Implementing the National Safety and Quality Health Service Standards Margaret Banks Program Director June 2, 2015 What is, and what is to come.

The system 1440 health services 53% public hospitals 21% private hospitals 22% day procedure services 4% other public health facilities 44 interim assessments since Jan 2013 Additional services: Community health services, dental services, prisons health services, Ambulance, Royal Flying Doctor Service

2013 and 2014 Comparison Total no. of services assessed7501,072 Public health services44%55% Private health services56%45% Mid cycle assessments60%40% Organisation wide assessments37%58% Interim assessments2%

Percentage facilities assessed

Distribution of not met actions 747

Rating at initial assessment for core actions all assessment types for 2013 and 2014 Total 2013 Health service with all actions met56% Health service with actions that need to be re- assessed within 120 days 44% Health services not accredited0% 2014 Health service with all actions met63% Health service with actions that need to be re- assessed within 90 days 37% Health services not accredited<1%

Top core not met actions for all types of assessments 2014 ActionRequirement Number of services with not met core actions PublicPrivateTotal Auditing of compliance to aseptic technique Taking action to increase compliance to aseptic technique Monitoring of antimicrobial usage and resistance Taking action to improve antimicrobial stewardship Undertaking regular environmental cleaning audits Organisation-wide management system is in place for development, implementation and review of protocols Participation of clinical workforce in regular performance reviews Regularly reviewing the effectiveness of the infection prevention and control systems Access to ongoing S&Q training for the workforce Training in aseptic technique193453

Core actions not met at organisation-wide assessment as a percentage of total number of actions in each Standard

Developmental actions not met at organisation-wide assessment as a percentage of total number of actions in each Standard

Evaluation of the NSQHS Standards Formal external evaluation Consumer survey pre and post accreditation Cost-benefit analysis Interrogation of State and Territory administrative data sets pre and post Standards implementation Longitudinal survey of attitudes Ongoing evaluation Ongoing review of accreditation outcome data and feedback from the system Review of approved accrediting agencies and the approvals process

What people have said: “Quality used to be ‘quality’s’ job, but now it’s everyone’s job.” “Overall the standards are positive in effect. The real clinically important issues have been chosen.” “Having an independent person reviewing your practice is a very good way of ensuring quality.”

Evaluation – where are we up to: High degree of awareness of the NSQHS Standards Driving clinical engagement Too early to be able to make direct links with improvements in patient care Broad agreement the standards are having a positive effect on health care Standards provide a consistent framework for defining good care and monitoring improvement The Standards provide consistency for staff working across multiple sites and sectors

Review of the NSQHS Standards Commence 2015 Collating and interpreting information from the informal and formal evaluation processes Consulting with consumers, technical experts, nurses, doctors and allied health Consider national and international issues emerging in safety and quality

Guiding Principles The aim of the Standards to protect the public from harm and improve the quality of health service will be retained. Universal patient safety standards that can be applied across all health care settings Focus on areas of known risk to patients, where there is good evident of safer care Focus on implementation of systems to prevent harm Reduce duplication Address concerns with version 1

Feedback on version 1 NSQHS Standards Positive feedback Address major safety and quality issues Are clinically focused Are patient-centred Are making a difference to safety and quality in health services Negative feedbacks Are applicable but difficult to interpret across all health care sectors Burden of audit Auditing demonstrates gap, but it can be difficult to address these gaps Variable levels of engagement of medical staff Difficulty implementing Standard 2 Duplication of actions and evidence required at accreditation Burden associated with increased documentation Nutrition, end of life, bariatric, mental health and cognitive impairment not covered.

Issue for nurses the Standards are not just the responsibility of nurses medical practitioners are difficult to engage the Standards need interpreting for services such as community, multi-purpose services don’t want auditing for auditing sake the burden of auditing takes nurses away from patient care Commission resources are too dense for frontline staff language used in the resources doesn’t resonate with clinicians

Research into safety and quality Mental health Cognitive impairment End of life care Health literacy Aboriginal health

National Safety and Quality Health Services 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

New areas introduced into version 2 of the NSQHS Standards Leadership Safe environment Organ and tissue donation Malnutrition and dehydration Diversity of consumers provided with care Social, economic and geographic circumstances of consumers

National Safety and Quality Health Services Standards

NSQHS Standards NSQHS Standards version 1NSQHS Standards version 2 1. Governance for Safety and Quality in Health Service Organisations GSGovernance for safety and quality 2.Partnering with ConsumersPCPartnering with consumers 3. Preventing and Controlling Healthcare Associated Infections IC Preventing and controlling healthcare associated infections 4.Medication SafetyMSMedication safety 5. Patient Identification and Procedure Matching CSCommunicating for safety 6.Clinical Handover - CCConsumer-centred care - RHReducing harm where risks are high 7.Blood and Blood ProductsBPBlood and blood products 8. Preventing and Managing Pressure Injuries - 9. Recognising and Responding to Clinical Deterioration in Acute Health Care RR Recognising and responding to acute deterioration 10.Preventing Falls and Harm from Falls -

Feedback from stakeholders Resources reviewed, updated, approved and distributed Development and delivery of education and training NSQHS Standards Education and training Resources DraftingPilotingEndorsement Finalising draft Review of the NSQHS Standards – key milestones and activities Regulatory Impact Statement Cost benefit assessment Review and amend Australian Health Service Safety and Quality Accreditation scheme Implementation requirements

Proposed deliverables from the review process 1.NSQHS Standards, version 2 2.Revised Safety and Quality Improvement Guides 3.Accreditation workbooks tools 4.Translation of the NSQHS Standards for consumers 5.Identification of the training requirements of the NSQHS Standards for education bodies and health service organisations 6.Associated safety and quality measures for each Standard 7.Train the trainer package for accrediting agencies and surveyor and information packages for health services

Recently released Consultation draft: Guide to the NSQHS Standards for community health services Guide to the NSQHS Standards for health service boards National Consensus Statement: Essential elements for safe and high-quality end-of-life care Consultation draft: Delirium Clinical Care Standard Consultation draft: Hip Fracture Care Clinical Care Standard App resource: for clinicians “A better way to care” for dementia and delirium Release of the National Strategy to address antibiotic overuse