1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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Preventing Bungee Jumping in Healthcare
The implementation of Quality and Safety Structures in
Community Health Services
Caralyn Horne, MSc in Healthcare Management
Abstract
The aim of this organisational development project was to implement integrated quality and safety structures in community health services in the context of the National Standards for Safer Better Healthcare. As healthcare has increased in complexity, so have the hazards, which are now statistically similar to bungee jumping. The literature supports formal governance structures and standardised processes to meet the challenge of high-quality safe healthcare, balanced with regulation compliance. The project reflects organisational policy and recent national and international report recommendations regarding healthcare failures. The HSE Organisational Development Model was used to initiate, plan, implement, and mainstream the project. This included the establishment of Quality and Safety Committees at Area and Divisional levels to serve as the overarching governance structures. The Quality and Safety Department was established to support services, particularly in quality improvement and performance reporting, and the assessment of Primary Care against the National Standards for Safer Better Healthcare was planned and commenced. The evaluation indicated that the aim and objectives were achieved, with the governance structures in place, supported by newly implemented processes and these are now being reported on through the recently established Quality and Safety department. A key process implemented was the assessment of Primary Care against the National Standards, which is the beginning of the journey to achieve compliance. The overall findings are discussed which includes the strength of a multi-disciplinary shared leadership approach at all levels, along with the reciprocal relationship between structure-process-outcome. It was observed that changes in processes and outcomes occurred simultaneously with changes in the culture of the organisation. In conclusion, there is a balanced discussion of the strengths and limitations of the project, along with recommendations for future organisational developments.

2. Preventing Bungee Jumping in Healthcare
The implementation of Quality and Safety Structures in
Community Health Services
Caralyn Horne, MSc in Healthcare Management
Introduction & Background
Methodology
Organisational Impact
The hazards of healthcare have been shown to be statistically similar to bungee jumping1. Organisations are required to provide evidence of systems they have in place to meet modern healthcare requirements.
Prior to this project, quality and safety structures recommended by the HSE had not been implemented. Most management teams addressed quality & safety issues by discipline with no structured opportunities to share learning from incidents, complaints, or quality initiatives. Also, the National Standards for Safer Better Healthcare2 (Figure 1) which require multidisciplinary corporate and clinical governance, had been enacted. Figure 1:
The HSE Change Model3 designed for Irish healthcare was utilised:
Developing the proposal, engaging stakeholders, identifying sources of power, and driving / restraining forces.
Agreeing quality & safety structures; developing a project plan for assessing Primary Care against National Standards; planning the Quality & Safety dept.
Quality and Safety Committees established; National Standards assessment started; commencement of Quality Improvement Falls Prevention.
Quality & Safety Committees becoming the ‘way we do business’; National Standards assessment completed and cycle of QIPs to commence; first stage of Quality Improvement Falls Prevention project completed.
1.Change from uni-disciplinary to multi-disciplinary management of Quality and Safety (Figure 3)
2.Quality Improvement methodology being implemented and spread
3.Assessment of National Standards completed prior to HIQA inspections
Figure 3: Structural Model5
Structures-Processes-Outcomes which have moved from uni-disciplinary to multidisciplinary
Initiation
Planning
PROCESS
- Complaints and Incident management
- Risk escalation
- Service user experience collection
- Audits
- Quality Improvement Initiatives
Implementation
STRUCTURE
- Quality & Safety structures
- Regulation
- Policy development
- Information management systems
Mainstreaming
OUTCOME
- Learning
- Service User feedback
- Implementation of Report Recommendations
- Audit documentation
Evaluation
Stufflebeam4 Context Input Process Product (CIPP) evaluation model:
All Quality & Safety Committees
in place and evaluated (Figure 2)
All National Standards Themes
were assessed in Primary Care
Quality Improvement Project at
multi-level (top-down meets bottom-up) with standardised care bundles: 58% reduction in residential falls
Incident reporting and Risk
Registers audited for compliance
Conclusion
The strength of utilising a shared leadership approach with multi-disciplinary teams at all levels, with strategies to deal with resistance
Changes in processes and outcomes occurred simultaneously with shifts in quality & safety culture
Next steps include incorporating the local Mental Health Division
Aims & Objectives
Aim: Implement integrated Quality and Safety Governance Structures across the Divisions of Primary Care and Social Care in the context of the National Standards for Safer Better Healthcare.
Objectives:
1. Establish Quality and Safety Committees at Area and Divisional levels to serve as the structures for implementing a comprehensive Quality and Safety programme.
2. Establish a Quality and Safety Department to support the Divisions in Quality and Safety improvement.
3. Lead a multidisciplinary team to complete an assessment of Primary Care against the National Standards
Figure 2: Quality & Safety Committee Compliance
References
1 Pearson, P., Steven, A., Howe, A., Sheikh, A., Ashcroft, D., and Smith, P. (2010) Learning about patient safety: organizational context and culture in the education of health care professionals. Journal of Health Services Research & Policy. 15(1):4–10
2 HIQA (2012) National Standards for Safer Better Healthcare. Health Information Quality Authority
3 HSE (2008) Improving our services: A User’s Guide to Managing Change in the HSE. HSE
4 Stufflebeam, D. & Shinkfield, A. (2007) Evaluation Theory, Models, and Applications. Jossey-Bass CA
5 Kunkel, S., Rosenqvist, U., and Westerling, R. (2007) The structure of quality systems is important to the process and outcome. BMC Health Services Research