Influencing The Quality Of Aged Care: The Board’s Role In Clinical Governance

1. Influencing The Quality Of Aged Care: The Board’s Role In ClinicalGovernance Alison Brown Lead Consultant Australian Centre For Healthcare Governance August 2014

2. Overview What is quality in aged care services? How do we improve quality? The role of the board in service quality

3. 'The only constant in life is change'

4. Do you provide quality aged care services at your organisation?

6. No more than a third of evidence-based clinical guidelines are routinely adhered to (based on clinician and patient self-report) (Mickan et. al. Postgrad Med J 2011; 87:670-679) No more than 60% of patients at any one time receive the care deemed appropriate by current science (based on case reviews) (Runciman et. al. Med J Aust 2012;197: 100-105) The national benchmark for hand hygiene is 70% (interim benchmark advised by the Australian Commission on Safety and Quality in Health Care), In 2012 50 % of hospitals were at or below the national benchmark (AIHW, Myhospitals)

7. Rate the quality of the services at your organisation 10 1

8. Board members’ self-assessment of performance compared with a typical health service in Victoria

9. What does meeting accreditation tell you?

10. What does meeting accreditation tell you? Minimum acceptable standard

11. ‘…organisations should shift away from their reliance on external agencies as guarantors of safety and quality and toward proactive assessment and accountability on their own’. 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

12. Clinical Governance, quality governance or governance of service quality can be defined as : the combination of structures and processes at and below board level to : ensure required standards are achieved investigate and take action on sub‐standard performance plan and drive continuous improvement identify, share and ensure delivery of best‐practice identify and manage risks to quality of care Quality Governance in the NHS, 2011

13. What improves quality? High performing services • Dissatisfaction with the current quality of care • A shared vision for achieving high quality care and appropriate leadership structures • Strategic/operational plan actions translated into measurable quality of care objectives • Accountabilities for providing safe care and improving care are clear • A focus on measurement, systems redesign and human behavior to improve care. Baker, G.R., et al, 2008, High Performing Healthcare Systems: Delivering Quality by Design. Longwoods Publishing, Canada.

14. Hospitals with more active & engaged Boards appear to have better patient outcomes - higher care scores; lower patient mortality Large differences in board activities between high-performing and low-performing hospitals Jha and Epstein, 2009 Jiang et al 2009

15. The role of the board

16. The role of the board

17. What is Quality in aged care?

18. The dimensions of care that patients value include: Access to care Coordination and integration of care Transitions and continuity of care Respect for patient’s values, preferences and expressed needs Information and education Physical comfort Emotional support Family and friends Continuity of care and transition after discharge (Picker Institute 2008)

19. Step 1: Define the goal

21. National Aged Care Alliance domains of quality 1. Person centred interactions 2. Health and wellbeing 3. Engaging socially 4. Daily services 5. Physical environment 6. Organisational and governance

22. Step 2:Communicate the vision

23. Is this your current vision of quality?

24. Step 2:Communicate the vision

25. Ensure that every member of staff that has contact with clients/residents, or whose actions directly impact on patient care, is motivated and enabled to deliver quality care (effective, safe and person‐centred care)

26. The role of the board

27. “Strong, effective board oversight of patient care quality and safety programs is, without question, one of the most fundamental bench-marks of good governance today.”

28. Step 3: Monitoring and Planning

29. Reporting framework To measure service quality need a mixture of Quality System measures Process of care Outcomes of care (impact of care in the community setting)

30. Impacts and processes Supporting Systems

31. Quality indicators used in Vic PSRAC Prevalence of stage 1 to 4 pressure ulcers Prevalence of falls and related fractures Incidence of use of physical restraint Incidence of residents using nine or more medications Prevalence of unplanned weight loss

32. Quality indicators in community aged care? ? Access ? impact indicators –QOL, life satisfaction, ADL, PADL Appropriateness of Care Client experience

33. Key data for reporting framework • Agreed dataset aligned to agreed dimensions of quality and incorporating minimum standards • Indicators aligned to strategic quality goals • Indicators aligned to high risk areas

34. Reporting key questions What to report? Format: How much detail: trends , benchmark, action taken How often?: Depends on the audience and content Who is the target audience?: Exec, Quality , Audit Committee, Board

35. How effective are boards?

36. How effective are boards?

37. How effective are boards?

38. Barriers for Boards • Insufficient resources • Deficit of skills and expertise • Inadequate intelligence

39. Summary Invest in board clinical governance skills Develop organisation wide awareness of what is a quality service Undertake Improvement planning Develop Reporting Framework for measurement of quality Report on achievements throughout organisation

40. For more information about board evaluations, clinical governance and other resources go to: healthcaregovernance.org.au or alison.brown@healthcaregovernance.org.au