1. Caring,Sharing,Devotion,Worship Dr TA Taylor Wellington 2009

2. Significant Event - Using what we have

3. Significant Event Definition: Dr TA Taylor Wellington 2009 “ any event that any member of the team considers to be significant in terms of the care of the patient and the conduct of the practice[organisation] ” (Pringle et al.; 1995)

4. “ Doctors will become safe when they choose to become safe” Five Years After To Err is Human – What have we Learned? Lucian Leap & Don Berwick. Jama.2005; 293 : 2384-2390 Dr TA Taylor Wellington 2009

6. Significant Event Definition Our Definition: “ Any situation, event, process, attitude and/or behaviour that another person can learn from to improve the outcome.” Dr TA Taylor Wellington 2009 “ any event that any member of the team considers to be significant in terms of the care of the patient and the conduct of the practice[organisation] ” (Pringle et al.; 1995

11. CMDHB projected population growth by ethnicity Maaori PacificAsian Other Total 199661,70058,70028,800204,800354,000 200169,23078,55047,700198,200393,710 200676,10090,80068,200 207,300 442,400 201183,000103,00081,600216,100483,600 201689,600114,90097,200221,100522,800 202196,600127,500109,100228,800562,000 2026104,300141,100120,100 236,000 601,500 % change 2001-26 51%80%152% 19% 53% Source: 1996 and 2001 are Census data. Remainder Statistics NZ medium ethnic-specific projections for MoH Nov 2006. Ethnicity is prioritised in the order given in the table Dr TA Taylor Wellington 2009

12. Socio-economic status 37% (160.000) people NZ Dep Index 9 – 10 58% ( 45.000) of All Maori in CM Decile 9 - 10 79 % ( 74.000)of All Pacific people in CM Decile 9 - 10 46% of 0 – 4 yr old in CM live in Decile 9 - 10 NZ Census 2001 Dr TA Taylor Wellington 2009

13. Nurse GP Clinical Assistant Receptionist Patient Whanau Dr TA Taylor Wellington 2009

14. Registered Population 120.000 Enrolled and Funded 87.000 Pacific People 40.000 Maori 14.000 Patients Clinics 40 Reception staff 12 Clinics 47 GP’s 45 Nurses 9 Clinical Assistants 9 Management 16 Admin Support Dr TA Taylor Wellington 2009

15. New Zealand Trained Doctors 7 New Zealand Trained Doctors Pakeha 2 New Zealand Trained Doctors Asian 2 New Zealand Trained Doctors Pacific 3 IMG Maori 1 IMG 41 (87%) Doctors from Multicultural and Diverse Backgrounds Dr TA Taylor Wellington 2009

16. 25 Doctors are Fellows of RNZCGP 20 Doctors are working towards it (GPEP1 and GPEP2) 1 Clinic ACC/ AMPA Accredited 56 Staff Achieved the CBMC Certificate Culture of Quality Dr TA Taylor Wellington 2009

17. Quality Pursuits - Cornerstone Accreditation

21. KnowledgeAttitudesBehaviour Lack of awareness Lack of agreement with evidence External barriers Volume of information Uncertain interpretation Environmental factors Barriers to evidence uptake Sources of behaviour change Institutional factors Unclear applicability Access to resources Lack of motivation of previous practice

22. In 2006 ~ 10 SE per quarter ( 3.3 per month) In 2007 onwards ~ 50 SE per month ( 150 per quarter) ETHC SE Reporting Dr TA Taylor Wellington 2009

23. What Does this Mean ? Are we getting worse ? Does this increase our risk ? (professional, financial, other) Are our patients at more risk ? Dr TA Taylor Wellington 2009

24. Definition: “Any activity or process that facilitates the transfer of high quality evidence from research into effective changes in health policy, clinical practice, or products.” “…combines the elements of research, education, quality improvement, and electronic systems development to create a seamless linkage between interventions that improve patient care and their routine implementation in daily clinical practice.” Ann Emerg Med. 2007;49:355-363 Knowledge Translation Dr TA Taylor Wellington 2009

26. Consequences Likelihood InsignificantMinorModerateMajorCatastrophic 12345 A (Almost certain) HHEEE B (Likely) MHHEE C (Moderate) LMHEE D (Unlikely) LLMHE E (Rare) LLMHH

27. P C M G Identification – Documentation – Reflection Cycles

28. Challenges How do we engage our patients in developing safer environments ? Technological Advances at its best can only reflect human relationships Governance - Taking it Seriously

29. Pre-requisites Right culture Right leadership Right relationships Right systems Regular reflection on practice Take Home Messages Dr TA Taylor Wellington 2009

30. “ Doctors will become safe when they choose to become safe” Five Years After To Err is Human – What have we Learned? Lucian Leap & Don Berwick. Jama.2005; 293 : 2384-2390 Waiting until doctors choose to become safe is not an option. Safety is first and foremost the patients prerogative. We need to develop toxic environments for poor and unsafe practices – These are called Learning Environments. Dr TA Taylor Wellington 2009

31. Thank You