Performing better and measuring better performance

A forum regarding the implementation of ‘A Quality

Framework and Suite of Quality Measures for the Emergency

Department Phase of Acute Patient Care in New Zealand’

Provisional objectives

1. General; Explore what it (the document) is about, and how me might go about implementing it

2. Specific; Discuss some specific DHB examples

3. Next steps; Consider what we should do locally and (perhaps) nationally

What we are not doing

Re-litigating the content of the document

Usual conventions apply

• The forum is for sharing• It is explicitly formative• No question/comment is unworthy• Presentations are topic starters

– the discussion will add as much again

A Quality Framework and Suite of Quality Measures for the Emergency Department

Phase of Acute Patient Care in New Zealand

Forward

• We must do this• It is only one part of acute care• Balance between aspirations and pragmatism• Minimised the measures and staged

implementation • Definitions, tools and standards not in place• Quality improvement, not accountability

Introduction and aim

• Wrapping the target in a suite of quality measures• Development through multiple stages• Concerns

1. The document is given to the ED to ‘implement’ without the appropriate resources, including time and expertise.

2. It is considered an isolated ED project without good linkages to a DHB quality structure.

3. It is forgotten that much of the quality occurring in an ED is determined by people, processes and resources outside the ED’s jurisdiction.

4. There is not a commitment to act, on deficiencies identified by the quality measures.

Selecting the measures

• International precedents (rapidly evolving)• ED advisory group• Survey of ED CDs• Input from a separate research project• NZ EDs conferences, Taupo, 2012 and 13• Two stage feedback process

A comprehensive consideration of quality

• Donabedian categories– Structure– Process– Outcomes

• Institute of medicine domains– Safe, effective, patient-centred, timely,

efficient, equitable

A quality framework for NZ EDs

Quality measures will fall under each of these profiles

The context of an ED quality framework in an acute care

system

• The ‘ED phase of acute care’• Emphasises that many efforts to improve

the ED phase will occur outside the ED• However, it doesn’t scrutinise care outside

the ED

Quality measures – frequency of measurement

• C – continuous – as often as possible, at least monthly

• R – regular – at least twelve monthly • O – occasional – two to five yearly

Quality measures – relevance

• Some, particularly under the education and training, and research profiles, will have less relevance for some EDs

• However, where they are present they are part of an ED’s quality profile

Mandatory?

• Some are expected – particularly in the Clinical Profile

• Others are recommended

Definitions, tools and standards• Not just yet• We want DHBs to do it

– Making them do it one way would increase the burden

– Waiting for definitions, tools and standards would take too long

• They will evolve

Summary of measures

• 59 possible measures• 20 (+1) are mandatory

– 2 continuous (+ 1 more if an obs unit)– 18 regular

Mandatory measures

Expectations

• Commitment in 2014/15 annual plan• Staged approach

– Q1 a Quality Framework is in place– Q1 measure the mandatory measures– Q3 measuring and responding to mandatory

measures and adding non-mandatory measures

Expectations

• The quality framework is– Not routinely reported but is available– Supported by appropriate resourced and skilled

personnel– Supported by IT development consistent with

the direction of the National IT Board