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National Strategies to Build Capability for Quality Improvement
April 2016
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WHY A CAMPAIGN
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Where we started
• NZ generally performs well• People still harmed• Lack of consistent uptake of actions to prevent harm• HQSC established 2010
– Lead and coordinate– Monitor and report– Help providers improve
• 2012 release of SAE Report highlighted patient safety issues• Campaign from May 2013 to June 2016
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Campaign Strategy:
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brand
alignment
acceleratepartnership
networks
measurement simple changes
strong evidence
national design
regional implementation
inspire
campaign for the nation
clinical leaders
engage
capability
patients & families
What success would look like
• People working together on agreed goals and actions
• More clinical leaders who are quality and safety champions
• Consumers as partners in care and catalysts for change
• Greater capability for sustainable improvement
• Culture change – involving consumers, teamwork, able to speak up about concerns
• Uptake of process changes and improved outcomes.
• An increase in local and regional initiatives
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PARTNERING WITH CONSUMERS
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Consumer Partnership
• Consumers on all Commission expert advisory groups
• Consumer network
• Support for each region to engage with consumers
• Patient and clinician stories are available on the Open website
• Patient Safety Week – to have a consumer engagement focus
• Co-design projects
• Health literacy and consumer and family resources
ENGAGEMENT
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BUILDING LEADERSHIP AND IMPROVEMENT CAPABILITY
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Leadership & Capability
• Four Regional steering groups to lead and coordinate campaign
• One-off start-up funding of $50k per region
• HQSC funding for Improvement Advisor
• HQSC funding people to attend patient safety programme, EQA and APAC conference
• Support through visiting speakers and sharing information
• Developing resources that help to bring evidence into practice
• Improvement capability through programmes
CAMPAIGN TOPICS
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• Hospitals
– risk assessment and individualised care planning
– safe care environments
• Aged residential care
– Vitamin D
• Community/at home
– strength and balance
Topic 1: Reducing harm from falls
10 Topics
Safe environments
• Developing a promotion on safe environments and uncluttered wards
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Topic 2: Preventing surgical site infections
• SSI surveillance
• Timing and dose of prophylactic antibiotics
• Skin preparation before surgery
• Clipping not shaving the surgical site
Arthur Asks
• Developing a promotion on correct skin preparation procedures
• Cardboard cut outs, posters and a quiz delivered to theatre tea rooms
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Topic 3: Safe Surgery
• WHO Safe surgery checklist
• Briefing and debriefing
• Teamwork and communication
• Surgical safety culture
• VTE prophylaxis
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• ‘One-step’ resources
• Let’s PLAN health literacy resource
• National workshop and Webinars
• Patient stories
• Safe and effective use of Opioids
collaborative
Topic 4: High Risk Medicines
Mid-Campaign refocus- working well
• High visibility and profile for patient safety work
• Falls was a good first topic and the topic focus worked well
• Access to resources, experts and other support was fantastic
• Strengthened regional networks and alliances
• Capability building through the campaign was appreciated
• Quality and Safety Markers for measurement got the attention of senior leaders
• Alignment with Letters of Expectation to DHBs improved uptake of campaign topics and demonstrated alignment with Ministry of Health
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Mid-Campaign refocus – to improve
• Some confusion of people not knowing what the campaign is about with a lack of coherent story across topic areas
• Competing priorities between programmes and the campaign, existing campaigns and the Open campaign
• The campaign moved at a fast pace and this was a challenge for a busy health care workforce
• Variability of consumer representation across the regions• Perception in some areas that QSMs are about compliance,
rather than being data for improvement
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Patient Safety Week 2014
• Launch of Let’s PLAN consumer
resource
• Dr Jim Bagian workshops
learning from adverse events and
safe surgery 300+ people
• National Serious Adverse Events
Report
• DHB and other events
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Topic 5: Falls Revisited
• Atlas of healthcare variation
• Stay independent falls prevention toolkit for clinicians
• National and regional workshops with international and local speakers
• Competitions – April falls quiz, limerick competition, falls wall and video competition
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Patient Safety Week 2015
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Topic 6: Leadership for quality and safety
• Open Forum International Series• ½ day workshop for emerging clinical leaders
– what makes a good clinical leader?– where is patient harm occurring and, as leaders, what can
we do about it?– leading change within a complex system– quality improvement knowledge and skills– measurement and evaluation of quality.
• Highlighting how leadership has made a difference
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SUSTAINABILITY
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Sustainability
• Improvement programmes underpin campaign
• Building practice change into process of care
• Increasing focus on consumer partnerships
• Building leadership and improvement capability
• Quality and safety markers
• Regional leadership and coordination
• Annual patient safety week
• Open Forum – International series
• Improving Quality: a Ministerial priority
MAKING A DIFFERENCE
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Evaluation
1. Did desired change in safety practice occur?
2. Did a reduction in harm and cost occur?
3. How successful was the process of effecting change through the campaign?
4. Has the campaign resulted in sustainable improvement?
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Results so far
• Falls – improved risk assessment and care planning plus fewer in-hospital falls with #NOF
• Surgical site infections – improved skin preparation, timing and dose of antibiotics, no significant reduction in infections
• Safe Surgery – improved use of WHO safe surgery check-list, change of measure to focus on teamwork and communication
• High Risk Medicines – from safe use of opioid collaborative focus on interventions to reduce nausea, vomiting and constipation. No nationally consistent outcome measure
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Risk assessment & care planning
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In-hospital falls causing #NOF
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External Evaluation
• Still early days• Positive signs of sustainable improvement• Strong support for improvement work• Need for leadership• Greater engagement at all levels• Culture focused on quality• Build capability for improvement
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LEARNING AND ADVICE FOR OTHERS
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Reflections
• Patients and families at the centre• Engage people• Enable leadership• Focus on practical topics and simple changes• Be responsive• Learn from everyone• Build capability• Be creative
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Engagement
• Signing the pledge• Personal stories• Social and other media• Series of focused promotions and events• Sharing success through website, newsletters • Learning from international experts• Creating networks and connecting people• Simple facts sheets – evidence based
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Standing on the Shoulders of Giants
Anne-Grete Skjellanger | Director, Norwegian Patient Safety Program-
International Forum on Quality and Safety in Healthcare 2016
The Challenge
From whom we «stole» theIDEAS
…and where we needed theWILL & EXECUTION
• 4 regions
• < 30 hospitals
• 428 municipalities
• 2 different systems
The owners, co-creators and the
important executers
Ministry of Health and Care Services
The Steering Committee
The Secretariat Advisory Council 15 Expert groups
Hospital TrustLocal Program Managers
Municipalities22 428
Regional Health AuthorityRegional Program Managers
Centres for Development of Nursing Homes and Home Based Care
4 38
Creating the safest healthcare in the
world
Aims:
• 25% reduction of avoidable
harm
• Build competence and lasting
structures for patient safety
• Improve patient safety culture
Aims for spread
• Full spread within 2016/2018
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5-year national program
We want change – for the patients,
their families and the healthcare
professionals
• Reduce patient harm by 25% • Reduce 7 different infections by 25%• Increase 30-day survival following hip fracture by 2%• Increase 30-day survival following stroke by 3%• Increase 30-day overall survival by 3%• 80% of all units reports a good patient safety climate
• Improve hospital patients' patient safety satisfaction by 5%
Reducing patient harm in hospitals
(Global Trigger Tool)
6
8
10
12
14
16
18
2010 2011 2012 2013 2014
We aim to improve patient safety
culture
56%Mature climate for patient safety
44%A climate which may cause an increased
risk of patient harm
We measure results and activity on a
local, regional and national level
Activity/SpreadLocal resultsNational
dashboard
We have focused on target areas we
have adopted from the Giants
TARGET AREAS• Safe surgery • Medication reconciliation• Drug review in nursing homes• Drug review in home care services• Stroke treatment• Prevention of pressure ulcer• Prevention of urinary tract infection• Prevention of central line infection• Prevention of suicide in inpatient psychiatric units• Prevention of overdose deaths after discharge from an institution• Prevention of falls in healthcare institutions• Patient Safety Management
NEW TARET AREAS (COMING 2016/2017)• Sepsis• Early Warning Score• Nutrition• Prevention of overdose deaths after discharge from prison
Building capability and capacity
We use the Breakthrough Series Model
Sketch of the Breakthrough Series Model by Paul Batalden (1994)
1 pilot
20 teams
All
20x20
National program Healthcare services
54
Implementation and spread
Spread and infrastructureIn
frastr
uctu
re
(buy-i
n, fe
edback a
nd m
easure
ment
syste
ms,
com
pete
nces. etc
)
Size of Spread(locally, regionally, national)
Spread and infrastructure
We are here!
In
frastr
uctu
re
(buy-i
n, fe
edback a
nd m
easure
ment
syste
ms,
com
pete
nces. etc
)
Size of Spread(locally, regionally, national)
I will talk to you about…
We are here!
…whatwehave!
In
frastr
uctu
re
(buy-i
n, fe
edback a
nd m
easure
ment
syste
ms,
com
pete
nces. etc
)
Size of Spread(locally, regionally, national)
I will talk to you about…
Size of Spread(locally, regionally, national)
We are here!
…whatweneed!
…whatwehave!
In
frastr
uctu
re
(buy-i
n, fe
edback a
nd m
easure
ment
syste
ms,
com
pete
nces. etc
)
WE HAVE
Units working with huddle boards
WE NEED
System to work as the finest
clockworkCEO and senior
management group
Division
Department
Unit
WE NEED
System to work as the finest
clockworkDialogue, reflections and actions
CEO & Co
Dialogue, reflections and actions
Division
Dialogue, reflections and actions
Department
Dialogue, reflections and actions
Unit
?
monday
?
tuesday
?
wednesday
?
thursday
Reducing falls in 20 wards atHelse Stavanger Trust
0
5
10
15
20
25
30
35
Share of falls with injury per month
0
200
400
600
800
Days between pressure ulcers, lung ward
Working on eliminating pressure ulcers at University Hospital North-Norway
Reducing time from admission to CT for stroke patients at Telemark Hospital
0
20
40
60
80
Min
ute
s
Minutes from admission to CT
6
8
10
12
14
16
18
2010 2011 2012 2013 2014
Patient harm (Global Trigger Tool)
WE NEED
More data on a national level to tell us
if the changes are an improvement
WE HAVE
«Just ask!» og «Rounds chair»
Just ask
!
Getanswers
WE NEED
To radically change the conversations
about patient centered care
Inpatients don’t needto be patient, theybook a time slot in the doctors rounds
From what’s thematter?
to What matters to you?
Patients and theirfamilies in the
improvement teams and in recruitments
Whatmatters to you?
Key take aways
The improvement work has to be integrated in the hospitals
and municipalities dailyoperations
1
A national program needsfrequent national data – just as much as the local improvement
team needs their run charts
2
We need more than stunts to actually deliver patient
centered care – we need to change the conversation and
shift the power
3
Visit us in Norway!
Standing on the
Shoulders of Giants
