WORKING IN PARTNERSHIP FOR QUALITY HEALTHCARE IN HAWKE S BAY

Transcription

1 WORKING IN PARTNERSHIP FOR QUALITY HEALTHCARE IN HAWKE S BAY A QUALITY IMPROVEMENT & SAFETY FRAMEWORK DECEMBER 2013

2 2 1 IMAGE NEEDED CONTENTS INTRODUCTION 2 WHAT DO WE WANT TO ACCOMPLISH 4 QUALITY HEALTH CARE 6 WELLNESS 8 PEOPLE S EXPERIENCE OF HEALTHCARE 10 WORKING WITH THE PEOPLE OF HAWKE S BAY 12 LEADERSHIP AND WORKFORCE DEVELOPMENT 14 HEALTH IMPROVEMENT INDICATORS, REPORTING AND MONITORING 16 ACTION PLAN TO DELIVER THE FRAMEWORK 18

3 2 3 INTRODUCTION In 2013 the Minister of Health wrote to all DHBs requiring them to have a consistent and continued focus on maintaining the quality and safety of their health services. Key requirements included ensuring a culture of care and compassion, and involvement of patients and their family/whānau. The Quality Improvement and Safety Framework is an initiative of the Hawke s Bay Clinical Council, in partnership with the Hawke s Bay Health Consumer Council. The purpose of this framework is to support integrated quality improvement and performance across the Hawke s Bay health sector by providing direction and priorities. It will enable the entire health sector to have a shared sense of direction in provision of quality care for the Hawke s Bay people. THE DIMENSIONS OF QUALITY HEALTH CARE The document breaks quality improvement and safety into four areas to provide a focus for our work and help us identify more readily opportunities for improvement. WELLNESS: Improving the health of our communities. PEOPLE S EXPERIENCE OF HEALTH CARE: Continuously improving the safety of our services, underpinned by a culture of care and compassion. WORKING WITH THE PEOPLE OF HAWKE S BAY: The patient, family/whānau and carer voice as an essential component of clinical quality improvement and patient safety. LEADERSHIP AND WORKFORCE DEVELOPMENT: Clinical quality improvement and safety is embedded within the Hawke s Bay health sector workforce and leaders. THERE ARE THREE THEMES THAT WILL BECOME THE FOCUS OF QUALITY IMPROVEMENT AND SAFETY. THESE ARE CORNERSTONES OF THE NZ HEALTH CARE TRIPLE AIM FOR QUALITY IMPROVEMENT AND PATIENT SAFETY OUTCOMES: EQUITY (Improved health and equity for all populations) Inequities are defined as differences which are unnecessary and avoidable but in addition are considered unfair and unjust (Whitehead 1992). In Aotearoa, ethnic inequalities between Māori and non-māori are the most consistent and compelling inequities in health and are the result of a complex, layered spectrum of factors. Equity in health outcomes can be improved by ensuring equitable access to the determinants of health such as income and education, equitable access to health services and equitable treatment within health services. Good quality health services and care pathways will therefore help reduce health inequities. PEOPLE CENTRED (Improved quality, safety and experience of care) By having the patient and family/whānau at the heart of everything we do, we support individual and whānau/family participation and decision making about health sector services at every level. EFFICIENCY (Best value for public health system resource) The third theme of quality improvement and safety is the efficiency that quality care produces. Obtaining the best value from health care resources by ensuring the right care is delivered to the right people, in the right place and the first time. DO THE SICK NO HARM FLORENCE NIGHTINGALE 1859 FIRST DO NO HARM HIPPOCRATIC CORPUS

4 4 5 WHAT WE WANT HOW WILL WE DO THIS? TO ACCOMPLISH HEALTH CARE MUST BE 1 : HAWKE S BAY HEALTH SECTOR S VISION IS EXCELLENT HEALTH SERVICES WORKING IN PARTNERSHIP TO IMPROVE THE HEALTH AND WELLBEING OF OUR PEOPLE AND TO REDUCE HEALTH INEQUITIES WITHIN OUR COMMUNITY. To achieve this we have agreed the values and behaviours that guide the way we deliver services to the people of Hawke s Bay. TAUWHIRO delivering high quality care to patients and consumers. RĀRANGA TE TIRA working together in partnership across the community. HE KAUANUANU showing respect for each other, our staff, patients and consumers. ĀKINA continuously improving everything we do. Ensuring quality and safety, within hospitals and wider health services, is a fundamental responsibility of District Health Boards (DHBs). SAFE: EFFECTIVE: PEOPLE CENTERED: TIME: EFFICIENT: EQUITABLE: Avoiding harm to patients from care that is intended to help them. Providing services based on evidence and which produce a clear benefit, with neither underuse nor overuse of the best available techniques. Establishing a partnership between clinicians and patients, inclusive of family and whānau, to ensure care respects patient s needs and preferences; and the person should play an active role in making decisions about their own care. Reducing waits and sometimes harmful delays. Constantly seeking to reduce waste. Providing care that does not vary in quality because of a person s characteristics. WHAT DOES SUCCESS LOOK LIKE? Every person that works in the Hawke s Bay Health sector will be aware of their responsibility for quality improvement and patient safety. Consumers are active participants in determining their wellness and their voice is valued in decision making. Clinical participation in management and governance of health services is essential in creating the culture needed for effective quality improvement and patient safety. Clinicians are not only responsible for the provision of high quality patient care, but their leadership is also important at all levels of the system. WE WILL: Support change, focusing on the quality improvement and safety agenda. Build partnerships across the health sector and with the people of Hawke s Bay. Continue to push for stories that support quality improvement in the health care delivery. Maintain and develop our governance and infrastructure supporting quality improvement. 1 Quality improvement made simple August Health Foundation ISBN

5 6 7 QUALITY HEALTHCARE Every person who works in the Hawke s Bay health sector will understand the needs and goals of the patient and their family/whānau. We will understand our clinical systems and work towards excellence across the health sector, engaging with all staff in quality improvement and learning from our mistakes. We will focus on the person receiving care in everything that we do. Equity People Centred Efficiency PLACE THE QUALITY OF PATIENT CARE, ESPECIALLY PATIENT SAFETY, ABOVE ALL OTHER AIMS DON BERWICK, 2013 Wellness WORKING IN PARTNERSHIP FOR QUALITY HEALTH CARE IN HAWKE S BAY Working with the people of Hawke s Bay Peoples experience of Health Care Leadership and workforce development INDICATORS - REPORTING - MONITORING

6 8 9 WELLNESS IMPROVING THE HEALTH OF OUR COMMUNITIES Population health and prevention programmes ensure that people are better protected from accidents, ill health and disability. The programmes support people to maintain healthy lifestyles. Hawke s Bay, along with the rest of New Zealand, is experiencing growth in long term conditions such as diabetes, heart disease, renal disease and chronic lung disease. These conditions are major causes of poor health and account for a large number of visits to general practice teams and hospitals. Given our ageing population and projected demographics we can expect the burden of long term conditions to increase. SUPPORTING HAWKE S BAY PEOPLE TO MAKE HEALTHY CHOICES AND MANAGE THEIR HEALTH WILL HELP THEM TO IMPROVE THEIR QUALITY OF LIFE AND AVOID, DELAY OR REDUCE THE IMPACT OF LONG TERM CONDITIONS. Other major influences of health and quality of life are: Housing Transport Education Family violence Alcohol and drug misuse Income Disability As part of this framework we acknowledge the importance of making sure that health information about conditions and services, are easily accessible and easy to understand. This will reduce barriers for access to services as well as improve equity in health services and outcomes. QUALITY IMPROVEMENT AND SAFETY PRIORITIES: How we present quality health information. Ensuring that our most vulnerable people are identified and have all available resources to support their journey through the health system, whether it is via a Health Passport, or improved information sharing. Making sure that our systems of communication are responsive to the people of Hawke s Bay. Working across different sectors to ensure that the most vulnerable receive appropriate services and care. Improving the communication between the health professional and the consumer throughout the interaction, and particularly in the beginning. Continuing to monitor health inequities and access rates to services, to inform service improvements. We will continue to support and strengthen existing screening programmes in primary care and other early intervention plans.

7 10 11 PEOPLE S EXPERIENCE OF HEALTHCARE CONTINUOUSLY IMPROVING THE SAFETY OF OUR SERVICES, UNDERPINNED BY A CULTURE OF CARE AND COMPASSION. The health experience Hawke s Bay people have is of utmost importance to us. We understand that some people may be vulnerable and may be going through life changing diagnoses and treatments. It is our goal that we make this experience the best that it can possibly be. THIS MEANS WE WILL SUPPORT A CULTURE OF CARE AND COMPASSION, SUSTAIN AN OPEN, TRANSPARENT SYSTEM THAT WILL ENSURE THOSE PEOPLE THAT USE THE HEALTH SERVICE COME FIRST AT ALL TIMES. We will ensure all those who provide care for these people, both individuals and organisations, are aware of their role in ensuring a high quality and safe service, and are accountable for what they do. QUALITY IMPROVEMENT AND SAFETY PRIORITIES: Implementing and monitoring the Health Quality and Safety Commissions patient safety initiatives relating to improved medication safety, reduced falls. Related harm, prevention and control of infection and reducing perioperative harm. Improving clinical oversight in all provider contracts. Having a consistent and efficient communication pathway across the patient journey, whether this be clinical pathways or individual pathways for different services. Strengthening referral networks within the health system.

8 12 13 WORKING WITH THE PEOPLE OF HAWKE S BAY THE HAWKE S BAY HEALTH SECTOR WILL COLLABORATE TO ACTIVELY SEEK OUT AND LISTEN TO THE PATIENT, FAMILY/WHĀNAU AND CARER VOICE AS AN ESSENTIAL COMPONENT OF CLINICAL QUALITY IMPROVEMENT AND PATIENT SAFETY. We acknowledge the people who use our services have a unique perspective of health services and are able to provide us with important information about how we design, deliver and monitor health services. Our challenge is to find the best way to capture people s experiences of care and to identify how we can use that information to develop new ideas, measure change and report back to the people of Hawke s Bay. Working together with the people of Hawke s Bay includes developing and maintaining stronger partnerships to share information between all those involved including Primary Care, Secondary or Hospital Care, Non Government Organisations (including Māori health providers and disability service providers) and Aged Residential Care providers to ensure that the right care, is given to the right person, at the right time and by the right person. WE WILL LISTEN, LEARN AND LINK. THE QUALITY IMPROVEMENT AND SAFETY PRIORITIES THAT WILL SUPPORT TRANSFORMING PATIENT INVOLVEMENT 2 ARE: Improving the process of gathering patient experience data and stories, and how we share these across the sector, from governance to those working at the front line. Improving the process of monitoring consumer feedback, ensuring that it has clear executive ownership and accountability. This will include sharing outcomes and recommendations within the health sector and with the affected parties. Developing community engagement and communication channels. Supporting the consumer voice to be a formal part of any planning or redesign process. Working with the Health Quality and Safety Commission and Hawke's Bay Health Consumer Council to implement consumer engagement programmes. Identifying the strengths, weaknesses and opportunities by completing a true gap analysis in the area of quality improvement and patient safety across the sector. Building on and strengthening existing relationships and structures within the sector, such as clinical committees and cross sector quality forums. Implementing clinical pathways/patient journeys that will provide a standardised, clear and consistent approach to care provision for common conditions. Implementing integrated Information Technology solutions that will support the quality improvement cycle and improve patient journeys. Developing policies and funding mechanisms to support quality improvement and safety across the Hawke s Bay health system. 2 Transform and Sustain - HBDHB Feedback from Māori Health Strategy focus groups

9 14 15 LEADERSHIP AND WORKFORCE DEVELOPMENT ENSURING THAT CLINICAL QUALITY IMPROVEMENT AND SAFETY IS EMBEDDED WITHIN THE HAWKE S BAY HEALTH SECTOR WORKFORCE AND LEADERS. Ultimately we want a health system that focuses on system wide improvements and not on individuals. We want to examine underlying contributing factors and root causes to identify changes that could be made to improve systems and process to improve quality of care. WE WILL TRANSFORM THE SECTOR CULTURE AND SYSTEMS TO ENSURE QUALITY IMPROVEMENT AND PATIENT SAFETY IS AT THE HEART OF IT, IF WE ARE ALL TRULY COMMITTED TO THIS GOAL. As cited by Berwick 3, leadership is about mobilising attention, resources and practice of others towards particular goals, values or outcomes. Ultimately we want a culture of open reporting where staff are empowered to make decisions relating to quality improvement and patient safety as close as possible to the person receiving care. QUALITY IMPROVEMENT AND SAFETY PRIORITIES: The clinical/manager partnerships will be embedded at every level of the organisation and across the sector. This will empower quality innovation and creativity and encourage research. Empowering consumer leadership through training and development. Implementing clinical leadership and building leadership capacity at all levels. Facilitating the quality agenda through clinical and management leadership and governance structures, promoting Board responsibility for quality improvement and patient safety. Supporting credentialing and maintenance of high professional standards improves public confidence in the health system and clinicians. Improving workforce engagement as an engaged workforce that is valued is central to meeting the needs of our patients and wider population, and in providing an effective, high quality service. Building specialised skills throughout the organisations including quality improvement methodology and capability of staff and teams across the sector to understand and interpret quality data. Supporting ongoing professional development and learning to realise the potential of our workforce. Continuing to develop and further enhance quality improvement education packages, support and facilitate maintaining recertification, encourage the development of postgraduate studies and through the personal development review process identify quality leadership. IMPROVE QUALITY IMPROVEMENT ANALYTICAL CAPABILITY FOR THE HEALTH SECTOR BY: Identifying the information gaps and the main areas of need throughout the sector. Establishing trending information, both clinical and people s feedback, to inform quality improvement design. 3 A promise to learn a commitment to act, (2013). The National Advisory Group Report. UK. Ensuring that quality improvement and safety reporting and monitoring is given to the right people/groups at the right time via effective information and monitoring systems.

10 16 17 HEALTH IMPROVEMENT INDICATORS, REPORTING AND MONITORING MEASUREMENT FOR IMPROVEMENT. INFORMATION SHOULD BE COMPLETE, FUNCTIONAL AND TRANSPARENT. CLINICAL QUALITY AND SAFETY MONITORING AND REPORTING SHOULD BE SHARED IN A TIMELY MANNER. It is important to measure and evaluate how well health and disability services are operating. This information helps us to: Inform the public. Improve future service design. Fulfill accountabilities. WE WILL FOCUS ON MEASURING WHAT MATTERS, AND WHAT SUPPORTS QUALITY IMPROVEMENT AND PATIENT SAFETY. QUALITY IMPROVEMENT AND SAFETY PRIORITIES: As part of a transparent system that can track changes in key quality and safety markers, which will inform decision making, we will develop a whole of sector dashboard. Working with Health Quality and Safety Commission and the Hawke's Bay Health Consumer Council to develop a means of capturing and measuring the consumer experience. Utilising all available information to support quality improvement and decision making, such as Health Round-table benchmarking, the Productive Series and the Health Quality and Safety Commission information. Ensuring that data is shared within the sector to support the patient journey and access to services. The priorities and actions identified in this framework will drive quality improvement and safety performance monitoring and reporting, through appropriate accountability lines.

11 18 19 ACTION PLAN TO DELIVER THE FRAMEWORK The delivery of our framework will be through a series of actions identified and monitored through Hawke's Bay DHB s and Health Hawke s Bay, Clinical Council, Hawke s Bay Health Consumer Council, Executive Management Teams and other key stakeholders. These actions will contribute to achieving our Hawke s Bay health sector vision excellent health services working in partnership to improve the health and wellbeing of our people and to reduce health inequities within our community. The priority actions that we will tackle are: Implement information technology solutions to support quality improvement. Ensure that our most vulnerable have all available resources needed to support their health journey. Improve process of gathering patient experience data, and how we share it. Support ongoing professional development. Develop consistent patient journeys through clinical pathways or individual pathways for different services. QUALITY CANNOT BE VIEWED AS THE RESPONSIBILITY OF THE QUALITY DEPARTMENT. IT HAS TO BE SEEN AS EVERYONE S JOB. ORGANISATIONS WHERE THAT TYPE OF MINDSET IS STILL PREVALENT AMONG STAFF WILL BE SIGNIFICANTLY STYMIED IN TRULY ELEVATING THE QUALITY OF PATIENT CARE 4 The Hawke s Bay health sector needs to ensure that quality improvement and patient safety is not a back room function and instead is delivered by a patient centred and proactive health sector focused on identifying new opportunities for improvement and working directly with clinicians, managers and the people of Hawke s Bay. WE WILL Use appropriate proven quality improvement methods on a project by project, or action basis. Monitor our action plan, and progress will be reported to the Hawke s Bay DHB Executive Management Team bi monthly. A regular report on high level progress will be provided to Clinical Council and Consumer Council quarterly, and then through to the Governance Boards. Ensure that all responsibilities and accountabilities of health service providers are considered when developing this action plan. Develop a change management process to support the development and implementation of the action plan. Consider all resources that are needed to support the implementation of this framework and future action plans. Develop quality accounts for public awareness. Providing a realistic picture of the quality of the Hawke s Bay health service and clear actions plans for improvement or maintenance. 4 The Clinical Advisory Board Company, Building a Best-in-Class Quality Infrastructure, 2009, The Advisory Board Company Washington DC.

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