Practices for Improving Quality and Safety

Size: px
Start display at page:

Download "Practices for Improving Quality and Safety"

Transcription

1 2 Practices for Improving Quaity and Safety Practices for Improving Quaity and Safety The capabiity of boards and board quaity committees to function effectivey and to move appropriatey between fiduciary and strategic modes reies on boards and senior eadership capacity to deveop trust and a strong coaborative reationship, whie not undermining the board s duty to ask chaenging questions. (Canadian Patient Safety Institute, 2011) 18

2 Heathcare providers continuousy grappe with execution of effective systems for quaity and safety. The deveopment of the right strategies to get the board on board to improve quaity and safety require investment and the impementation of appropriate processes at the board, organisationa and cinica eves (Canadian Patient Safety Institute, 2011). Many countries have a statutory duty for boards on ensuring quaity is a core part of the main board meetings and discussed in more detai by a quaity and safety committee (Nationa Leadership Counci for Board Deveopment, 2010; Exceent Care for A Act, 2010). The Oireachtas Committee on the Future of Heathcare: Sáintecare Report (2017) recommends a statutory quaity and safety committee of the board that may hep to organise information and review a materia pertinent to quaity and safety. Athough a board may deegate some tasks, the entire board is sti responsibe for oversight and decision making around quaity and safety (Canadian Patient Safety Institute, 2011). In Ireand, the HSE (2015) Code of Governance section 7 outines the commitment to service quaity, safety and risk management and the commitment to a quaity and patient safety enabement function in the HSE. The board estabishes the structures to make quaity and safety a centra tenet on the board s agenda by: Buiding the board s capabiity (knowedge and skis) Prioritising board time discussing quaity and safety Estabishing a board quaity and safety committee, and Evauating the board s performance with an emphasis aways on quaity and safety improvement. Practices for Improving Quaity and Safety Recent studies suggest that effective hospita governance by boards is reated to a hospita s performance on quaity (Miar, et a., 2013; Jiang et a., 2009; Jones et a., 2017; Tsai et a., 2015). Hospitas with a higher eve of board attention to quaity are ikey to have stronger management practices centred on monitoring quaity. Understanding the dynamics among heathcare providers governance, management, cinicians and reguators offers new opportunities for improving quaity and safety (Fresko and Rubenstein, 2013). Buiding Board Knowedge and Skis for Improving Quaity Boards bear the utimate responsibiity for everything in a heathcare provider, incuding quaity and safety. To discharge that responsibiity we, board members require a soid knowedge base about quaity and safety and appy that knowedge in action (McGaffigan et a., 2017; Reinertsen, 2017). As board members may not have backgrounds in heathcare, a comprehensive board induction and mentoring programme wi provide support to new board members in their roe. An orientation programme wi provide an overview of the organisation and roes and responsibiities of a board member. Assigning a mentor for each new board member is another method of ensuring that board members transition into their roe. Organising one-to-one meetings prior to and after board meetings wi enabe new board members understand the business of the board and the information on quaity and safety provided to it. Ongoing deveopment of individua board member s knowedge and skis can be achieved through peer support, forma mentoring programmes and more focused training days or master casses. Board deveopment days can provide members with opportunities to earn and work together, and bring the board members, executives and other eaders in the same room (see Tabe 2 outine of board deveopment). Deveopment days can aso foster a shared agenda, as we as enabe acquisition of quaity improvement skis and knowedge. Board members may vaue support in the form of discussion forums, action based interventions, and group coaching (Canadian Patient Safety Institute, 2011). The board can create opportunities to earn from other simiar boards as organisations can share eading practices and initiatives through existing networks and conferences. Critica friend visits using an appreciative enquiry ethos have aso been used effectivey (Heathcare Improvement Scotand, 2015). Using a board evauation process to identify what the board perceives as their education requirements wi support the deveopment of ongoing programmes (See Resources for sampe approaches). 19

3 Tabe 2: Outine of Board Deveopment Orientation programmes for new directors with specific references to quaity and safety Inviting board members to attend key briefings on nationa poicies / reguatory requirements Distributing artices and reevant reading materia Participating in quaity improvement programmes with academic partners Raising awareness of outside conferences / master casses Partnering with simiar organisations to organise site visits Inviting staff to brief board members on quaity improvement initiatives Participating in quaity and safety wak-rounds across the service Meeting with service user forums / councis or panes. Source: adapted from Bader and O Maey (2006) There is an opportunity to estabish practices - at board eve and committee - that aow board members time to appy their knowedge effectivey (see Tabe 3). This wi avoid fiing up meeting time sharing information that coud easiy be read in advance of the meeting, thereby creating sufficient time for board discussion and questioning with the executive (Reinertsen, 2017). Board Quaity and Safety Committee The board quaity and safety committee oversees quaity and safety on behaf of the board (See Resources for sampe terms of reference, agenda, minutes, and checkist for prioritisation of measures). This group focuses on the organisation s approach to quaity and safety (Joint Commission Internationa, 2007). The board quaity and safety committee has a roe in heping the board to focus its discussions on important opportunities to improve safety and quaity across the system (Joint Commission Internationa, 2007). The HSE service agreement with Section 38 and 39 heathcare providers requires them to estabish a quaity and safety committee of their board (Part one cause 24.6). Part 2 of the agreement describes the committee s function (Schedue 2 quaity and safety). The committee terms of reference can ceary set out the responsibiity of this committee - to carry out work on behaf of and report to the board. The committee can carefuy seect board members with quaity / safety expertise from other professions and members of the committee can aso earn from cinica staff on the committee through schedued one-one meetings or wakrounds in services (HSE, 2016c). The board s quaity and safety committee may ook at more detaied reports than the fu board does. The entire board see the areas that are important to the specific quaity and safety objectives / targets. Dashboards can be hepfu with a narrative summary of key indicators (Joint Commission Internationa, 2007). Staff can be invited to attend board meetings to present quaity improvement initiatives. Service users and famiy members can give a new perspective on how the provider deivers care and can provide a human face to the care represented by the data presented (Joint Commission Internationa, 2007; Thompson, 2013). The board quaity and safety committee is estabished to (HSE, 2016b): Provide a eve of assurance to the board on the appropriate governance; structures, processes, standards, oversight and contros Oversee the deveopment by the executive management team of a quaity improvement pan for the service in ine with an agreed quaity improvement strategy Recommend to the board a quaity and safety programme and an executive management team structure, poicies and processes that ceary articuates responsibiity, authority and accountabiity for safety, risk management and improving quaity across the service Secure assurance from the executive management team on the impementation of the quaity and safety programme and the appication of appropriate governance structure and processes (e.g. communicating risk) incuding 20

4 monitored outcomes through quaity indicators and outcome measures Secure assurance from the executive management team that the service is conforming with a reguatory and ega requirements to assure quaity safety and risk management Consider in greater depth matters referred to the committee by the board and referra of issues to the board for consideration when necessary. The board quaity and safety committee normay consist of a number of executive and non-executive directors (drawn from the board) and service user representatives / advisors. The committee is normay chaired by a non-executive director (member of the board) who reports on behaf of the committee to the chair of the board. Board Evauation Annua evauation of the board and its operations is a good method to ensure that the board is functioning effectivey as set out in the terms of reference and standing orders. When board committees are effective they enabe more time to be used at board meetings for discussion and deveopment opportunities. Working committees are the engine that powers effective boards and despite the importance of committees, it is noted that few boards engage in a reguar and focused evauation of their working parts (Canadian Patient Safety Institute, 2011). The Code of Practice for the Governance of State Boards (2016) provides a mode Board sef-assessment evauation questionnaire. Board evauations can take many different forms using externa reviewers, surveys of members or faciitated workshops. Practices for Improving Quaity and Safety Boards with higher eves of maturity in reation to governing for quaity improvement (QI) have the foowing characteristics: expicity prioritising QI; baancing short-term (externa) priorities with ong-term (interna) investment in QI; using data for QI, not just quaity assurance; engaging staff and service users in QI; and encouraging a cuture of continuous improvement; enabed and supported by board-eve cinica eaders. (Jones et a., 2017) 21

5 Tabe 3: Embedding Board Discipines Competent, systematic board discipines form the bedrock of good board functioning. The chair gives thoughtfu attention to board agenda panning and management to maintain a baance between oversight of operations (incuding dedicated time for quaity and safety) and strategy. Chairs face the chaenge of attending to the fu breadth of the board s roe whie ensuring that board meetings do not descend into a grueing test of board member endurance. The foowing board discipines are considered: Board and committee year panners and annua programmes of work: to ensure a coherent programme for forma board meetings, board seminars and away-days and committee meetings. It is good practice for the work of every committee (incuding quaity and safety) of the board to be shaped by an annua pan. Board papers: The effectiveness of the board is dependent on the timey avaiabiity of board papers. Timeiness: the board papers provided ideay a week ahead of meetings (incuding reports and quaity of care indicators). Cover sheets: incuding, for each paper, the name of the author, a brief summary of the issue, the organisationa forums where the paper has been considered (for exampe executive quaity and safety committee), the strategic or reguatory objective. Executive summaries: Succinct executive summaries that direct the readers attention to the most important aspects. Action ogs: Boards and committees can be heped to keep track of actions agreed by maintaining and monitoring a og. The og shoud show a actions agreed by the board and for each action the ownership, due dates and status. Source: adapted from Nationa Leadership Counci for Board Deveopment (2010) 22

6 Board Considerations - Practices for Improving Quaity and Safety Does our board prioritise quaity and safety on the board s agenda? As a board, do we spend a minimum of 25 % of board meetings discussing quaity and safety of care? How do we support board members to understand the information presented on quaity and safety of care? How do we monitor progress towards quaity and safety goas? What are the ways in which our board evauates performance on quaity and safety? Practices for Improving Quaity and Safety 23