they need to ensure the appropriate metrics are in place to provide the information needed to inform and monitor the system.

Experts also work closely with the middle managers to enable the translation of organisational goals into actions at the frontline. For this, they need a sophisticated level of knowledge about the use of data to monitor the reliability of processes and the safety of systems to identify gaps. An ability to interpret and communicate results at the appropriate level is essential.

Expertise here is often referred to as ‘deep’ knowledge in the fields of improvement and safety science – but they also need the skills to mentor and coach others across all levels in the organisation. Experts need to be able to have relationships across the spectrum from consumers to boards, and be able to communicate effectively at all levels to effect change.

Coming from diverse backgrounds experts often bring a very strong system perspective and a focus on process that challenges health care thinking and guides it towards new paradigms.



5.1 Partnerships with patients/consumers and their whānau/familiesEstablish meaningful engagement and partnership with patient/consumer and their whānau/family as the central participant of the health care team


1.1.1. the core values associated with patient centred care

1.1.2. the concepts of patient engagement and patient partnership across the spectrum of health care as key strategies for improving health outcomes

1.1.3. the principles of health literacy and cultural competency

1.1.4. the concept of co-design in health care as a way of involving patients in co-producing health at the individual, organisational and policy levels, to improve the experience of care for patients

5.1.5 promote, provide guidance and collaborate to ensure consumer participation and decision- making about health and disability services occurs at every level – including governance, planning, policy, setting priorities, and highlighting quality improvement opportunities

5.1.6 model and support staff in applying the principles of patient centred care as part of their everyday practice

5.1.7 work with teams/organisations to facilitate consumer participation in the design of care across all levels of health care

5.1.8 collaborate with consumers to provide guidance to ensure patient centred care principles are applied in organisational decision-making

5.2 Quality and safety cultureContribute to and role model a culture that values and promotes quality and safety as top priorities



5.2.2 how to analyse safety culture measurements and use for improvement


5.2.4 system versus individual approaches to improving the safety and reliability of health care

5.2.5 champion an ideal quality and safety culture within their own work environment and across the organisation

5.2.6 ensure their words and actions model openness and transparency

5.2.7 provide guidance and support with measuring the safety culture and using the results for improvement

5.2.8 assist senior leaders with identifying and prioritising and addressing quality and safety concerns






5.3.6 work with senior leaders to set and lead the organisational strategic direction for quality improvement

5.3.7 support the senior leadership team in bringing a quality and safety focus to organisational meetings

5.3.8 chair or participate in organisational committees that have a key influence on

5.4 Systems and process thinking Optimise system performance by being aware that a system is an interdependent group of items, people or processes with a common purpose and work with others to avoid unintended consequences



5.4.2 New Zealand Triple Aim and managing resources appropriately to achieve best value outcomes for individuals and the population


5.4.4 systems and processes in key organisations and agencies they interact with

5.4.5 tools available to analyse the organisation and its processes

5.4.6 teach about the complex interplay between patients, health care workers and the work environment and the implications for the quality and safety of care

5.4.7 ensure human factors knowledge is applied in detecting and ameliorating deficiencies in the processes of care

5.4.8 work with multidisciplinary teams to analyse system quality and safety gaps and prioritise strategies for action

5.4.9 facilitate the coordination of quality and safety improvement initiatives locally and across organisational boundaries

5.4.10 lead organisational quality and safety leadership and capability building to improve system resilience

5.4.11 challenge the status quo by asking the right questions









5.5.6 giving and receiving constructive




5.5.10 work with senior leadership and middle managers to help clarify and support roles and responsibilities in quality and safety across the organisation, including their own

5.5.11 adapt and adjust their own behaviour and strategies to meet service and


feedback organisational objectives





5.6.1 the application of appropriate statistical techniques, evidence-based practice methods and tools

Expertise in:


5.6.3 the role of quantitative and qualitative data for improving system performance


5.6.5 the reliability validity and limitations of metrics for measurement

5.6.6 data analysis, interpretation and presentation to communicate results

5.6.7 provide guidance on identifying and using evidence and industry benchmarks to set organisational performance standards

5.6.8 take decision to get the best value for health care resources at population and individual levels

5.6.9 promote the use of evidence-based practice across the organisation

5.6.10 ensure data is used as evidence to support any quality and safety initiative

5.6.11 set up and use a broad range of metrics to measure and monitor system performance and reliability to identify improvement opportunities

5.6.12 undertake robust data analyses and communicate the results effectively and timely

5.6.13 teach measurement methods and tools to build organisational capability in using appropriate measurement strategies to drive improvement

5.6.14 apply relevant statistical methods to support improvement



KNOWLEDGE ACTIONS

Expertise in





5.7.5 effective implementation strategies and how to sustain improvements

5.7.6 how other organisations, nationally and internationally, have successfully improved aspects of care

5.7.7 ensure the use of effective sets of measures to monitor quality performance of services and support openness and transparency with communicating the results

5.7.8 lead creativity and innovative practice in patient centred system change

5.7.9 teach quality improvement concepts, theories, skills and tools to build quality improvement capability and expertise in the organisation to meet future demand

5.7.10 share learning through coaching, mentoring, and presentations to enable cross pollination of ideas and lessons

5.7.11 help organisations in the use of appropriate tools and techniques

5.7.12 provide expertise and feedback to quality improvement initiatives

5.7.13 facilitate the implementation and sustainability of quality improvement initiatives

5.8 Patient safety knowledge and skillsApply appropriate tools and methods to enhance the delivering of safe care

KNOWLEDGE ACTIONS

Expertise in

5.8.1 patient safety concepts

5.8.2 the psychology of human error

5.8.3 concepts of harm and the role of human factors and its application in health care to improve quality and safety

5.8.4 approaches to manage safety risks at the individual and organisational levels

5.8.5 incident investigation and analysis process


5.8.7 work with senior leaders and middle managers to guide and support the application of appropriate safety practices to manage risk and increase the reliability of safe care locally and across the system

5.8.8 work with senior leaders and middle managers to ensure an effective clinical governance structure

5.8.9 model clinical and operational risk awareness and support reporting of safety concerns by staff and patients

5.8.10 are proactive in anticipating future threats and work with staff at all levels to identify and take steps to minimise risk

5.8.11 uphold and teach a systems approach in responding to and mitigating the consequences of human error

5.8.12 teach human factors knowledge to increase


the safety of system performance

5.8.13 lead adverse event reviews to address system vulnerabilities

5.8.14 set up and support a system for sharing learning from failures and successes to improve system performance

5.8.15 teach, coach, mentor, and support others to build capability and expertise in patient safety to meet future demands

5.8.16 work with senior leaders to ensure that systems and processes are in place to support patients, whanau/families and staff after adverse events



Expertise in





5.9.5 communicate and support the organisational vision for change with senior executives, boards and operational and clinical leads

5.9.6 assess and communicate the readiness for organisational change

5.9.7 champion and support organisational change processes

5.9.8 build good relationships and networks across organisational and agency boundaries to influence and engage others for change

5.9.9 facilitate and lead a collaborative change process

5.9.10 actively communicate successful change and encourage participants to share their stories


6 Capabilities of governance/boards

A commitment to improving quality and safety starts with the Board and is operationalised and led by senior organisational leaders. The Board with the senior leadership team set the organisational strategic quality direction and goals aligned with national priorities for improvement. These leaders uphold and model the organisational values for staff and consumers and have ultimate responsibility for the governance of compassionate, patient centered, quality clinical care within their health organisation. They are instrumental in setting, championing and ensuring a quality and safety culture within their organisations.

The Board, along with the senior organisational leaders, needs to ensure flexible and responsive governance structures are used that enable and support teams and the organisation to adapt to constantly changing and challenging health care environments and ensure that effective clinical governance systems are in place. They are responsible for putting in place the structures and systems to support patient engagement and partnership.

The Board and senior leaders need to set clear expectations of staff and communicate a compelling story in a way that supports an organisational culture for learning, and helps create the imperative for change, to make care safer and more effective.

The Board or governance team needs to ensure and enable training programmes for building capability and leadership within the organisation, to ensure all staff have the necessary knowledge, skills and behaviours to meet the quality and safety requirements appropriate to their role.

All board members need a base ‘foundation’ level understanding about the importance of improving quality and safety in health care by reducing harm, waste and variation.

6.1 Partnership with patients/consumers and their whānau/familyEstablish meaningful engagement and partnerships with patients/consumers and their whānau/families as the central participant of the health care team



6.1.2 the concepts of patient engagement and patient partnership across the spectrum of health care as key strategies for improving health outcomes


6.1.4 the concept of co-design in health care as a way of involving patients in co-producing health at the

6.1.5 ensure and enable consumer participation and decision-making about health and disability services at every level – including governance, planning, policy, setting priorities, and highlighting quality improvement opportunities

6.1.6 ensure that staff apply the principles of patient centred care as part of their everyday practice

6.1.7 facilitate participation by consumers in the co-design of care across all levels of health care


individual, organisational and policy levels, to improve the experience of care for patients

6.1.8 apply patient centred principles to board decision-making




6.2.2 safety culture and measurements to inform improvement


6.2.4 champion and ensure a quality and safety culture within their organisation

6.2.5 ensure that each Board agenda has quality and safety as the first item, and includes patient stories, feedback and qualitative reports and measures

6.2.6 uphold the values of openness and transparency culture

6.2.7 ensure that the organisational strategic plan clearly articulates the quality and safety vision for the organisation

6.2.8 review safety culture measurements and ensure senior executive team act on outcomes

6.2.9 ensure clinical and operational risk management systems are current, effective and given equal consideration.

6.2.10 ensure that quality accounts are published annually and used to inform strategic quality plans and agenda

6.3 LeadershipLeadership is about doing what is right and setting an example so that others follow. In the context of a defined role, it is also that, but carries the responsibility of setting the direction for improving the quality and safety of care consistent with organisational and national goals



6.3.4 set and lead the organisational strategic direction for quality and safety in collaboration with the executive team


6.3.2 organisational theory and management in health care (including strategic planning)

6.3.3 clinical and operational risk management

consistent with national priorities

6.3.5 with senior management set specific goals to reduce harm each year

6.3.6 ensure structures and processes are in place to support the strategic vision and direction for quality improvement and safety

6.3.7 ensure structures and processes are in place to support organisational leadership and emerging leaders

6.4 Systems and process thinking Optimise system performance by being aware that a system is an interdependent group of items, people or processes with a common purpose and work with others to avoid unintended consequences



6.4.2 the New Zealand Triple Aim and managing resources appropriately to achieve best value outcomes for individuals and the population


6.4.4 ensure and support management in building quality and safety capability and capacity

6.4.5 ensure that quality and safety is coordinated across organisational boundaries

6.4.6 ensure the organisation meets the national agenda for quality and safety

6.4.7 draw on multidisciplinary input and use quality improvement advisors to explore and advise on system quality and safety gaps and to prioritise strategies for action






6.5.3 effective communication skills

6.5.7 clarify roles and responsibilities in quality and safety for the board

6.5.8 build board capability by undertaking training and education in quality and safety


6.5.10 adapt and adjust behaviours and strategies


including active listening




to meet board and organisational objectives

6.5.11 model trust and respect for others in the board and organisation





[6.6.1] the principles of evidence- based practice methods and tools

6.6.1[6.6.2] a broad range of metrics as part of the requirement for a broad range of metrics to understand system performance and reliability

6.6.2[6.6.3] measurement strategies for system improvement

6.6.3[6.6.4] types of data, sampling methodologies, data collection and management

6.6.4[6.6.5] the reliability, validity and limitations of metrics for measurement

6.6.5[6.6.6] data analysis, interpretation and presentation to communicate results

6.6.6[6.6.7] use evidence and industry benchmarks to evaluate organisational performance and take decisions to get the best value for health care resources at population and individual levels

6.6.7[6.6.8] receive and act on information from multiple sources to drive organisational quality and safety improvement

6.6.8[6.6.9] apply evidence for best practice to their own board activities for improving board performance


KNOWLEDGE ACTIONS

Have a basic understanding of



6.7.3 the basic principles of improvement methodologies and tools

6.7.6 use an effective set of measures to monitor quality performance of the organisational and its services and foster openness and transparency with the results

6.7.7 ensure resources and expertise are appropriately allocated to achieve quality and patient safety goals to meet current and future demand


6.7.4 the basic principles of measurement strategies for improvement


6.7.8 ensure and resource consumer participation and partnership in quality improvement

6.7.9 encourage creativity and innovative practice in system redesign

6.7.10 ensure management is undertaking continuous quality improvement





6.8.3 human factors including human error

6.8.4 managing safety risks at the individual and organisational levels

6.8.5 incident management systems for organisational reporting and learning

6.8.6 the barriers and enablers for reporting on and learning from system failures

6.8.7 ensure the organisation has a coherent and effective safety framework to manage current and future safety risks

6.8.8 ensure and resource an effective clinical governance structure

6.8.9 receive an effective set of measures to monitor safety performance of the organisation and its services and foster openness and transparency with the results

6.8.10 ensure staff use appropriate safety practices to manage risk and increase the reliability of safe care across the system

6.8.11 ensure all staff report operational and clinical safety concerns

6.8.12 champion and take part in safety walk-arounds with the senior executive team

6.8.13 ensure openness and transparency in learnings about system successes and failures

6.8.14 ensure and resource adequate patient safety expertise to operationalise the safety framework and build organisational capability




6.9.2 how change can impact on the

6.9.4 assess the readiness for organisational change that addresses quality and safety improvements


organisation


6.9.5 champion and support organisational change processes that target quality and safety improvements

6.9.6 actively communicate successful change that improves patient safety and health care delivery

6.9.7 empower change within their organisation


References

Baker, D. P., et al. (2006). "Teamwork as an Essential Componenet of High-Reliability Organizations " Health Research and Educational Trust 41(4): 1576-1598.

Batalden, P. B., et al. (1998). Knowledge domains for health professional students seeking competency in the continual improvement and innovation of health care Boston Institute for Healthcare Improvement

Batalden, P. B. and F. Davidoff (2007). "What is 'quality improvement' and how can it transform healthcare? ." Quality & Safety in Health Care 16: 2-3.

Bodenheimer, T. and C. Sinsky (2014). "From Triple to Quadruple Aim: Care of the patient requires care of the provider " Annals of Family Medicine 12(6): 573-576.

Cooper, J. B., et al. (2000). "The National Patient Safety Foundation Agenda for Research and Development in Patient Safety " Medscape General Medicine 2(3).

Evans, M. (2014). Quality Improvement in Healthcare.

Fraser, S. W. and T. Greenhalgh (2001). "Coping with complexity: Educating for capability " British Medical Journal 323: 799-803.

Garman, A. (2011). "Leading for Quality in Healthcare: Development and Validation of a Competency Model." Journal of Healthcare Management 56(6): 373-382.

Health Quality & Safety Commission (2014). Statement of Intent 2014-18. Wellington, NZ, Health Quality & Safety Commission

Hollnagel, E. (2014). Safety-I and Safety-II: The Past and Future of Safety Management. , Farnham, UK: Ashgate.

Lachman, P. (2013). A novel approach to building capacity in QI in a resource constrained environment. IAQUA: Building Capacity and capability for Healthcare Improvement Conference Edinburgh, Scotland

Minister of Health (2003). Improving Quality: A systems approach for the New Zealand Health and Disability Sector Wellington Ministry of Health

National Advisory Group on the Safety of Patients in England (2013). A Promise to learn, a commitment to act: Improving the Safety of Patients in England.

NHS Scotland Quality Improvement Curriculum Framework NHS Scotland

Rimmer, M. (2012). "Discussion /Scoping Paper: Building Quality and Safety Capability in the New Zealand Health & Disability Sector."

Robert Francis, Q. (2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry UK.

Scrimshaw, K. and J. Parisi (2013). Building Improvement Science Capability Wellington, NZ, Right Management


The Health Foundation (2012 ). Quality improvement training for healthcare professionals Evidence Scan. London UK, The Health Foundation.

The Health Foundation (2014). Building capability to improve safety Event Report London, UK

The Safety Competencies Steering Committee (2008). The Safety Competencies: Enhancing Patient Safety Across the Health Professions J. R. Frank and S. Brien. Ottawa, Canada Canadian Patient Safety Institute

Wales, N. (2014) Improving Quality Together

Went, S. (2013). Building Quality Improvement Infrastructure in Scotland. ISQUA: Building Capacity and Capability for Healthcare Improvement Conference Edinburgh, Scotland


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