National Standards for Safer Better Healthcare: How can I introduce these to my organisation?
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1 National Standards for Safer Better Healthcare: How can I introduce these to my organisation? Dr. Michael Lucey Martina O Reilly
2 What is this all about? Legislation - National standards for safer better health care approved in June HIQA can monitor compliance against these standards since June Licencing of Health care premises is planned for Applies to all healthcare services (excluding Mental Health Services) provided or funded by HSE. General standards awaiting service specific standards.(including KPIs)
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4 Key Dimensions 4 Key Patient Quality Dimensions: 1: Person-centered Care & Support 2: Effective Care & Support 3: Safe Care & Support 4: Better Health & Well Being 4 Key Organisational Dimensions: 5:Leadership, Governance and 6: Workforce 7:Use of Resources 8:Use of Information
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6 Key Elements 4 Key Quality Dimensions: 1: Person-centered Care & Support (42) 2: Effective Care & Support (52) 3: Safe Care & Support (36) 4: Better Health & Well Being (5) 4 Key Organisational Dimensions: 5:Leadership, Governance and (45) 6: Workforce (29) 7:Use of Resources (13) 8:Use of Information (23)
7 Standards Open to significant interpretation, enabling organisations flexibility in approach. Challenge is how do we know we are moving in the right direction? In order to benchmark compliance with any standards, there must be a either numbers (%compliance) or levels/ bands of compliance.
8 Clinical Program. Looked at this question. Developed workbooks to aid HIQA standard interpretation.. Identified the essential element around each HIQA standard. Interpreted the standards for the palliative care service around 4 levels of quality. Emerging improvement. Continuous improvement. Sustained improvement. Excellence.
9 Quality Assessment and Improvement Eight workbooks. Workbooks ( QA & I ) Supplement HIQA standards. Help Palliative Care Services approach meeting the standards.
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11 What's different about these? Move the standards closer to the palliative care service. Yet, aren't restrictively prescriptive. Allow services to progress towards higher levels of quality excellence Gives examples of how an organisation might fulfil the standards. Incorporates systems thinking into the standards at the level of the palliative care service.
12 Levels of quality. Structure and Process Outcome and Monitoring Innovation and Leadership
13 Development Expertise on accreditation, self assessment, standards implementation. Documents: Towards Excellence in Palliative Care Self Assessment Tool (developed by the HSE South) HSE Quality Assessment and Improvement workbooks for Acute Hospital services. Consultation process.
14 Example
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16 Workbook Still allows organisations to create additional evidence to fulfil the levels of quality. Advocates a number of healthy quality assurance practices.
17 Quality profile
18 How can I introduce these to my organisation?
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20 Milford Quality restructuring HIQA standards.(june 2012) HSE standards and recommended practices. Tallaght recommendations.(may 2012) What strategy? 3 phases.
21 Strategy Phase 1 Baseline Assessment Phase 2 Structures and processes. Phase 3 Serial Reporting
22 Phase 1 Baseline Assessment Baseline assessment. ( HIQA, HSE, Tallaght standards) Identified Quality Gaps. Evaluated Gaps Gap Analysis. Quality gap: Any standard where we did not have documented evidence that we were compliant.
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24 Identified Gaps: Source of template - Voluntary Hospitals Risk Forum
25 Evaluate Quality Gaps. Identified gaps. Mostly documentation evidence gaps. Needed to evaluate these gaps and see how we can fill them. Gap analysis Question: How can we, as an organisation, approach introducing a system that will implement CQI in all these areas?
26 Strategy Phase 1 Baseline Assessment Phase 2 Structures and processes. Phase 3 Serial Reporting
27 Phase 2 Structure and Process Look at the organisational structure. Can it address these quality gaps? Developed a process (project plan). Each standard. Are we achieving this? How can we measure this? Plan to improve. Document progress.
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29 Phase 1 Baseline Assessment Phase 2 Structures and processes. Phase 3 Serial Reporting Phase 2: Structures Needed a structure that would support a sustainable focus on Project management Documentation of Standard compliance. Continuous quality improvement. Three types of group. Supervisory group. 2 groups. 5 Working Groups. Three levels of reporting.
30 Team Research Initiatives, Research Register & Clinical ICP/ Key Process Review per care area - Audit of Key Processes leading to Performance Indicators. Systems & Research Group Quality & Safety Group Validate Gap Analysis Clinical Quality Assurance Non Clinical Quality Assurance Clinical Services & Patient safety Environment and hygiene Finance Information Governance Human Resources & Learning Development Clinical Risk Medicines Service User Feedback Systems Complaints Annual Audit Programme Incident Infection Control Health Promotion Policy Development and Approval Environment & Risk. Incident Fire Safety Systems Water Security Oxygen Mgt Health & Safety Mgt Hazardous Materials & Dangerous Goods Control Energy Mgt. Waste Mgt Catering Infection Control Contractor Mgt Policy Development and Approval Financial Risk, Budgetary Control/Financial Effectiveness Systems, Purchasing Systems Asset, Contract Policy Development and Approval Information Risk Integration of ICT Systems ICT Governance Data Protection Assurance Patient Chart Administration Document Control Policy Development and Approval Human Resources Risk HR Strategic Planning. Performance Appraisal. Staff Records Recruitment & Selection Practise Training Needs Assessment /Competency Assessment Systems Induction Systems Staff Communication Systems Promotion of quality of working life Policy Development and Approval
31 Team Research Initiatives, Research Register & Clinical ICP/ Key Process Review per care area - Audit of Key Processes leading to Performance Indicators. Systems & Research Group Quality & Safety Group Address Gap Analysis Level 3 Level 2 Clinical Quality Assurance Non Clinical Quality Assurance Clinical Services & Patient safety Environment and hygiene Finance Information Governance Human Resources & Learning Development Clinical Risk Medicines Service User Feedback Systems Complaints Annual Audit Programme Incident Infection Control Health Promotion Policy Development and Approval Environment & Risk. Incident Fire Safety Systems Water Security Oxygen Mgt Health & Safety Mgt Hazardous Materials & Dangerous Goods Control Energy Mgt. Waste Mgt Catering Infection Control Contractor Mgt Policy Development and Approval Financial Risk, Budgetary Control/Financial Effectiveness Systems, Purchasing Systems Asset, Contract Policy Development and Approval Information Risk Integration of ICT Systems ICT Governance Data Protection Assurance Patient Chart Administration Document Control Policy Development and Approval Human Resources Risk HR Strategic Planning. Performance Appraisal. Staff Records Recruitment & Selection Practise Training Needs Assessment /Competency Assessment Systems Induction Systems Staff Communication Systems Promotion of quality of working life Policy Development and Approval
32 Phase 2 Structures and processes. Phase 1 Baseline Assessment Phase 3 Serial Reporting Phase 2: Processes (project plans) Found that standards could be grouped together ( collapsed or chunked ) Some projects and documentation fulfill a number of standards. Much like the workbooks have done with essential elements.
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34 Strategy Phase 1 Baseline Assessment Phase 2 Structures and processes. Phase 3 Serial Reporting
35 Phase 3 Serial Reporting Now we had the quality structure, the project plans, and the working groups to implement these and report progress. Commencement of quarterly reporting
36 Team Research Initiatives, Research Register & Clinical ICP/ Key Process Review per care area - Audit of Key Processes leading to Performance Indicators. Systems & Research Group Quality & Safety Group Validate Gap Analysis Clinical Quality Assurance Non Clinical Quality Assurance Clinical Services & Patient safety Environment and hygiene Finance Information Governance Human Resources & Learning Development Clinical Risk Medicines Service User Feedback Systems Complaints Annual Audit Programme Incident Infection Control Health Promotion Policy Development and Approval Environment & Risk. Incident Fire Safety Systems Water Security Oxygen Mgt Health & Safety Mgt Hazardous Materials & Dangerous Goods Control Energy Mgt. Waste Mgt Catering Infection Control Contractor Mgt Policy Development and Approval Financial Risk, Budgetary Control/Financial Effectiveness Systems, Purchasing Systems Asset, Contract Policy Development and Approval Information Risk Integration of ICT Systems ICT Governance Data Protection Assurance Patient Chart Administration Document Control Policy Development and Approval Human Resources Risk HR Strategic Planning. Performance Appraisal. Staff Records Recruitment & Selection Practise Training Needs Assessment /Competency Assessment Systems Induction Systems Staff Communication Systems Promotion of quality of working life Policy Development and Approval
37 Information Governance Group.
38 Team Research Initiatives, Research Register & Clinical ICP/ Key Process Review per care area - Audit of Key Processes leading to Performance Indicators. Systems & Research Group Quality & Safety Group Validate Gap Analysis Clinical Quality Assurance Non Clinical Quality Assurance Clinical Services & Patient safety Environment and hygiene Finance Information Governance Human Resources & Learning Development Clinical Risk Medicines Service User Feedback Systems Complaints Annual Audit Programme Incident Infection Control Health Promotion Policy Development and Approval Environment & Risk. Incident Fire Safety Systems Water Security Oxygen Mgt Health & Safety Mgt Hazardous Materials & Dangerous Goods Control Energy Mgt. Waste Mgt Catering Infection Control Contractor Mgt Policy Development and Approval Financial Risk, Budgetary Control/Financial Effectiveness Systems, Purchasing Systems Asset, Contract Policy Development and Approval Information Risk Integration of ICT Systems ICT Governance Data Protection Assurance Patient Chart Administration Document Control Policy Development and Approval Human Resources Risk HR Strategic Planning. Performance Appraisal. Staff Records Recruitment & Selection Practise Training Needs Assessment /Competency Assessment Systems Induction Systems Staff Communication Systems Promotion of quality of working life Policy Development and Approval
39 Clinical services and Patient Safety.
40 Phase 1 Baseline Assessment Phase 2 Structures and processes. Phase 3 Serial Reporting Phase 3 Quarterly analysis. Check variance from standards. Adapt projects to minimise variances. Measure again in next quarter Check variance from standards Adapt projects to minimise variances. etc
41 PDCA Cycle of Continuous Quality Improvement (Deming),
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43 In summary Baseline assessment. Identified of quality gaps. Performed a Gap Analysis. Restructured the quality governance of the organisation. Produced project plans. Implemented these and produced quarterly reports. Introduced cycles of CQI.
44 Simple
45 Team Research Initiatives, Research Register & Clinical ICP/ Key Process Review per care area - Audit of Key Processes leading to Performance Indicators. Systems & Research Group Quality & Safety Group Validate Gap Analysis Clinical Quality Assurance Non Clinical Quality Assurance Clinical Services & Patient safety Environment and hygiene Finance Information Governance Human Resources & Learning Development Clinical Risk Medicines Service User Feedback Systems Complaints Annual Audit Programme Incident Infection Control Health Promotion Policy Development and Approval Environment & Risk. Incident Fire Safety Systems Water Security Oxygen Mgt Health & Safety Mgt Hazardous Materials & Dangerous Goods Control Energy Mgt. Waste Mgt Catering Infection Control Contractor Mgt Policy Development and Approval Financial Risk, Budgetary Control/Financial Effectiveness Systems, Purchasing Systems Asset, Contract Policy Development and Approval Information Risk Integration of ICT Systems ICT Governance Data Protection Assurance Patient Chart Administration Document Control Policy Development and Approval Human Resources Risk HR Strategic Planning. Performance Appraisal. Staff Records Recruitment & Selection Practise Training Needs Assessment /Competency Assessment Systems Induction Systems Staff Communication Systems Promotion of quality of working life Policy Development and Approval
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48 Valley of despair!
49 Expect the expected! Challenge-of-Change-.aspx
50 Basic principles Amicus change management framework : Combines 3 foundation issues with 5 change levers: Foundation issues: Leadership. Shared vision. Culture ( ie. Proper Corporate Governance!) Found in: Leading Physicians Through Change: How to achieve and sustain results. Jack Silverstein and Mary Jane Kornacki. ACPE Publications 2000
51 5 Change levers Align a change team Involve Health Care professionals & administrative personnel. Buy in Develop tension for change Address resistance to change: Supportive manner. Build consistency Change process should be a continuous improvement cycle.
52 Change team. Assembled line managers and representatives of all the working groups. Worked through all the standards and developed project plans together. Met with working groups individually and amended plans according to their ideas and further developed these. Meet each team quarterly for updates and further consultation.
53 Currently Just finished Q4 reporting. Improving compliance. Meeting groups and refining projects. Published quality profile/ account. Itemises activities of each group. Future plans.
54 Phase 1 Baseline Assessment Phase 2 Structures and processes. Phase 3 Serial Reporting Success
55 Thank You
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