Influencing The Quality Of Aged Care: The Board’s Role In Clinical

Governance

Alison BrownLead Consultant

Australian Centre For Healthcare Governance

August 2014

Overview•What is quality in aged care services?•How do we improve quality?•The role of the board in service quality

'The only constant in life is change'

Do you provide quality aged care services at your organisation?

•No more than a third of evidence-based clinical guidelines are routinely adhered to (based on clinician and patient self-report) (Mickan et. al. Postgrad Med J 2011; 87:670-679)

•No more than 60% of patients at any one time receive the care deemed appropriate by current science (based on case reviews) (Runciman et. al. Med J Aust 2012;197: 100-105)

•The national benchmark for hand hygiene is 70% (interim benchmark advised by the Australian Commission on Safety and Quality in Health Care), In 2012 50 % of hospitals were at or below the national benchmark (AIHW, Myhospitals)

Rate the quality of the services at your organisation

1 10

Poor quality service

Excellent quality service

Board members’ self-assessment of performance compared with a typical health service in Victoria

What does meeting accreditation tell you?

Poor quality services

Excellent quality services

What does meeting accreditation tell you?

Poor quality services

Excellent quality services

Minimum acceptable standard

‘…organisations should shift away from their reliance on external agencies as guarantors of safety and quality and toward proactive assessment and accountability on their own’.

National Advisory Group on the Safety of Patients in England, 2013. A promise to learn– a commitment to act: Improving the Safety of Patients in England

Clinical Governance, quality governance or governance of service quality can be defined as :

the combination of structures and processes at and below board level to : •ensure required standards are achieved •investigate and take action on sub standard performance ‐•plan and drive continuous improvement •identify, share and ensure delivery of best practice ‐•identify and manage risks to quality of care

Quality Governance in the NHS, 2011

What improves quality?

High performing services 1. Dissatisfaction with the current quality of care2. A shared vision for achieving high quality care and appropriate leadership

structures3. Strategic/operational plan actions translated into measurable quality of care

objectives4. Accountabilities for providing safe care and improving care are clear5. A focus on measurement, systems redesign and human behavior to improve

care.

Baker, G.R., et al, 2008, High Performing Healthcare Systems: Delivering Quality by Design. Longwoods Publishing, Canada.

• Hospitals with more active & engaged Boards appear to have better patient outcomes - higher care scores; lower patient mortality

• Large differences in board activities between high-performing and low-performing hospitals

Jha and Epstein, 2009Jiang et al 2009

The role of the board

The role of the board

What is Quality in aged care?

The dimensions of care that patients value include:•Access to care •Coordination and integration of care •Transitions and continuity of care •Respect for patient’s values, preferences and expressed needs •Information and education •Physical comfort •Emotional support •Family and friends•Continuity of care and transition after discharge

(Picker Institute 2008)

Step 1: Define the goal

Dimensions of Quality Quality GoalsPerson centred care

Provide personalised care that is tailored to individual needs is flexible and respects values , culture and choices

Safe

Safe care is provided and takes into account the persons need to feel safe and trusting in their environment

Appropriate care and systems

Continuously monitor, evaluate and improve the appropriateness of care

Friendly, welcoming environment

A welcoming environment is provided through a positive organisational culture, appropriate infrastructure and equipment.

National Aged Care Alliance domains of quality1. Person centred interactions2. Health and wellbeing 3. Engaging socially4. Daily services 5. Physical environment6. Organisational and governance

Step 2:Communicate the vision

Is this your current vision of quality?

Quality and accreditationSafe, coordinated, person centred, effective services

Step 2:Communicate the vision

Ensure that every member of staff that has contact with clients/residents, or whose actions directly impact on patient care, is motivated and enabled to deliver quality care (effective, safe and person centred care)‐

The role of the board

“Strong, effective board oversight of patient care quality and safety programs is, without question, one of the most fundamental bench-marks of good governance today.”

Step 3: Monitoring and Planning

Data Where are we now? Where do we need to be?

Reporting framework

To measure service quality need a mixture of •Quality System measures •Process of care•Outcomes of care (impact of care in the community setting)

Impacts and processes

Supporting Systems

Quality indicators used in Vic PSRAC•Prevalence of stage 1 to 4 pressure ulcers•Prevalence of falls and related fractures•Incidence of use of physical restraint•Incidence of residents using nine or more medications•Prevalence of unplanned weight loss

Quality indicators in community aged care?•? Access•? impact indicators –QOL, life satisfaction, ADL, PADL•Appropriateness of Care•Client experience

Key data for reporting framework•Agreed dataset aligned to agreed dimensions of quality and incorporating minimum standards•Indicators aligned to strategic quality goals•Indicators aligned to high risk areas

Reporting key questions • What to report?• Format: How much detail: trends , benchmark, action taken• How often?: Depends on the audience and content• Who is the target audience?: Exec, Quality , Audit Committee, Board

How effective are boards?

How effective are boards?

How effective are boards?

Barriers for Boards

• Insufficient resources

• Deficit of skills and expertise

• Inadequate intelligence

Summary

1. Invest in board clinical governance skills 2. Develop organisation wide awareness of what is a quality

service3. Undertake Improvement planning 4. Develop Reporting Framework for measurement of quality5. Report on achievements throughout organisation

For more information about board evaluations, clinical governance and other resources go to:

healthcaregovernance.org.auoralison.brown@healthcaregovernance.org.au