Caring,Sharing,Devotion,Worship Dr TA Taylor Wellington 2009

Significant Event - Using what we have

Significant Event Definition: Dr TA Taylor Wellington 2009 “ any event that any member of the team considers to be significant in terms of the care of the patient and the conduct of the practice[organisation] ” (Pringle et al.; 1995)

“ Doctors will become safe when they choose to become safe” Five Years After To Err is Human – What have we Learned? Lucian Leap & Don Berwick. Jama.2005; 293 : Dr TA Taylor Wellington 2009

Significant Event Definition Our Definition: “ Any situation, event, process, attitude and/or behaviour that another person can learn from to improve the outcome.” Dr TA Taylor Wellington 2009 “ any event that any member of the team considers to be significant in terms of the care of the patient and the conduct of the practice[organisation] ” (Pringle et al.; 1995

CMDHB projected population growth by ethnicity Maaori PacificAsian Other Total ,70058,70028,800204,800354, ,23078,55047,700198,200393, ,10090,80068, , , ,000103,00081,600216,100483, ,600114,90097,200221,100522, ,600127,500109,100228,800562, ,300141,100120, , ,500 % change %80%152% 19% 53% Source: 1996 and 2001 are Census data. Remainder Statistics NZ medium ethnic-specific projections for MoH Nov Ethnicity is prioritised in the order given in the table Dr TA Taylor Wellington 2009

Socio-economic status 37% ( ) people NZ Dep Index 9 – 10 58% ( ) of All Maori in CM Decile % ( )of All Pacific people in CM Decile % of 0 – 4 yr old in CM live in Decile NZ Census 2001 Dr TA Taylor Wellington 2009

Nurse GP Clinical Assistant Receptionist Patient Whanau Dr TA Taylor Wellington 2009

Registered Population Enrolled and Funded Pacific People Maori Patients Clinics 40 Reception staff 12 Clinics 47 GP’s 45 Nurses 9 Clinical Assistants 9 Management 16 Admin Support Dr TA Taylor Wellington 2009

New Zealand Trained Doctors 7 New Zealand Trained Doctors Pakeha 2 New Zealand Trained Doctors Asian 2 New Zealand Trained Doctors Pacific 3 IMG Maori 1 IMG 41 (87%) Doctors from Multicultural and Diverse Backgrounds Dr TA Taylor Wellington 2009

25 Doctors are Fellows of RNZCGP 20 Doctors are working towards it (GPEP1 and GPEP2) 1 Clinic ACC/ AMPA Accredited 56 Staff Achieved the CBMC Certificate Culture of Quality Dr TA Taylor Wellington 2009

Quality Pursuits - Cornerstone Accreditation

KnowledgeAttitudesBehaviour Lack of awareness Lack of agreement with evidence External barriers Volume of information Uncertain interpretation Environmental factors Barriers to evidence uptake Sources of behaviour change Institutional factors Unclear applicability Access to resources Lack of motivation of previous practice

In 2006 ~ 10 SE per quarter ( 3.3 per month) In 2007 onwards ~ 50 SE per month ( 150 per quarter) ETHC SE Reporting Dr TA Taylor Wellington 2009

What Does this Mean ? Are we getting worse ? Does this increase our risk ? (professional, financial, other) Are our patients at more risk ? Dr TA Taylor Wellington 2009

Definition: “Any activity or process that facilitates the transfer of high quality evidence from research into effective changes in health policy, clinical practice, or products.” “…combines the elements of research, education, quality improvement, and electronic systems development to create a seamless linkage between interventions that improve patient care and their routine implementation in daily clinical practice.” Ann Emerg Med. 2007;49: Knowledge Translation Dr TA Taylor Wellington 2009

Consequences Likelihood InsignificantMinorModerateMajorCatastrophic A (Almost certain) HHEEE B (Likely) MHHEE C (Moderate) LMHEE D (Unlikely) LLMHE E (Rare) LLMHH

P C M G Identification – Documentation – Reflection Cycles

Challenges How do we engage our patients in developing safer environments ? Technological Advances at its best can only reflect human relationships Governance - Taking it Seriously

Pre-requisites Right culture Right leadership Right relationships Right systems Regular reflection on practice Take Home Messages Dr TA Taylor Wellington 2009

“ Doctors will become safe when they choose to become safe” Five Years After To Err is Human – What have we Learned? Lucian Leap & Don Berwick. Jama.2005; 293 : Waiting until doctors choose to become safe is not an option. Safety is first and foremost the patients prerogative. We need to develop toxic environments for poor and unsafe practices – These are called Learning Environments. Dr TA Taylor Wellington 2009

Thank You