Reviewing the Quality of Outpatient Care today Safe Timely Effective Efficient Equitable Patient at the centre STEEEP

More long term care More frail patients More need to use resource wisely

How are we doing , how much better could we be and at what pace are we improving ? aim 1er driver 2er driver Conceptual Framework Select Standard or Re-audit position Select Sample Comparing reality with standard Identify the gaps Apply Improvement Methodology

Hope is not a Plan

Data I select Ladder of Enquiry Actions I take Conclusions I draw recommend Conclusions I draw Meanings I conclude (through advocacy or enquiry) Interpretations I make Data I select

Think Differently

Microsystem- where patient, family, caring staff and system meet Purpose Patients Professionals Processes Patterns Strengths of current system? What could be improved? Global Aim- then map the processes Specific Aim agreed- fish bone review (people, equipment, materials, processes) Every systems is perfectly designed to get the results it gets

PATIENT, STAFF AND ORGANISATION OUTCOME CHANGE Safety by Design Systems Engineering Initiative for Patient Safety (SEIPS) model Carayon et al Quality and Safety Healthcare ; 2006 15 i50-8 BMJ Publishing Group TECHNOLOGY AND TOOLS ORGANISATION PEOPLE TASK ENVIRONMENT PATIENT, STAFF AND ORGANISATION OUTCOME CHANGE

Human Factors need attention Organisational accident model (Adapted from Reason, 1997) the Contributory Conditions set people up for Active Failure- omissions, slips, cognitive failures, memory lapses, mistakes – Sort out the Contributory Conditions This is a more explicit model of the SWISS Cheese- consider an example you have experience in Knowledge or lack of it is only one component yet we rely all the time on training, re training and guidance we don’t spend time on the system in which work is done, the chaotic clinical space, the poor attention to reliable processes, the haphazard arrangement of communications, the patients involvement is minimised by bureacracy not maximised by engagement

Intervene to Optimize care Safer Health Care- Strategies for the Real World 2016 Charles Vincent and Rene Amalberti Optimal care (Quality) FIVE LEVELS OF CARE (Vincent and Amalberti 2016) 1. Care envisaged by the standard 2. Compliance with standards- ordinary care with imperfections 3. Unreliable care/ poor quality care and patient escapes harm 4. Poor care with probable minor harm but overall benefits 5. Care where harm undermines any benefits Intervene to Optimize care   Intervene to manage risk Increased risk of harm (Safety)