STRATEGIC PLANNING, LEADERSHIP AND IMPLEMENTATION FOR PATIENT SAFETY Michele McKinnon Director, Safety and Quality SA HEALTH

SA Health SESSION OUTLINE >Introduction to SA Health >Context of Governance for Safety and Quality Australia South Australia >What informs both strategic planning and work plan development >Exercise on Governance >Leadership and implementation – lived examples

SA Health WELCOME TO SOUTH AUSTRALIA >Population of 1.67 million 3

SA Health SA HEALTH AT A GLANCE >On any day, on average… people were admitted to public hospitals 1498 people were treated in accident and Emergency Departments 5130 people were seen in hospital outpatient clinics Ambulance service responded to 719 incidents and assessed, treated or transported 640 patients. >Each week…. 900 South Australians had an elective surgery procedure 4400 patient visits were made by Royal District Nursing Service nurses 4860 patient were screened for breast cancer, cervical cancer, or bowel cancer. 4

SA Health WHAT ARE THE CURRENT CHALLENGES? >Ageing population >Increasing demand >Growing burden of chronic disease >The high cost of new technologies >Workforce shortages and age of workforce >Ageing infrastructure >Increasing patient harm Health care associated infection Deteriorating patient Medication safety Unwarranted variation in practice >Poor consumer experience 5

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SA Health OBJECTIVE AND ROLE OF DEPARTMENT OF HEALTH >Key objective is to lead and deliver a comprehensive and sustainable health system that aims to ensure healthier, longer & better lives. >Role of Department – assists Minister for Health to set the policy framework & strategic directions for SA Health.

SA Health NATIONAL STRATEGIC CONTEXT >National Australian Commission on Safety and Quality in Healthcare  Leads and coordinates health care safety and quality improvements in Australia  Australian Safety and Quality Framework for Health Care >Consumer Centred >Driven by Information >Organised for Safety  3 year work plan endorsed by Australian Health Minister Advisory Council

SA Health NATIONAL STRATEGIC CONTEXT >Priority areas included in 2013/16 work 1.National safety and clinical standards 2.Formulation and implementation of national accreditation schemes 3.Reduction in unwarranted variation in practice and outcomes for individuals and populations 4.Nationally coordinated action to address healthcare associated infections and antimicrobial resistance 5.National data set development 6.Publishing and reporting 7.Knowledge and leadership for safety and quality. 9

SA Health National Safety & Quality Health Service Standards Standard 7 Blood and Blood Products Standard 10 Preventing Falls and Harm from Falls Standard 1 Governance for Safety and Quality in Health Service Organisations Standard 2 Partnering with Consumers Standard 4 Medication Safety Standard 3 Healthcare Associated Infections Standard 8 Preventing and Managing Pressure Injuries Standard 9 Recognising and Responding to Clinical Deterioration in Acute Health Care Standard 5 Patient Identification and Procedure Matching Standard 6 Clinical Handover

SA Health AUSTRALIAN SAFETY AND QUALITY GOALS 11

SA Health STATE STRATEGIC CONTEXT >State Aligned program of work to National, particular focus on National Standards Established governance through:  Strategic / operational / advisory groups  Policy / guidelines / tools for implementation >Process and outcome measures >Communication plan >Education and training plan  Reporting >Patient Safety Report >Monthly performance >Safety Learning System >Consumer Experience

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SA Health AUSTRALIAN FRAMEWORK APPLIED LOCALLY 1.Consumer Centred 1. Charter of rights 2. Feedback through Safety Learning System >Compliment / advice / suggestion / complaint 3. Consumer Experience >Monthly surveillance system >Internationally validated tool 4. Review of Consumer & Community participation policy / guideline 5. Open Disclosure 6. Communication and teamwork

SA Health AUSTRALIAN FRAMEWORK APPLIED LOCALLY >Driven by Information 1.Annual patient safety report 2.Monthly safety and quality report  Patient incidents >Harm (SAC 1/2) >Number (culture) >Type >Sentinel  Healthcare associated Infection >MRSA – acquisition / infections >SABS >Clostridium >VRE >Hand hygiene

SA Health AUSTRALIAN FRAMEWORK APPLIED LOCALLY >Driven by Information Clinical Incident / Risk Screening Process  Coroner notifications  Coroner’s findings of inquest and follow up  SAC 1 / 2 incidents (includes sentinel)  Recommendations arising from investigations / RCA  Notifications to Insurers  TGA  SAICORP / Legal recommendations  Recommendations from Annual reports: >Pregnancy outcome >Perioperative Mortality Clinical networks

SA Health AUSTRALIAN FRAMEWORK APPLIED LOCALLY >Organised for Safety Healthcare associated infection  Hand hygiene  Antimicrobial stewardship  Surveillance  Infection Control guidelines Medication safety Patient identification  Standardised arm band  Labels – 3 identifiers  Surgical Team Safety Checklist

SA Health AUSTRALIAN FRAMEWORK APPLIED LOCALLY >Organised for Safety Safety Alert Broadcast System Equipment / procurement Safety by Design  EPAS  NRAH and other building projects Mandated accreditation process for all SA Health Services Education and training  Simulated Learning Environments  Core competency Credentialling and Scope of Clinical Practice

SA Health AUSTRALIAN FRAMEWORK APPLIED LOCALLY >Organised for Safety Clinical Handover ISBAR App Communication and Teamwork TeamSTEPPS Blood and Blood Product Pressure Injury Recognising and responding to clinical deterioration Preventing Falls and Fall Injury

SA Health WHAT INFORMS A STRATEGIC SAFETY AND QUALITY PLAN >Considerations: New legislation or changes to National standards that have been mandated by government Existing strategic plans for government and health Role of health department – centralised vs decentralised Emerging clinical risk issues  Medical malpractice notifications  Coroner  Patient safety incidents Community / consumer experience and expectation

EXERCISE GOVERNANCE FOR SAFETY AND QUALITY

SA Health GOVERNANCE FOR SAFETY AND QUALITY >53 actions required – 49 which are core / 4 developmental (A) Governance & quality improvement systems (B) Clinical practice (C) Performance and skills management (D) Incident and complaints management (E) Patient rights and engagement 22

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IMPLEMENTATION FOR PATIENT SAFETY 24

SA Health CRITICAL FACTORS >Policy framework >Communication strategy Communication plan >Education, Training and Competencies >Systems of collection and analysis

SA Health CRITICAL FACTORS >Policy framework Advisory Group (clinical experts and representatives) clearly articulated terms of reference Strategic action plan Governance  Policy directive  Guideline  Tool kit to support implementation >Information sheet – staff >Information sheet – patient / consumers >Frequently asked questions >Assessment tools / surveys

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Working together for patient safety – free download from iTunes

ISBAR iPhone/iPad App A tool to support effective clinical handover

SA Health SUSTAINABLE EDUCATION PLATFORM

SA Health FALLS PREVENTION

SA Health SYSTEMS OF COLLECTION AND ANALYSIS >Safety and quality metrics Leverage existing systems and processes for data capture by health services to improve quality and safety across SA Health by providing standardised, accurate and timely information on safety and quality >Monitoring progress of implementation and outcomes over time

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FALLS

SA Health CLINICAL HANDOVER

SA Health HAND HYGIENE

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Consumer Experience Annual Report

THANK YOU QUESTIONS?