Quality in Australian Health Care Study

1. Leading the Safety and Quality Agendain Australian Health CareCoalition of National Nursing OrganisationsChris Baggoley2 May 2008

2. Quality 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

3. ACSQHC • 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

4. ACSQHC • Our Priority Programs • 1. 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

5. DRAFT: Australian Charter of Health Rights

6. ACSQHC • 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

7. Evidence 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.

8. ACSQHC • 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

9. ACSQHC • PATIENT CHARTER • Patient rights • ACSQHC response • By this time next year we will have…

10. Open 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

11. Health Care Associated Infection • This time next year, we will have: - Infection Control Guidelines updated and disseminated - Nationallyagreed standards for: Surveillance of hospital infections Monitoring resistance to antibiotics Use of antibiotics - Empowered Infection Control Practitioners to effect change in their facilities

12. Patient 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

13. Clinical 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

14. Medication 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

15. Accreditation • 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

16. Information 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

17. Not 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

18. ACSQHC • PATIENT CHARTER • Patient rights • ACSQHC response • But how will this make a difference? To Consumers To Clinicians

19. ACSQHC Consumer Engagement Health Ministers States and Territories, and their public hospitals Regulators Primary Care Sector Private Sector Health Care Complaints Commissioners State/ Territory Safety and Quality Organisations Consumers Patients Citizens Actions to make health care more patient centred, to improve safety and quality Experience, wisdom, knowledge and views Australian Commission on Safety and Quality in Health Care

20. ACSQHC • SAFETY: Safe and high quality care • Patients, 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: Patient or Consumer Health Care Providers Health Service Organisation • Tell staff if you think that an error might have occurred or something has been missed in your care • 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 • Ensure that health care providers are appropriately qualified, competent and experienced, and that facilities and procedures meet industry standards • Ensure that health care providers have the resources to allow them to provide safe, effective and appropriate health care • Ensure that systems are in place that promote patient safety and that instructions to patients and consumers are clear and well communicated

21. Literature • On the Trail of Safety and Quality in Healthcare • Richard 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

22. Literature • 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

23. Organisational 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

24. Organisational Factors • Organisational interventions to improvement in patient care : a structured review of reviews • Revision of professional roles

25. Organisational Factors • Organisational interventions to improvement in patient care : a structured review of reviews • Integrated care services

26. Organisational Factors • Organisational interventions to improvement in patient care : a structured review of reviews • Knowledge management

27. Sun Herald – ‘simple jab’

28. Effecting Change Prime Minister COAG National Health and Hospitals Reform Commission AMA Media Private Sector AHMC AHMAC Safety and Quality Bodies IJC CHF Consumer engagement Community Commission Private Hospital Sector Committee Information Strategy Committee Primary Care Committee Staff Clinical Quality Registries Committee Advisory Committees Working Parties AIHW TGA CPMC NHMRC NICS NeHTA Nursing Orgs ACHSE Allied Health Orgs University Sector Research Sector