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,

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  Clinical  Integrated 7

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

Australia  The primary aims of the NSQHS Standards are to protect the public from harm and to improve the quality of health service provision. 9

10 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. 11

Dilbert

Safety 1 Reactive  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 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 – % - 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 claims The Research Person Centred

Australia 2012  58, 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 19

Main findings in Accredited Hospitals  51% showed improvements in organisational structures & process  53% demonstrated greater performance in outcome measures but only since

25 Benefits Listed  Risk Mitigation System  Strengthens interdisciplinary team effectiveness  Improves communication  Promotes measurement and use of indicators Improvements 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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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

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