Is your organisational quality system supporting you to meet the new accreditation requirements? Dr Cathy Balding www.cathybalding.com

The quality game changed in 1995… The 1995 QAHC Study found that 16.6% patients are harmed in Australian hospitals Blood clots (VTE) kill three times more people than die on Australian roads Falls account for up to 75% of adverse events in some settings CABG costs 3x as much if the patient gets an infection 18% patients in hospitals Have at least one pressure ulcer and a stage 4 ulcer costs approx $80k In 1995, we found out for the first time just how unsafe hospitals can be for patients when the Quality in Australian Health Care Study was published. From that study and subsequent studies in other countries, we now know that there are some key risks to members when they come into hospitals and aged care facilities. If we know what they are, we can do something about them! Since 1995 we have been working hard to reduce these risks in a number of different ways. …………………………………………………………………………………………………………… 10,000 people worldwide are harmed by medical error every day Errors with medications and blood are key threats to patients

Since then? Adverse events increase the case cost up to 7X; and $1 in every $7 spent on healthcare in Australia is used to treat a healthcare-associated injury (Ehsani J, Jackson T, Duckett S (2006) The Incidence and Cost of Adverse Events in Victorian Hospitals, 2003–04. MJA, vol 184 no 11, pp. 551–55) 27% patients experience healthcare-associated harm in the US in 2012 - 48% of these are preventable (US Office of Inspector General, 2012 study of Medicare patients in 189 hospitals) Up to 83% incidents are not reported (U.S. Office of Inspector General Medicare patients study, 2012) 57% of patients receive care based on best available evidence via guidelines (Runciman WB et al. CareTrack: assessing the appropriateness of healthcare delivery in Australia. Medical Journal of Australia 2012;197(2):100-105)

Our Risk Systems improved… But our quality systems?...

The game changed again this year – nearly 20 years on…in more ways than one… Standard 1 Governance for Safety and Quality in Health Service Organisations Standard 2 Partnering with Consumers Standard 3 Healthcare Associated Infections Standard 10 Preventing Falls and Harm from Falls Standard 4 Medication Safety Standard 9 Recognising and Responding to Clinical Deterioration in Acute Health Care The National Safety and Quality Health Service Standards (NSQHSS): have been developed by the Australian Commission on Safety and Quality in Health Care (the commission) following extensive public and stakeholder consultation. are a critical component of the Australian Health Services Safety and Quality Accreditation Scheme endorsed by the Australian Health Ministers in November 2010 provide a nationally consistent and uniform set of measures of safety and quality for application across a wide variety of health care services propose evidence based improvement strategies to deal with gaps between current and best practice outcomes that affect a large number of patients are standards that will apply consistently across all hospitals and day procedure services, public and private no matter who the accrediting agency is are supported by the work of the Commission and the State - the policy platform, tools and resources are there for people to use Accreditation is an organisation wide process, quality managers will need the continued support of their CEO’s, DONs, administration and others. The department is happy to work with health services to confirm how you can move to the NS. Standard 5 Patient Identification and Procedure Matching Standard 8 Preventing and Managing Pressure Injuries Standard 7 Blood and Blood Products Standard 6 Clinical Handover 5

Maintenance and Compliance: Improving quality (and achieving the nationals safety and quality standards) can be transactional – doing stuff and ticking boxes… What’s the point? Improvement: Improving existing care and services, reacting, reducing risk Maintenance and Compliance: Monitoring quality and risk, ensuring standards and policies are met Quality/Clinical Governance Systems

Or – Strategic and transformational Creating a great consumer experience Tools, strategies and behaviours to achieve the quality experience for every person, every time Improvement: Proactive activities for improving existing care and services, reducing risk Maintenance: Static and reactive activities for monitoring quality and risk, ensuring standards and policies are met Quality/Clinical Governance Supporting Systems

How do you get from transactional… to transformational? But… How do you get from transactional… to transformational?

It’s not easy in a complex environment… Ideal Care Unacceptable Care Time

Where are you starting? Your organisation’s quality framework and plan is? A clear map for supporting staff to reach the destination of great care for every consumer every time? A series of quality activities heading in different directions? A Quality Manager ‘to do’ list?

Let’s get concrete! Health Service Organisational Quality System Maturity Scale (Balding 2013) Maturity Level Characteristics 1. Informal Lack of systematic approach: random improvement activities based on minimal and poor data. Managerial response to quality problems largely dependent on staff ‘trying harder’. Limited staff input into identifying problems and improvements.   2. Compliance   Problem based and reactive approach with minimal systematic collection or analysis of data on key issues. Focus on compliance with external/funding requirements. ‘Doing quality’ is staff code for auditing and other data collection with little implementation or follow up. Lack of relationship between quality system mechanics and quality of care – ‘quality’ still seen as the responsibility of the quality manager.  3. Reactive Risk Focus on risk management and compliance with accreditation and other external requirements. . Systematic tracking of key indicators, consumer feedback and incident reporting. Evidence of some system improvement and follow up. No agreed change and improvement model in use. Reliance on policy shifts and education as key change tools. Leaders are developed to improve safety. 4. Proactive Continuous Improvement Quality system is a key component of clinical/quality governance system and is integrated at operational level, with plans for improvement at organisation-wide and local levels. Lack of common and uniting goals with the improvement program comprising a series of (possibly unrelated) monitoring, improvement and redesign projects. Minimum dataset reported across all quality dimensions, Data are analysed and reported through the organisational levels to the governing body, and there is evidence of effective systems improvement as a result. Strategies in place for developing leaders to engage staff and consumers in improvement across the dimensions of quality. 5. Strategic The desired quality of the consumer experience at point of care is defined with staff and consumers, and achieving it is a strategic priority. The organisational quality plan is designed and systematically implemented to create the defined quality consumer experience, through developing people and improving systems. Roles and responsibilities at all levels of the organisation for creating the quality consumer experience are described and supported. Governance systems are owned by the governing body and executive team and designed to support staff to create the quality consumer experience. A model for change and improvement is in use. 

Creating a consumer experience that is: : And then seek crystal clarity about the What, Who and Why ‘3PQ’ Purpose, People and Pillars for creating great consumer experiences (Balding, 2013) QG Pillars Goals, objectives, measures, data, risk and improvement strategies Culture, leaders, support, roles, development, training Evidence, standards, policy, systems, resources Board and Executive People Empathic Skilled Informed Proactive Accountable Purpose: Creating a consumer experience that is: Responsive Integrated Safe Effective

Integrate the quality system as a strategic and operational pillar of your organisation Goal Care and services are delivered as a partnership between consumers and staff and based on mutual respect: We listen. Consumers are not harmed by our care and services: We do not harm. Care and services experienced by each consumer are right for that person and achieve what they are designed to do: The right thing that works. Consumers experience our care and services as coordinated and streamlined: No surprises. Dimension of Quality Person centred Safe Appropriate and Effective Continuous and Integrated

Make it real Get it right No Harm: We listen No Surprises Responsive to each person: We listen No Harm: Our consumers are safe The right thing with the right outcome: Get it right Coordinated and Smooth: No Surprises Dr Cathy Balding 2012 www.cathybalding.com

Make it real… See facilitator guide for wrap up of the day.

Thankyou! www.cathybalding.com