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Evidence and magic How to transform Quality in NZ?

Evidence and magic How to transform Quality in NZ?. Wellington Feb 2009 Bruce Arroll, Department of General Practice & Primary Health Care Faculty of Medical & Health Science University of Auckland, Auckland, New Zealand. Acknowledge. Prof John Buchannan

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Evidence and magic How to transform Quality in NZ?

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  1. Evidence and magicHow to transform Quality in NZ? Wellington Feb 2009 Bruce Arroll, Department of General Practice & Primary Health Care Faculty of Medical & Health Science University of Auckland, Auckland, New Zealand

  2. Acknowledge • Prof John Buchannan • “grand” father of quality in Auckland • Kept the interest in the topic when we were flagging

  3. Disclaimer Fresh eyes on what is happening At a global level I am happy with the health system I work at the University 70% of my time and 30% I work in a clinic in Manurewa, which I partly own, one of the most disadvantaged suburbs in New Zealand No concerns about waiting lists – a side show

  4. Story Story of 6 year old girl She is having chemotherapy for a blood cancer She is bald All her class mates are laughing at her Her teacher considers Her teacher does something outrageous → Problem solved This is magic or transformation – a step change

  5. Rod Jackson Health is all about quality and cost and nothing else Perceptions are generally wrong –you need to audit and compare – we overestimate We need a step improvement in quality

  6. Shave our heads for quality Make quality the centre of the health system If we can grow moustaches for prostate cancer surely we can shave our heads for quality

  7. My contribution to quality

  8. What would quality look like The computer system would have audit functions made user friendly as well as for clinical stuff The current systems are really designed to make clinical work more effective with audit as a secondary consideration Press a button and get an audit We should know how we are doing as a nation Each clinic would have a “quality person”

  9. What would quality look like Diana North and Drinfo –press a button and find out how you are doing and selects those who need to be called in to get their management improved Ensure that practitioners know how to use their computers Enter the data in to data base not in as text A robust method of evaluating performance UK make figures public- audit police

  10. Are the decks burning #1 2007-2008 gout audit 38% of patients with gout with uric acid levels < 0.36 mmol/l Practice in same suburb 43% After intervention 45% How does this rate nationally No one knows

  11. Are the decks burning #2 Auckland 2001 81% of patients on ACE inhibitors/CHF UK 2007 80% of patients on ACE inhibitors with CHF Auckland 2005 70% of patients on ACE inhibitors Personal communication V Andersen 2009 Does this matter => hospitalisations, QoL, death

  12. Are the decks burning #3 • Immunisation • DTP NZ 2004-5 79.3% coverage • DTP UK 2003-4 94%

  13. NZ vs UK • We don’t know • Echocardiogram for patients with CHF 92.5% in the UK in an Auckland population 58% • NZ most likely no better than the UK on any measured parameter in the QoF and probably worse on most if not all • Perhaps we should measure what’s happening here as a starting point • UK system unlikely to go backwards

  14. What is needed • A transformation i.e a step change in attitude towards quality • Consider a systemic approach • Pegasus with CME and audit synchronised • There are plenty of criticisms but the UK is probably as good as or better than us on every indicator that they use -they are the bench mark • A national system

  15. What’s missing ? Political devolution of responsibility to DHB/PHOs means nobody is in charge Problem with transferring electronic detail from one clinic to another using Medtech software. Eg adverse drug reaction info is lost Computers do this well humans do not Some one will die or get sick No single person can change this situation other than perhaps the minister of health

  16. Summary Gary Sinclair Aims for the best not just better health care If we want the best we need a transformation. Waiting for change to happen spontaneously is wishing for magic We need to embrace quality We need to measure how we are doing-QoF nz survey

  17. Summary • We need to consider a system that works for NZ without the downside of QoF • The UK may not have the Rugby world cup but they do have the world cup on quality • Somebody needs to be in charge

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