1. 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: UK:

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

3. What is Safety?

4. 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…...

5. What is Patient Safety?
Greater Risk..

6. 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.

7. Patient Safety

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

10. 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

11. Patient Safety

12. 9/7/2018
C. Alpha Healthcare Ltd 2006

13. 9/7/2018
C. Alpha Healthcare Ltd 2006

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

15. 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

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

17. 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

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

19. 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

20. 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

21. 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

22. 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?

23. Learning from Industry
Taking NHS England figures
Severe errors  0.18%,
Industry 6 sigma  %
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!

24. 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

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

26. “ 5 S” - Prevention!

27. Quality Systems
c. Alpha Primary Care Ltd 2009

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

29. 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

30. 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. 

31. Quality Improvement Division -HSE

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

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

34. QI and Patient Safety

35. 9/7/2018
C. Alpha Healthcare Ltd 2006

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

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

38. 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

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

40. 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

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

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

43. 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.

44. 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..

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

46. 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.

47. 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.