1. Reviewing the Quality of Outpatient Care today
Safe
Timely
Effective
Efficient
Equitable
Patient at the centre
STEEEP

2. More long term care More frail patients More need to use resource wisely

3. How are we doing , how much better could we be and at what pace are we improving ?
aim
1er driver
2er driver
Conceptual Framework
Select Standard or
Re-audit position
Select Sample
Comparing reality with standard
Identify the gaps
Apply Improvement Methodology

4. Hope is not a Plan

5. Data I select Ladder of Enquiry Actions I take Conclusions I draw
recommend
Conclusions I draw
Meanings I conclude
(through advocacy or enquiry)
Interpretations I make
Data I select

6. Think Differently

7. Microsystem- where patient, family, caring staff and system meet
Purpose
Patients
Professionals
Processes
Patterns
Strengths of current system?
What could be improved?
Global Aim- then map the processes
Specific Aim agreed- fish bone review (people, equipment, materials, processes)
Every systems is perfectly designed to get the results it gets

8. PATIENT, STAFF AND ORGANISATION OUTCOME CHANGE
Safety by Design Systems Engineering Initiative for Patient Safety (SEIPS) model
Carayon et al Quality and Safety Healthcare ; i50-8 BMJ Publishing Group
TECHNOLOGY AND TOOLS
ORGANISATION
PEOPLE
TASK
ENVIRONMENT
PATIENT, STAFF AND ORGANISATION OUTCOME CHANGE

10. Human Factors need attention Organisational accident model (Adapted from Reason, 1997) the Contributory Conditions set people up for Active Failure- omissions, slips, cognitive failures, memory lapses, mistakes – Sort out the Contributory Conditions
This is a more explicit model of the SWISS Cheese- consider an example you have experience in
Knowledge or lack of it is only one component yet we rely all the time on training, re training and guidance we don’t spend time on the system in which work is done, the chaotic clinical space, the poor attention to reliable processes, the haphazard arrangement of communications, the patients involvement is minimised by bureacracy not maximised by engagement

11. Intervene to Optimize care
Safer Health Care- Strategies for the Real World Charles Vincent and Rene Amalberti
Optimal care (Quality)
FIVE LEVELS OF CARE (Vincent and Amalberti 2016)
1. Care envisaged by the standard
2. Compliance with standards- ordinary care with imperfections
3. Unreliable care/ poor quality care and patient escapes harm
4. Poor care with probable minor harm but overall benefits
5. Care where harm undermines any benefits
Intervene to Optimize care
Intervene
to manage risk
Increased risk of harm (Safety)