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14% Hospital Acquired Infections 10% Harmed 20 – 40% Health budget wasted Why do we need Governance? WHO 2014
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Governance & Standards
What is happening internationally
Triona Fortune, March 2016
In this session
Best practices from around the world
Core principles
14%Hospital Acquired Infections
10%Harmed
20 – 40%
Health budget wasted
Why do we need Governance?
WHO 2014
Standards
Provide the framework Voluntary or Regulatory
4
Institute of Medicine: Quality Dimensions
Safe Timely Effective Efficient Equitable Patient Centered
Institute of Medicine. Crossing the Quality Chasm, 2001.
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Corporate
Governing Body & Deed Executive Strategic plan -MVV Clear roles Ethical principles Legal Delegated management Operational plan Financial control Effectiveness measured
Clinical Standards / Guidelines Risk
Proactive & Reactive Quality
PPG’s & Audi PCC
Proactive & Reactive Education & Research
Supports a culture of Quality and Safety
Governance
Corporate ClinicalIntegrated
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Clinical Governance A framework through which organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish
high standards of care transparent responsibility and accountability for those
standards, and a constant dynamic of improvement.
NHS 1995
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Australia
The primary aims of the NSQHS Standards are to protect the public from harm and to improve the quality of health service provision.
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1. Governance for Safety and Quality in Health Service Organisations
2. Partnering with Consumers 3. Preventing and Controlling Healthcare Associated Infections
4. Medication Safety
5. Patient Identification and Procedure Matching
6. Clinical Handover
7. Blood and Blood Products
8. Preventing and Managing Pressure Injuries
9. Recognising and Responding to Clinical Deterioration in Acute Health Care
10. Preventing Falls and Harm from Falls
The National Safety and Quality Health Service Standards
Governance for Safety and Quality There are integrated systems of governance to actively manage patient safety
and quality risks.
Care provided by the clinical workforce is guided by current best practice
Managers and the clinical workforce have the right qualifications, skills and approach to provide safe, high-quality health care.
Incident and complaints management Patient safety and quality incidents are recognised, reported and
analysed, and this information is used to improve safety systems.
Patient rights and engagement Patient rights are respected and their engagement in their care is
supported.
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Dilbert
Safety 1Reactive Adverse events Complaints Investigations Anonymous
Safety 11
It is more important to know what sort of person has a disease than to know what sort of disease a person has.
Sir William Olser 1849 - 1919
Person Centred
Patient feedback
Satisfaction surveys Measuring experience PROM’s PREM’s PAM’s
#hellomynameis
No tokenism
Do we always include the patient?1004 clinicians in DK, US, UK & Israel – 2009
90% - important to ask patients 16% - actually did 20% nurses vs 11% doctors
What would make a difference? Leadership support
CLINICIANS’ ATTITUDES AND SELF PERCEPTIONS TOWARDS MANAGING PATIENT EXPECTATIONS AND PATIENT SATISFACTION: AN INTERNATIONAL SURVEY R. Rozenblum et al, ISQua 2010
Benefits • Decreases mortality• Decreases rates of HAI’s• Decreases surgical complications• Improves clinical outcomes• Supports compliance with
medication safety• Produces higher levels of staff
satisfaction and retention• Decreases malpractice claimsThe Research
Person Centred
Australia 2012
58,000 - 122 empirical studies 29 countries Majority after 2006 US & Australia most dominant 6 EU & 13 LMIC 64% acute care
Narrative synthesis of health service accreditation literature, Hinchcliff et al, 2012 BMJ
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Main findings in Accredited Hospitals
51% showed improvements in organisational structures & process
53% demonstrated greater performance in outcome measures but only since 2006
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25 Benefits Listed Risk Mitigation System Strengthens interdisciplinary team effectiveness Improves communication Promotes measurement and use of indicatorsImprovements needed Does not increase patient satisfaction Data capture
Canada 2011
Accreditation Canada, Value and impact of accreditation: a literature review (2011)
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Accrediting the Accreditors since 1999
ISQua Standards
8 Standards Governance Strategic, operational and
financial management Risk management and
performance Human resources management Information management Surveyor management Survey and client management Accreditation or certification awards
ACCREDITATION OR CERTIFICATION AWARDS
SURVEYOR MANAGEMENT
GOVERNANCE
STRATEGIC, OPERATIONAL AND FINANCIAL MAN-AGEMENT
RISK MANAGEMENT AND PERFORMANCE IM-PROVEMENT
HUMAN RESOURCES MANAGEMENT
INFORMATION MANAGEMENT
SURVEY AND CLIENT MANAGEMENT
ASSESSOR MANAGEMENT
ASSESSMENT MANAGEMENT
0 2 4 6 8 10 12 14 16 18 20
ORGANISATION SURVEY - Recommendations Overview
Surveys 2014
Success Factors
Strong committed senior leadership – Accountability Support staff at service level Communication Regular measurement and feedback reporting
Patients & Staff Building staff capacity –education Culture strongly supportive of change & learning
Luxford et al (2011)
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