1. Quality and Patient Safety: QPS Audit Ms. Edwina Dunne Director Quality Patient Safety Audit Quality and Patient Safety Directorate

2. Knowledgeable patients, receiving safe and effective care from skilled professionals in appropriate environments with assessed outcomes Vision Source: Commission on Patient Safety and Quality Assurance (2008)

3. Clinical Governance  Clinical governance is defined today as: A framework through which healthcare teams are accountable for the quality, safety and satisfaction of patients in the care they have delivered.  For health care staff this means: Specifying the clinical standards you are going to deliver and showing everyone the measurements you have made to demonstrate that you have done what you set out to do. “Corporate accountability for clinical performance” (The Scottish Office, 1997)

4. Whose door? Clinical Care/ Corporate Functions/ Management Team/ Board

5. Vision for clinical governance development  Each individual, as part of a team: Knows the purpose and function of leadership and accountability for good clinical and social care; Knows their responsibility, level of authority and who they are accountable to; Understands how the principles of clinical governance can be applied in their diverse practice; Consistently demonstrates a commitment to the principles of clinical governance in decision making  A culture of trust, openness, respect and caring is evident among mangers, clinicians, staff and patients  Clinical governance is embedded within the overall corporate governance arrangements for the statutory and voluntary health and personal social services in realising improved outcome for patients.

6. Principles for Good Clinical Governance

7. “My job is to make sure that patients are safe and well cared for…and I have no other”. (Colin Ovington, Director of Nursing and Midwifery, Mid Staffordshire Trust, 2011) Three elements of quality  Patient care (clinical outcome)  Patient experience  Staff experience. The Clinical Governance..Mantra

8. Embedding Clinical Governance Processes in Corporate Governance  “The resonance of the two terms is important, for if clinical governance is to be successful it must be underpinned by the same strengths as corporate governance; it must be rigorous in its emphasis, accountable in its delivery, developmental in its thrust and responsive in its connotations” (Scally and Donaldson, 1998)

9. Assurance  Is confidence, based on sufficient evidence, that internal controls are in place and are operating effectively, and that objectives are being met. (NHS Internal Audit Standards)  Assurance “Gap” The risk committee prompt! The assurance framework in the HSE had three levels of assurance (1,3, and 4). No internal independent assurance for healthcare services. The controls assurance process did not formally include clinical and social care services.

10. HSE, Assurance Framework 2010 QPSD

11. Definition of Clinical/healthcare Guidelines  C. G. are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioners and patients decisions about appropriates healthcare for specific clinical circumstances, across the entire spectrum.  Adapted from Fiels and Lohr,(1992,) in HSE, National Clinical Audit Guidance Document, 2013, pending

12. Clinical Audit Level 1.  ‘A clinically led, quality improvement process that seeks to improve patient care and outcomes through the systematic review of care against explicit criteria and to act to improve care when standards are not met’  Commission on patient Safety and Quality Assurance (2008, p.152.)

13. Clinical Audit  ‘ Constitutes the single most important method which any healthcare organisation can use to understand and ensure the quality of the service that it provides ’ CA is a tool which can be used to discover how clinical care is being provided and to learn if there are opportunities for improvement  Commission on patient Safety and Quality Assurance (2008, p.152.)

14. Quality Patient Safety Audit QPSA as part of the HSE assurance framework provides independent internal assurance for healthcare services on compliance to standards, policies and procedures. This assurance adds value to our services by building trust and confidence… “that we are delivering high quality safe services for all our patients and clients” (National Service Plan, 2012). Q

15. QPS Audit  Established in 2010 based on feasibility study and research on models - national and other jurisdictions (private & public).  Auditors recruited 16 internally and trained internally, auditor training, action learning, learning sets, team work.  SOP adopted from internal audit (NHS) and internal audit collaboration.  Audit requests sought from the Regional Director of Operations (RDO) level up.

16. QPS Audit, Level 2. Assurance  Provides independent assurance by testing the self assessment (Level 1) on the level of compliance to which standards/guidelines for health care activity are met across the system.  Identifying reasons why they are not met.  Make recommendations to implement change to achieve the required standard/best practice.  Follow-up audits will monitor the implementation of the recommendations.

17. 2011 Target 2011ou Outturn % target achie ved 2012 Targe t 2012 Outtu rn % target achiev ed Audits Commenced 2021105%2426108% Audits Completed on schedule 17 100%2023115% QPSA performance in 2011-12.

18. Directorate Distribution of Audits Progressed over 24 months, January 2011 – December 2012 Table 2: CompleteClosedAudit In Progress Scoping / Pre-Audit Total Hospitals128121 Primary Care2114 Mental Health235 Social Care 3 * 1 ** 5 Children ’ s Services 112 QPSD432110 Total23175247

19. Distribution of Audit Requests (30) 2012

20. QPSA Distribution of Audits Progressed, 2011 vs. 2012

21. QPSA Final Audit Recommendations: 2011 vs. 2012, by Category Heading2011 Recommendations2012 Recommendations Communication 11%22% Data Quality & Audit 11%20% Information Technology & Equipment 14%6% Policies, Procedures, Protocols and Guidelines (PPPGs) 13%22% Records Management 2%3% Risk & Controls 16%5% Service Development & Reconfiguration 4%6% Staffing 4%2% Standards & Definitions 9%3% Training 18%9%

22. QPSA in Challenging Times  New pro-active service/ innovation in QPSD that is working for patient safety and quality.  Is providing assurance that the controls for managing Healthcare risks are effective (making risk management real).  Is Identifying area of excellence/good practice, acknowledge and share at senior management team, board and across the services internally and externally.  Is Identifying areas of weakness and making recommendations to address.  Is improving the quality and reliability of information, used as basis for clinical and social care decision making.  Is embedding clinical governance in corporate governance equal to finance as part of Controls Assurance Process.  The “Voice” for clinical service at SMT and Board

23. Nursing in uncertain times  Leadership  ‘Leading in Uncertain Times Programme’  National Leadership and Innovation Centre  Quality Improvement Projects?  So What??? Where do we go from here?

24. “Excellence is never an accident. It is always the result of high intention, sincere effort, and intelligent execution; it represents the wise choice of many alternatives - choice, not chance, determines your destiny.” (Aristotle, 384 BC – 322 BC)

25. Thank you Edwina Dunne Director of Quality Patient Safety Audit R. 125, Dr. Steevens’ Hospital Dublin 8 Edwina.dunne@hse.ie 01 6352389.