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Caring ,Sharing , Devotion ,Worship

Caring ,Sharing , Devotion ,Worship . Significant Event - Using what we have. Significant Event . Definition:. “ any event that any member of the team considers to be significant in terms of the care of the patient and the conduct of the practice[organisation] ” (Pringle et al.; 1995) .

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Caring ,Sharing , Devotion ,Worship

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  1. Caring ,Sharing ,Devotion ,Worship Dr TA Taylor Wellington 2009

  2. Significant Event - Using what we have

  3. Significant Event Definition: “ any event that any member of the team considers to be significant in terms of the care of the patient and the conduct of the practice[organisation] ” (Pringle et al.; 1995) Dr TA Taylor Wellington 2009

  4. “ Doctors will become safe when they choose to become safe” Five Years After To Err is Human – What have we Learned? Lucian Leap & Don Berwick. Jama.2005; 293 : 2384-2390 Dr TA Taylor Wellington 2009

  5. Dr TA Taylor Wellington 2009

  6. Significant Event Definition “ any event that any member of the team considers to be significant in terms of the care of the patient and the conduct of the practice[organisation] ” (Pringle et al.; 1995 Our Definition: “ Any situation, event, process, attitude and/or behaviour that another person can learn from to improve the outcome.” Dr TA Taylor Wellington 2009

  7. Socio-economic status 37% (160.000) people NZ Dep Index 9 – 10 58% ( 45.000) of All Maori in CM Decile 9 - 10 79 % ( 74.000)of All Pacific people in CM Decile 9 - 10 46% of 0 – 4 yr old in CM live in Decile 9 - 10 Dr TA Taylor Wellington 2009 NZ Census 2001

  8. Clinical Assistant Nurse Patient Whanau GP Receptionist Dr TA Taylor Wellington 2009

  9. Patients Registered Population 120.000 Enrolled and Funded 87.000 Pacific People 40.000 Maori 14.000 Clinics 12 Clinics 47 GP’s 45 Nurses 9 Clinical Assistants 40 Reception staff 16 Admin Support 9 Management Dr TA Taylor Wellington 2009

  10. Doctors from Multicultural and Diverse Backgrounds IMG 41 (87%) New Zealand Trained Doctors 7 New Zealand Trained Doctors Pakeha 2 New Zealand Trained Doctors Pacific 3 New Zealand Trained Doctors Asian 2 IMG Maori 1 Dr TA Taylor Wellington 2009

  11. Culture of Quality 25 Doctors are Fellows of RNZCGP 20 Doctors are working towards it (GPEP1 and GPEP2) 1 Clinic ACC/ AMPA Accredited 56 Staff Achieved the CBMC Certificate Dr TA Taylor Wellington 2009

  12. Quality Pursuits - Cornerstone Accreditation

  13. Knowledge Attitudes Behaviour Sources of behaviour change Lack of awareness Lack of agreement with evidence External barriers Barriers to evidence uptake Volume of information Uncertain interpretation Environmental factors Access to resources Unclear applicability Institutional factors Lack of motivation of previous practice

  14. ETHC SE Reporting In 2006 ~ 10 SE per quarter ( 3.3 per month) In 2007 onwards ~ 50 SE per month ( 150 per quarter) Dr TA Taylor Wellington 2009

  15. What Does this Mean ? • Are we getting worse ? • Does this increase our risk ? (professional, financial, other) • Are our patients at more risk ? Dr TA Taylor Wellington 2009

  16. Knowledge Translation • Definition: • “Any activity or process that facilitates the transfer ofhigh quality evidence from research into effective changes in health policy, clinical practice, or products.” • “…combines the elements of research, education, quality improvement, and electronic systems development to create a seamless linkage between interventions that improve patient care and their routine implementation in daily clinical practice.” • Ann Emerg Med. 2007;49:355-363 Dr TA Taylor Wellington 2009

  17. Identification – Documentation – Reflection Cycles G M C P

  18. Challenges • How do we engage our patients in developing safer • environments ? • Technological Advances at its best can only reflect • human relationships • Governance - Taking it Seriously

  19. Take Home Messages • Pre-requisites • Right culture • Right leadership • Right relationships • Right systems • Regular reflection on practice Dr TA Taylor Wellington 2009

  20. “ Doctors will become safe when they choose to become safe” Five Years After To Err is Human – What have we Learned? Lucian Leap & Don Berwick. Jama.2005; 293 : 2384-2390 Waiting until doctors choose to become safe is not an option. Safety is first and foremost the patients prerogative. We need to develop toxic environments for poor and unsafe practices – These are called Learning Environments. Dr TA Taylor Wellington 2009

  21. Thank You

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