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IS YOUR ORGANISATIONAL QUALITY SYSTEM SUPPORTING YOU TO MEET THE NEW ACCREDITATION REQUIREMENTS?

Dr Cathy Balding

www.cathybalding.com

Falls account for up to 75% of adverse events

in some settings

Errors with medications and blood are key threats to patients

18% patients in hospitals Have at least one pressure ulcer and a stage 4 ulcer costs approx $80k

CABG costs 3x as much if

the patient gets an infection

The quality game changed in 1995…

Blood clots (VTE) kill

three times more people

than die on Australian

roads

The 1995 QAHC Study found that 16.6% patients are harmed in Australian hospitals

10,000 people

worldwide are

harmed by medical

error every day

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• Adverse events increase the case cost up to 7X; and $1 in every $7 spent on healthcare in Australia is used to treat a healthcare-associated injury

• (Ehsani J, Jackson T, Duckett S (2006) The Incidence and Cost of Adverse Events in Victorian Hospitals, 2003–04. MJA, vol 184 no 11, pp. 551–55)

• 27% patients experience healthcare-associated harm in the US in 2012 - 48% of these are preventable

• (US Office of Inspector General, 2012 study of Medicare patients in 189 hospitals)

• Up to 83% incidents are not reported • (U.S. Office of Inspector General Medicare patients study, 2012)

• 57% of patients receive care based on best available evidence via guidelines • (Runciman WB et al. CareTrack: assessing the appropriateness of healthcare delivery in Australia. Medical Journal of

Australia 2012;197(2):100-105)

Since then?

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Our Risk Systems improved…

But our quality systems?...

Standard 7Blood and Blood

Products

Standard 10Preventing Falls and

Harm from Falls

The game changed again this year – nearly 20 years on…in more ways than one…

Standard 1Governance for Safety and

Quality in Health Service Organisations

Standard 2Partnering withConsumers

Standard 4Medication Safety

Standard 3Healthcare AssociatedInfections

Standard 8Preventing and

Managing Pressure Injuries

Standard 9Recognising and

Responding to ClinicalDeterioration in Acute

Health Care

Standard 5Patient Identificationand ProcedureMatching

Standard 6ClinicalHandover

Improving quality (and achieving the nationals safety and quality standards) can be transactional – doing stuff and ticking boxes…

Improvement:

Improving existing care and services, reacting, reducing

risk

Maintenance and Compliance:

Monitoring quality and risk, ensuring standards and policies are met

What’s the point?

Quality/Clinical Governance Systems

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Creating a great consumer experience

Tools, strategies and behaviours to achieve the quality experience for every

person, every time

Improvement:

Proactive activities for improving existing care and services, reducing risk

Maintenance:

Static and reactive activities for monitoring quality and risk, ensuring standards and

policies are met

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Quality/Clinical Governance Supporting Systems

Or – Strategic andtransformational

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But…

How do you get from transactional…

to transformational?

Ideal Care

Unacceptable Care

It’s not easy in a complex environment…

Time

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Where are you starting?

Your organisation’s quality framework and plan is?

• A clear map for supporting staff to reach the destination of great care for every consumer every time?

• A series of quality activities heading in different directions?

• A Quality Manager ‘to do’ list?

Health Service Organisational Quality System Maturity Scale (Balding 2013)Maturity Level Characteristics1. Informal • Lack of systematic approach: random improvement activities based on minimal and poor data.

• Managerial response to quality problems largely dependent on staff ‘trying harder’. • Limited staff input into identifying problems and improvements.  

2. Compliance 

• Problem based and reactive approach with minimal systematic collection or analysis of data on key issues. • Focus on compliance with external/funding requirements. • ‘Doing quality’ is staff code for auditing and other data collection with little implementation or follow up.• Lack of relationship between quality system mechanics and quality of care – ‘quality’ still seen as the responsibility of the quality

manager. 3. Reactive Risk

• Focus on risk management and compliance with accreditation and other external requirements. .• Systematic tracking of key indicators, consumer feedback and incident reporting.• Evidence of some system improvement and follow up. • No agreed change and improvement model in use. • Reliance on policy shifts and education as key change tools. • Leaders are developed to improve safety.

4. Proactive Continuous Improvement

• Quality system is a key component of clinical/quality governance system and is integrated at operational level, with plans for improvement at organisation-wide and local levels.

• Lack of common and uniting goals with the improvement program comprising a series of (possibly unrelated) monitoring, improvement and redesign projects.

• Minimum dataset reported across all quality dimensions, • Data are analysed and reported through the organisational levels to the governing body, and there is evidence of effective systems

improvement as a result. • Strategies in place for developing leaders to engage staff and consumers in improvement across the dimensions of quality.  

5. Strategic • The desired quality of the consumer experience at point of care is defined with staff and consumers, and achieving it is a strategic priority.

• The organisational quality plan is designed and systematically implemented to create the defined quality consumer experience, through developing people and improving systems.

• Roles and responsibilities at all levels of the organisation for creating the quality consumer experience are described and supported.

• Governance systems are owned by the governing body and executive team and designed to support staff to create the quality consumer experience.

• A model for change and improvement is in use. 

Let’s get concrete!

:And then seek crystal clarity about the What, Who and Why

‘3PQ’ Purpose, People and Pillars for creating great consumer experiences (Balding, 2013)

Purpose:Creating a consumer

experience that is:ResponsiveIntegrated

Safe Effective

QG Pillars

Goals, objectives, measures, data, risk and improvement strategies

Culture, leaders, support, roles, development, training

Evidence, standards, policy, systems, resources

People Empathic Skilled Informed Proactive Accountable

Board and Executive

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Integrate the quality system as a strategic and operational pillar of your organisation

Goal

Care and services are delivered as a partnership between consumers and staff and based on mutual respect: We listen.

Consumers are not harmed by our care and services: We do not harm.

Care and services experienced by each consumer are right for that person and achieve what they are designed to do: The right thing that works.

Consumers experience our care and services as coordinated and streamlined: No surprises.

Dimension of Quality

Person centred

Safe

Appropriate and Effective

Continuous and Integrated

Make it real

Responsive to each person:

We

listen

No Harm:Our

consumers

are safe

The right thing with the right

outcome:

Get it

right

Coordinated and Smooth:

No

SurprisesDr Cathy Balding 2012 www.cathybalding.com

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Make it real…

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THANKYOU!

www.cathybalding.com