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

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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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Thank-you

tfortune@isqua.orgwww.ISQua.org