Quality and safety the national context RCSI Masterclass 6-11-12 Dr. Philip Crowley, National Director Quality Improvement The challenge that faces us       Budget Medical and nursing recruitment and retention Limited measurement of quality Media and morale New divisions – focus vs integration Fire fighting (comfortable) Vs process, practice and care improvement Nursing and Midwifery Developments  Expanding roles  Nurse and Midwifery Prescribing (medicinal products and X-ray)  Advanced practice (eg EDs, sexual assault, chronic disease mangement)  Driving key safety initiatives  NEWScores/IMews  Collaboratives,   pressure ulcers, falls Measuring Care (Nursing and midwifery) metrics Leading Quality Improvements Mid Staffs and nurse leadership    Presented to HSE leadership team X 2 Communication to system re acting up Audit:  229 CNM2/CMM2 posts acting up  = 14%  Ongoing support for developing CNM/CMM2 competency  Moderate levels of empowerment, time to lead?  And DoNs, ADoNs, CNM3??? Flipping Healthcare Move from “What’s the matter?” to “What matters to you?”     The patient is not the problem (Muir Gray) “Minimally Disruptive Medicine” (Victor Montori) Having conversations with the patient, understanding patients (not just their diseases) and their lives Patient goal setting Source: Barry MJ, Edgman-Levitan S. ”Shared Decision Making – The Pinnacle of Patient-Centered Care.” N Engl J Med. 366;9. pp 780-782. Montori, VM. “Shrinking the health care footprint.” Minnesota Physician. XXV(1). April, 2011 Quality led by Staff      Staff experience – seek and value feedback and ideas for improvement Quality and safety Walk-rounds Enable people to do a better job ‘Walk in my shoes’ Do reinvent the wheel QI Tools Driver Diagram Run Chart Greatest impact at ward level Leadership Patient involvement Clinical Governance Education & Learning: - Measurement - QI Methods Pathways Guidelines EWS Collaboratives Conditions Quality Improvement of Patient care National Trust Ward Increasing capacity for QI Now over 200 staff trained in QI from the Diploma, Scottish Patient Safety and CAWT Programmes. Pressure Ulcer to Zero Collaborative 73% Reduction in Pressure Ulcers Collaborative methodology February April June Final Celebratory Event Overall Collaborative trend over time 25 20 15 10 5 0 February March April May June July August Overall key learning was Teamwork – the benefits of working with a team/group and the visual impact of keeping data’ Key learning was the importance of working together, good collaboration and communication. Comments If managers support QI initiatives, teams can achieve great results. It’s all about teamwork and communication with a smile. Great team building experience My only advice or request is if you could organise the kind of learning sessions often, that would be a great help and encouragement. Academic Hospital Groups Academic Hospital Groups Can we move from “teaching hospitals” to “learning hospitals” and care settings? Where learning together about how we can improve quality and safety is at the heart of what we do Clear roles for Quality and Safety  Board  Providing direction and leadership  Overseeing/obtaining assurance on clinical care quality and safety (Board Q +S committee)   Executive  Operationally managing clinical care quality and safety (Executive Q+S committee) Staff  Delivering quality safe compassionate care  Contributing improvement solutions How can QI division support you? Quality Improvement Division Patients and Staff partnership Quality Improvement Capacity building Quality data analysis and audit Strategy and innovation Quality Improvement “We have two jobs: our job and the job of improving our job” Donald Berwick Philip Crowley [email protected] www.hse.ie/go/qps