Thursday, June 19, 2014

Innovation in health care - conference report (Part 1)

The Victorian Health care Quality Association committee decided to bring people into one room to share their award winning innovative practice. The papers focused on the acute health sector.

The innovation showcase was an event put on by the Victorian Healthcare Quality Association, the Centre of Research Excellence in Patient Safety, the Victorian Department of Health and the Australasian Association for Quality in Health Care. It was held in St Kilda over two days, and show cased quality improvement initiatives which have won major awards across Australia over the previous 12 months.

The day started with a short introduction by Prof Chris Brook, the Chief Advisor on Innovation, Safety & Quality. He has responsibility for quality and safety in health care and clinical trials in Victoria, no small task. 

He declared that working in quality and safety in health care in not for the faint hearted and went on to give three examples:

In the 1880s Semmelweis noticed that women giving birth at home had a much lower incidence of childbirth fever than those giving birth in the doctor's maternity ward. His investigation discovered that washing hands with an antiseptic solution before a delivery reduced childbed fever fatalities by 90%. He published his findings and was scorned by the medical profession. He died in poverty and misery.

In the 1920s a US surgeon, Codman was concerned that the rate of adverse events is too high and wanted to standardise practice. He developed the grand results idea in which he was focussed on measuring outcomes. And for this he was he was kicked out of Harvard, his hospital, and died in misery.

And finally, Dr Barry Marshall in WA who showed that  peptic ulcers were in fact a result of bacteria and not caused by stress, spicy foods, and too much acid. No one believed him as it would have meant stoping endoscopies! He won a Nobel Prize for his work. His work was incredibly important and changed the world yet he struggled, lost friends along the way...

Prof Brook also challenged participants to describe the notion of quality of health services in a way to make it understandable and meaningful for all parts of the system - for staff, patients and the community. There are lots of words to describe quality – but the more you have the harder it is to get people to commit to them and own them. How do you give ownership to different groups? How do you get clinicians to own the appropriateness and effectiveness of care and for consumers to own the patient engagement?

Dr Cathy Balding Governance for creating great consumer experience and governance for great care.
In the last few years, and particularly with the introduction of the national standards, Dr Cathy Balding has been interested about how to take governance form a thing that people have to do to something the fosters great care. Clinical governance is not something to endure but rather it is something to drive good practice and safe care.

Cathy spoke about the many dimensions of quality care and the complicated approach some organisations take in t developing their safety and quality frameworks and clinical governance structure. She said quite clearly that we spend too much time and energy focussing on the process rather than the end product. Ie, patient centred care, safe care.

There is an important role for maintenance in quality and safety, just like the airline industry. The foundation work is the monitoring of care, ensuring standards are met and that policies are implemented. And as for accreditation, Cathy Balding relayed a story from a colleague in which they likened accreditation to an exam – it is important to pass but it is not a means in itself.

Balding talks about quality governance and develop these systems with concrete purpose and show a concrete relationship between our quality governance systems and quality of care. There is nothing secret about how to create great consumer experiences. Balding refers to Mid Staffordshire as highlighting the key aspects of care. Now in the past year or so there has been lots of discussion and consideration of the findings of the public inquiry into Mid Staffordshire Trust in the NHS (UK), and for good reason. There were significant failings in governance and as a result a failure to deliver good, safe patient care.

Balding emphasised the importance of fostering a common culture shared by everyone in the service of putting the patient first. It is jargon- what does it mean? I agree with her on this. Patient Centred Care sounds good but it is an empty term and so we need to challenge the rhetoric.  For example, that someone who lives on the south coast and has to drive 3 hours away from the outpatients department at a large hospital. They then wait a long time in a crowded waiting room and then given an 8am appointment in month’s time. That happens all too regularly and with little (or no) consideration of what is involved for the consumer in getting there.

Balding also referred to the Picker Institute eight domains of care . We have been suing these in consumer training for many years and they make sense.  

We now have the Standards 1 and 2 so we now know that governance matters. There are five aspects that the standards cover:
  •     Governance and quality improvement
  •     Clinical practice
  •     performance and skills
  •     incidents and complaints – reporting and investigation systems, complaints systems and open disclosure
  •      patients rights and engagement – charter of healthcare rights, patients as partners, confidentiality, patient feedback
Pillars of quality governance
  •      Strategic planning leadership and culture
  •      Consumer participation
  •      Effective and accountable workforce
  •     Compliance good practice risk and improvement
Balding asked the audience: what do you want every one of your consumers and their families to experience every time?

We want care that is responsive to the individual, care that is connected, care that is safe and effective for everyone, every time. And we will be a hospital that supports our staff to deliver this.
And the executive leadership team need to commit to supporting staff and provide for this. We need to hear statements from them like: we will give you direction knowledge resources and support to make this happen.

Balding went on to talk about the framework for quality, safety and the patient experience at Western Health. There are four questions they ask:
  •   Were you seen and treated as a person?
  •   Did you receive help, treatment and information in a coordinated way
  •   Did you feel safe? Were you safe?
  •   Did your treatment have the desired effect?
These are great questions and I think more of us need to ask them.

Darlene Cox
Executive Director

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