Leading the Safety and Quality Leading the Safety and Quality AgendaAgenda

in Australian Health Carein Australian Health Care

Coalition of National Nursing OrganisationsCoalition of National Nursing Organisations

Chris BaggoleyChris Baggoley

2 May 20082 May 2008

Quality in Australian Health Care StudyQuality in Australian Health Care Study

“A furore erupted in mid-1995 when a former Federal Minister for Health, Dr Carmen Lawrence, released preliminary results of a study estimating that 14,00 people died in Australian hospitals each year as a results of complications in their health care. The public was alarmed, and doctors were furious.”

Sydney Morning Herald: 2/12/1997

ACSQHCACSQHC

The Australian Commission on Safety and Quality in Health Care

- Established by Health Ministers in 2005, commenced in 2006

- Reports to Health Ministers

- Commissioners diversity and strength

- Committee structure: IJC, PHSC, PCC, ISC

Enactors

- Stakeholders / Colleagues include: Consumers

Professional organisations

Health Service Executives

ACSQHCACSQHC

Our Priority Programs1. Patient Charter of Rights

2. Open Disclosure

3. Basic Care Issues- Hygiene- Patient Identification- Medication Safety- Handover-Patient at risk-Falls

4. Tools- Accreditation and credentialing- Quantitative & Benchmark Measures- Harnessing IT & Communication

DRAFT: Australian Charter of Health RightsDRAFT: Australian Charter of Health Rights

What can I expect from the health system?MY RIGHTS WHAT THIS MEANS

1. SAFETY: I have a right to safe and high quality care

•Safe and high quality health services provided to me with professional care, skill and competence

2. RESPECT: I have a right to respect, dignity and consideration

• Care that respects me and my culture, beliefs, values and personal characteristics

3. COMMUNICATION: I have a right to be informed about services, treatment, options and costs in a clear and open way

• Open, timely and appropriate communication about my health care provided in a way I can understand

4. PARTICIPATION: I have a right to be included in decisions about my care

• I may participate in making decisions about my care and about health service planning

5. PRIVACY: I have a right to privacy and confidentiality of my personal information

• My personal privacy is maintained and proper handling of my personal health and other information is assured

6. COMMENT: I have a right to comment on my care and to have my concerns addressed

• I can comment on or complain about my care and have my concerns dealt with properly and in a timely way

7. ACCESS: I have a right to health care • I can access services to address my health care needs

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PATIENT CHARTER

I have a right to safe and high quality care

I have a right:

-To be free of being infected by my hospital or health worker

-To be free of medication mishap

-To be assessed for the risk of VTE

-To have the correct procedure, operation, test, x-ray

-To be rescued if my condition unexpectedly deteriorates

Evidence based risk assessment for VTEEvidence based risk assessment for VTE

Evidence based risk assessment for DVT is disappointing despite national and international research.

Mortality due to DVT after hospital admission is 10 times greater than after MRSA.

Responsibility for assessment and prescription of prophylaxis are often confused.

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PATIENT CHARTER

I have a right to clear communication throughout the period of care

I have a right:

- For my health information to be passed accurately between settings and shifts of care

- To be told what happened when things go wrong

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PATIENT CHARTER

Patient rights

ACSQHC response

By this time next year we will have…

Open DisclosureOpen Disclosure

This time next year, we will have:

- The open disclosure standard endorsed

- Provided tools to assist jurisdictions and private sector implement the standard

Legal consistency

Patient stories

Patient support material

Implementation guide for health care facilities

- Published open disclosure evaluation in the peer reviewed literature

Health Care Associated InfectionHealth Care Associated Infection

This time next year, we will have:

- Infection Control Guidelines updated and disseminated

- Nationally agreed standards for:Surveillance of hospital infections

Monitoring resistance to antibiotics

Use of antibiotics

- Empowered Infection Control Practitioners to effect change in their facilities

Patient IdentificationPatient Identification

This time next year, we will have:

- An agreed national standard for patients ID

- Spread the 3Cs nationally to other areas, such as:Radiology

Radiotherapy

Dental care

- Disseminated learnings from patient ID adverse events

Clinical HandoverClinical Handover

This time next year, we will have:

- Completed national projects covering 4 areas:Specific handover processes

Electronic tools

Communication and team training

Tools for observation, monitoring and evaluation and handover

- Commenced national spread

- Advised international community

- Disseminated learning from clinical handover adverse events

Medication SafetyMedication Safety

This time next year, we will have:- Spread the National Inpatient Medication Chart to the

following areas:Paediatrics

Long stay

Specialist areas (eg insulin administration)

- Audited the effectiveness of the NIMC in jurisdictions

- Spread the VTE prophylaxis program to the private sector

- Assisted GPs manage warfarin medication

- Described and started to address other key medication safety gaps

AccreditationAccreditation

This time next year, we will have:

- An alternative model for accreditation

- A preliminary set of Australian Health Standards

- Reviewed surveyor participation

- Conducted research into patient journeys and unannounced surveys

- Defined a process of national coordination of accreditation

Information StrategyInformation Strategy

This time next year, we will have:

- Developed operating and technical standards for Australian Clinical Quality Registries

- Developed national indicators for safety and quality

- Recommended to Ministers national data sets for safety and quality

- An understanding of the economic costs of patient injury

Not only but alsoNot only but also

This time next year, we will have:

- The 2008 National Report

- Led and coordinated a national approach to credentialing

- Commenced a national approach to detection and response to the patient at risk

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PATIENT CHARTER

Patient rights

ACSQHC response

But how will this make a difference?

To Consumers To Clinicians

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Consumers

Patients

Citizens

Experience, wisdom, knowledge and views

Health Ministers

Actions to make health care more patient centred, to improve safety and quality

States and Territories, and their public hospitals

State/ Territory Safety and Quality Organisations

Private Sector

Primary Care Sector

Health Care Complaints Commissioners

Regulators

Australian Commission on Safety and Quality in Health Care

Consumer Engagement

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SAFETY: Safe and high quality carePatients, consumers and health care providers are entitled to a safe, secure and supportive health care environment. Patients and consumers have the right to expect that safe care and treatment will be provided in every encounter with the health system.

Some of the ways you can contribute to the provision of safe and high quality care are by:

Tell staff if you think that an error might have occurred or something has been missed in your care

Tell staff if you think that an error might have occurred or something has been missed in your care

Patient or ConsumerPatient or Consumer

Provide health care services with professional skill, care and competence Provide health care services that are informed and where possible, evidence based Participate in patient safety systems established by the health service organisations in which you work

Provide health care services with professional skill, care and competence Provide health care services that are informed and where possible, evidence based Participate in patient safety systems established by the health service organisations in which you work

Health Care ProvidersHealth Care Providers

Ensure that health care providers are appropriately qualified, competent and experienced, and that facilities and procedures meet industry standardsEnsure that health care providers have the resources to allow them to provide safe, effective and appropriate health careEnsure that systems are in place that promote patient safety and that instructions to patients and consumers are clear and well communicated

Ensure that health care providers are appropriately qualified, competent and experienced, and that facilities and procedures meet industry standardsEnsure that health care providers have the resources to allow them to provide safe, effective and appropriate health careEnsure that systems are in place that promote patient safety and that instructions to patients and consumers are clear and well communicated

Health Service OrganisationHealth Service Organisation

LiteratureLiterature

On the Trail of Safety and Quality in HealthcareRichard Grol, Donald Berwick, Michael Wensing BMJ 336 (2008) 74-76

Major problems persist to improve the quality and safety of healthcare

Factors include:

- Resistance to change among health professionals

- Organisational structures that block improvements

- Dysfunctional financial incentives

Research agenda topics suggested

LiteratureLiterature

On the Trail of Safety and Quality in Healthcare

Richard Grol, Donald Berwick, Michael Wensing BMJ 336 (2008) 74-76

Research agenda topics suggested include: - How to achieve sustained change in normal care

- How to guide clinicians towards scientifically correct and safe practice

- How to provide new evidence at the point of care

- How to create a culture of change and continuous improvement in the ward or practice

Organisational FactorsOrganisational Factors

“There is growing evidence base of rigorous evaluations of organisational strategies, but the evidence underlying some strategies is limited and for no strategies can the effects

be predicted with high certainty.”

Wensing M, Wollersheim H & Grol R Implementation Science, 2006

www.implementationscience.com/content/1/1/2

Organisational intervention to improvement in patient care : a structured review of reviews

Organisational FactorsOrganisational Factors

Organisational interventions to improvement in patient care : a structured review of reviewsRevision of professional roles

Focus Main results

Nurse practitioners in primary care ( 13 trials)

Improved: laboratory testing, resolution of pathology conditions, patient satisfaction

No change: quality of care, prescribing functional status, consultation rates, use of emergency service

Nurse practitioners in primary care ( 13 trials)

Improved: patient satisfaction

Increased: consultation length, investigations

No change: health status

Mental health workers in primary care (38 trials)

Replacement role: did not consistently change psychotropic prescribing, consultation rates or mental health referrals

Enlargement of the role of the public pharmacist (16 trials)

Changed: use of health care services, improved patient outcomes

No change: quality of life

Outreach nursing for COPD

(4 trials)

Increased: hospital service use

No change: mortality, lung function, health related quality of life

Organisational FactorsOrganisational Factors

Organisational interventions to improvement in patient care : a structured review of reviews

Integrated care services

Focus Main results

Stroke Units (19 trials)Reduced: mortality, dependency, institutionalisation, length of hospital stay

In-hospital pathways for stroke (10 trials)

Fewer: UTIs, readmissions

More: CT brain scans, carotid duplex

Reduced: patient satisfaction, quality of life

No change: mortality, dependency, discharge destination

Disease management for heart failure in patients discharged from hospital (11 trials)

Decreased: hospital use, costs

No change: all-cause mortality

Organisational FactorsOrganisational Factors

Organisational interventions to improvement in patient care : a structured review of reviews

Knowledge management

Focus Main results

Computerized information services in different settings

Improved: test ordering/prevention in A, B & C

Improved: drug prescription in D

Improved: patient knowledge in E

A. Provider prompt

B. Provider feedback

C. Computerized medical record

D. Assisted treatment planning

E. Computerized patient education

(100 trials)

Nursing record systems

(8 trials)

No change: patient care, patient outcomes

Some: administrative benefits

Sun Herald – ‘simple jab’Sun Herald – ‘simple jab’

Effecting ChangeEffecting Change

Commission

Private Hospital Sector Committee Information Strategy Committee

Primary Care Committee

IJCSafety and Quality

Bodies

Staff

Clinical Quality Registries Committee

CHF

Consumer engagemen

t

Community

AHMC

AHMAC

AIHW TGA CPMC NHMRC NICS NeHTA

Nursing Orgs ACHSE Allied Health OrgsUniversity

Sector

Prime Minister COAG

National Health and Hospitals Reform CommissionAMA

Media

Private Sector

Advisory Committees Working Parties

Research Sector