Irl: www.alphaprimarycare.com UK: www.alphaprimarycare.co.uk CMG Director of Nursing & Midwifery Conference 2017 Key Skills To Excel in Your Role Leading Quality Improvements & Patient Safety Dr Jack P Nagle CEO, Alpha Irl: www.alphaprimarycare.com UK: www.alphaprimarycare.co.uk

Learning Aims Patient safety Quality Improvement (QI) Quality Improvement Division Quality v Compliance

What is Safety?

What is Patient Safety? The simplest definition of patient safety is the prevention of errors and adverse effects to patients associated with health care. While health care has become more effective it has also become more complex, with greater use of new technologies, medicines and treatments and…...

What is Patient Safety? Greater Risk..

Hippocratic Oath I swear to fulfil, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

Patient Safety

Patient Safety Commission agreed Vision: Knowledgeable patients receiving safe and effective care from skilled professionals in appropriate environments with assessed outcomes

Governance Framework for Patient Safety & Quality The Commission’s work set out the following principles: Openness Patient Centredness Learning from mistakes – embed safety & Quality in the system Maximise benefits to Patients Accountability Patient/Family Involvement

Patient Safety

9/7/2018 C. Alpha Healthcare Ltd 2006

9/7/2018 C. Alpha Healthcare Ltd 2006

Some Key Stats – Ireland State Claims Agency –Report 2012 C. Alpha Healthcare Ltd 2006 9/7/2018

Risk in the Healthcare Setting Nosocomial Infections Communications Failures High Occupancy Wrong Identification of Patient Chemical/Radiation exposure Incorrect/Inappropriate Prescribing 11/12/2015 C. Alpha Healthcare Ltd 2006

Risk Management C. Alpha Healthcare Ltd 2006 9/7/2018

What is Risk Management? “… the process of making and carrying out decisions that will assist in the prevention of adverse events and minimize the effects of those events” Envisaging risks Assessing how likely they are to occur What action, if any, to be taken C. Alpha Healthcare Ltd 2006 9/7/2018

HIQA standards C. Alpha Healthcare Ltd 2006 9/7/2018

Purpose of Standards To drive improvement in quality and safety for service users: Describing what high quality safe healthcare should look like Helping service users to understand what to expect from well run services Strengthening accountability Identifying strengths, highlighting areas for improvement Providing the basis for day-to-day delivery of quality and safety Promoting up-to-date, effective practice Promoting better use of resources and information. C. Alpha Healthcare Ltd 2006 9/7/2018

Risk Management C. Alpha Healthcare Ltd 2006 9/7/2018 Source: Risk Management in the HSE: An Information Handbook C. Alpha Healthcare Ltd 2006 9/7/2018

TQM Total Quality Management is a philosophy that enables the management of people and business processes to ensure complete customer satisfaction. It has been widely used in industry to deliver huge benefits in customer service, efficiency and cost reductions. 9/7/2018 C. Alpha Healthcare Ltd 2006

Quality & TQM Quality – the delivery of effective, safe and quality healthcare is essential. TQM - a philosophy! Focus on the patient, Focus on preventing problems rather than having to fix them, Relentlessly eliminating waste and inefficiencies, Involving all staff, Benchmarking and sharing best practice, Monitoring and reviewing performance, Standards, Re Standards: Quality Management System, Lower level of errors, Continuous improvement, Change tone and theme - Introduce why talking about quality and TQM – enabler for efficiency ; improvements – prevention! Explain how – when introducing these - time; Study in UK – GPs /Practice Managers asked at a Development Forum – What key objective over next 6 months – > 70% said …what?

Learning from Industry Taking NHS England figures Severe errors  0.18%, Industry 6 sigma  0.0000034 % Why should healthcare & medication errors be at these levels? Only acceptable standard to aim for is ZERO errors – move towards a 6 sigma standard Standard – based on risk /impact /effort  Value Based Talk about “single dimension” thinking ? – we need to move to two, three and maybe even four dimensional thinking!

Using industry to help.. TQM - Total Quality Management, aspires to total customer satisfaction and focuses on the requirements of the customer - TQM focuses on “prevention” rather than “cure”. Lean aims to get one process to do only what the next process needs when it needs it; lean value streams extends this concept to link all processes from customer back to initial process. Value Added (Manufacturing in industry) looks at the manufacturing process in its entirety and breaks down every detailed action into a value add (VA) or non-value add ( NVA) activity. Aim is to eliminate all NVA’s. 5S - a philosophy that focuses on effective workplace organisation. It simplifies and enhances your work environment whilst improving quality and efficiency. Kaizen Event - any action whose output is an improvement to existing process. Promotes a “hands- on, get stuck in” approach. VALUE ADDED CARE  VAC

Improvement Model Report errors Review & analyse Agree changes Implement Monitor NO BLAME CULTURE

“ 5 S” - Prevention!

Quality Systems c. Alpha Primary Care Ltd 2009

Standards - Quality v Compliance… ‘BE QUALITY RATHER THAN COMPLIANCE DRIVEN’ Compliance will then follow… HIQA

Quality v Compliance A Compliance focus is putting in sufficient effort to meet HIQA’s & Legal minimum requirements. A Quality focus, on the other hand, is derived from a systematic continuous improvement process where management, resources and measurement systems are aligned and operated in such a way that continuous improvement and compliance is an inescapable outcome.  An organisation will never achieve those benefits with a compliance-only approach. Continuous Improvement (CI) holds the key to not only compliance, but even more so to improved productivity and therefore increased profitability. 9/7/2018 C. Alpha Healthcare Ltd 2006

Quality Improvement Division -HSE Who we are The Quality Improvement Division was established in 2015 to support the development of a culture that ensures improvement of quality of care is at the heart of all services that the HSE delivers. Our mission To work in partnership with patients, families and all who work in the health system to innovate and improve the quality and safety of our care. Role and function Our role is to champion, educate and build capacity for quality improvement; demonstrate new ideas and approaches to quality improvement.   Decision Making The National Quality Improvement Division has no role in providing services or administrating schemes for patients or service users. It does engage in funding Quality Improvement Programmes and Initiatives. 

Quality Improvement Division -HSE

QID Source: Dr P Crowley 9/7/2018 C. Alpha Healthcare Ltd 2006

Framework for Improving Quality 9/7/2018 C. Alpha Healthcare Ltd 2006

QI and Patient Safety https://www.youtube.com/watch?v=BjsvCe1vpiw

9/7/2018 C. Alpha Healthcare Ltd 2006

Framework for Improving Quality 9/7/2018 C. Alpha Healthcare Ltd 2006

QI Programs Quality Improvement Programmes being led by the Quality Improvement Division include: Global Health Assisted Decision Making Open Disclosure Audit Support Consent

Case Study : Reducing A&E and Emergency Admissions Approach ( Medical Centre, NE England – 15 GP Centre): Patients in Care Homes: Identified as one of the main areas for avoidable admissions, Optimise CDM of these patients Increase medication review rates to optimise treatment control Medication Review Protocol revised: Diabetic Patient Care: Complex patient pathway for diabetic care; Access problems for patients, Backlogs of waiting patients

Case Study - Diabetes Pathway: Identified access issues Reviewed patient pathway Set out review criteria Podiatrist Nurse Dietician GP Patient f

Case Study - Diabetes Result: New patient pathway defined Improved Diabetic Clinical review Increased Diabetic review capacity by 100% in 3 months, Eliminated patient backlog Leading to: Improved patient care, Clinically improved patient pathway Patients seen in community environment Better access ISO 9001 2008

Learning Aims Patient safety Quality Improvement (QI) Quality Improvement Division Quality v Compliance

Dr Jack Nagle Contact Details: jnagle@alphaprimarycare.com www.alphaprimarycare.com C. Alpha Healthcare Ltd 2006

The HSE Global Health The main goal of the programme is to make an effective contribution towards improving health in less developed countries main strategy is to facilitate linkages between Irish hospitals / health institutions and similar institutions in other countries.

Assisted Decision Making (Capacity) Act 2015 The Assisted Decision -Making (Capacity) Act was signed into law in December 2015 It repeals the Victorian Lunacy Regulations (Ireland) Act 1871 Replaces the dated “all or nothing” system when it comes to capacity It is about supporting decision making and maximising a person’s capacity to make decisions. Yet to be enacted..

Open Disclosure Supporting an open, timely and consistent approach to communicating with service users and their families when things go wrong in healthcare

Clinical Audit Clinical audit is the systematic review and evaluation of current practice against research based standards with a view to improving clinical care for service users.

National Consent Policy Consent is the giving of permission or agreement for an intervention, receipt or use of a service or participation in research following a process of communication about the proposed intervention. The National Consent Policy provides one overarching HSE policy to guide staff.