1. Healthcare Quality and Patient Safety Brasilia August 2013 www.isqua.org

2. ISQua Background  Non-profit, independent organisation founded 1985, international office moved Australia to Dublin in 2008  Members from 70 Countries (Individual and Institutional)  Governed by Board of 10: North America, South America, Europe, Asia / Pacific regions  Honorary Advisors: patients, accreditation, education, research, low and middle income countries  Board Committees (Editorial Committee, Accreditation Council: CBA, Brazil)

3. International Reach

4. ISQua Accreditation Activity in South America 4  Health Accreditation Service, Columbia  CBA, Brazil 2013/2014  ONA, Brazil 2013

5. Strategic Alliances 5  WHO – Official Relations  Health Technology Assessment International (HTAi)  URC/USAID  International Hospitals Foundation  Institute for Healthcare Improvement (IHI)

6. High Reliability Healthcare

7. WHO Facts about patient safety  In developed countries up to 10% of patients may be harmed while receiving hospital care  Risk of health care-associated infection in some developing countries is up to 20 times higher than in developed countries  In some countries, proportion of injections given with syringes/needles reused without sterilization is up to 70%. Unsafe injections cause 1.3 million deaths annually. 300,000 die in India from dirty syringes and 30% are reused  > 50% of medical equipment in developing countries is unusable, or only partly usable, and can result in serious injury or death  There is a 1:1,000,000 chance of a traveller being harmed in an aircraft. There is a 1:300 chance of a patient being harmed during health care

8. Key Ingredients Safety Quality Reliability Culture of Learning Informed Decision-Making It’s all about….

10. “Systems and processes are only as good as the people who work within them”

11. COMMUNICATIONS RELATIONSHIPS BEHAVIOURS MULTI-DISCIPLINARY TEAM WORKING CULTURE LEADERSHIP

12. Title Slide Bullet Point 1 Bullet Point 2 Bullet Point 3 Bullet Point 4

13. Leadership – Country Level  Understanding the population priorities for health and ‘social’ care  Aligning policy, strategy and resources for maximum overall population benefit  Developing and planning the workforce – building capacity and capability  Engaging with managers, clinicians and patients to mobilise for safety and quality improvement  Liberating the patient to safeguard their care and clarify expectations for safe services  Effective regulatory framework - responsive, pragmatic and proportionate

14. Global Context

15. Global Trends 1: Demographic  Economic slowdown  Globalization of diseases  Urbanization  Global mobility: professionals and patients (Regional strategies, health tourism)  Aging population: By 2050: - people over 65 ~= children < 14 - > 50’s population increase from 1.4 to 3.1 billion  Social care and support: older people, children, people with a disability

16. The Speed of Population Aging Time required or expected for percentage of population aged 65 and over to rise from 7 percent to 14 percent Source: Kinsella K, He W. An Aging World: 2008. Washington, DC: National Institute on Aging and U.S. Census Bureau, 2009.

17. Global Trends 2: Quality and Safety  Universal health coverage and integrated care  Reducing inequalities  Quality and safety frameworks: standards, measurement and evaluation – accreditation, licensing  Informed decision-making: Cost, clinical and comparative effectiveness. Health Technology Assessment: We should treat where there is evidence of benefit and not treat where there is evidence of no benefit (or harm)  Measuring performance and outcomes  Optimising technology solutions

18. Regulating for Improvement

19.  Core element to quality and safety agenda  Clear coherent quality and safety framework: legislation ~ standards ~ guidance  Outcome-based standards and assessment  Focus on the important…support…and persist  Not there to manage the system’s comfort zone  ‘Safety ripple-effect’ in everything we do: wider system learning  ‘Minding the safety gap’ between Regulators

20. Get it safe....keep it safe....and then we’ll build quality

21. “The future depends on what we do in the present.” Mahatma Gandhi