Download Scoping the Priorities for Quality in the Health

REPORT
Scoping the Priorities for Quality in the
Health and Disability Sector
Prepared for the New Zealand Minister of
Health
10th November 2006
Scoping the Priorities for Quality in the Health and Disability Sector
Executive Summary
Prepared by: Communio
Page 2 of 11
Executive Summary
Scoping the Priorities for Quality in the Health and Disability Sector
The Project
Purpose
The purpose of this report is to provide a way forward for progressing action
in six priority areas in quality in the New Zealand health and disability
sector. This report provides the scope of the six programmes proposed for
addressing these six priorities, including the strategy, the high level
implementation plan and the high level costs.
The six
Priorities
The priorities are:
1. The development and implementation of a nationally consistent
approach to the management of health care incidents. This should
include a major focus on the “open disclosure” of adverse events.
2. The implementation of a national programme for the improved
management of medications across all health and disability sectors. The
strategy should focus on medication reconciliation and high risk
medication management.
3. The development and implementation of a national programme that is
designed to improve the patient centredness and flow of patients in the
inpatient setting.
4. The development and implementation of a national programme for
infection control and prevention.
5. The provision of education and training for all health professional teams
in quality improvement methods.
6. The implementation of a strategy for improving consumer participation
in the health and disability sector.
This report and the programmes contained herein will form the basis of the
Improving Quality Action Plan for 2007 – 2010. The revision of this plan in
2006, was a Ministerial commitment made in 2003 when the plan was first
developed.
Prepared by: Communio
Page 3 of 11
Executive Summary
Scoping the Priorities for Quality in the Health and Disability Sector
What will make
these
programmes
work?
The primary objective in the identification, development and implementation
of these six priority programmes for the health and disability sector is to
improve the quality of care provided to consumers of health and disability
services in New Zealand. The New Zealand health and disability sector is
large and complex with 21 District Health Boards providing care and services
from several hundred service delivery points. Significant improvements will
be achieved if a number of enabling factors exist, or are created.
These can be categorised into four fundamental enablers:
1. Effective governance and accountability arrangements
Effective governance requires the right instruments, supports and structures,
to be in place to achieve accountability and sustained improvement. This
report recommends a framework for achieving this. The framework clearly
identifies the role of EpiQual, the Ministry of Health, the DHBs and clinicians
in the implementation of these programmes.
2. Sound and nationally co-ordinated implementation strategies.
Central co-ordination ensure action and accountability, enhances knowledge
management and allows lessons learnt in one organisation to be disseminated
across the nation. To achieve effective national co-ordination there need to be
sound implementation strategies. Each of the programmes identified in this
report is accompanied by such a strategy.
3. Effective project management.
The objectives for each of these programmes are ambitious, but still very
achievable. The scope is large, but realistic. The timeframes that are
suggested are tight but achievable. DHBs will need to be assisted in their
implementation efforts, through effective, nationally co-ordinated, project
management processes.
4. Leadership for culture change
It is essential that this leadership is demonstrated at all levels of the
organisation of health and disability services. A number of the programmes
that are proposed in this report, will go some way towards addressing the
leadership issue, in the many education and training programmes proposed
and the governance structures proposed.
Prepared by: Communio
Page 4 of 11
Executive Summary
Scoping the Priorities for Quality in the Health and Disability Sector
Each of the proposed programmes is summarised below.
PRIORITY 1
Incident
Management
There are two main components of this programme that need to be
developed and implemented in parallel over approximately eighteen
months to two years. By the end of this period the two components will
come together to form an integrated incident management system for New
Zealand.
COMPONENT 1
COMPONENT 2
THE CULTURE and ENVIRONMENT
TECHNOLOGICAL SUPPORT
Identification of technical and
business specs for and IT solution
Identification or development of the
solution
Implementation of the solution
18 – 24 months
Policy development
Education and training
Ongoing
An integrated consistent
approach to incident
management across all
health and disability
services
Prepared by: Communio
Ongoing national
Aggregation and analysis
Policy and strategy development
to reduce harm
Public reporting
Monitoring, support, education
and training for providers
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Executive Summary
Scoping the Priorities for Quality in the Health and Disability Sector
PRIORITY 2
There are two main components of this programme that need to be
developed and implemented in parallel over approximately eighteen
months to two years. By the end of this period the two components will
come together to form an integrated medication management system for
New Zealand.
COMPONENT 1
COMPONENT 2
A Breakthrough Series Collaborative
for:
Common medication chart
Medicines reconciliation
High risk drugs management
Work practice change
Development of bar coding
system
Implementation of the bar coding
system
18 – 24 months
Medication
management
Ongoing
An integrated consistent
approach to medication
management across all
health and disability
services
Prepared by: Communio
Ongoing national:
Monitoring, support, education
and training for providers
Policy development for
improving medication
management
System maintenance
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Executive Summary
Scoping the Priorities for Quality in the Health and Disability Sector
PRIORITY 3
A national Collaborative (also known as a Breakthrough Series) is proposed.
Patient Flows
This method is proposed because it provides the ideal process for bringing
together all the various bodies of work that are currently under way in the
sector. It will also provide the implementation plan for the work that the two
recently established Ministry of Health working groups will be developing.
They have been charged with identifying better ways of doing their respective
components of patient flow. These groups are already undertaking a large
component of the work that an expert group would need to do in preparation
for the Collaborative. This method also provides the ideal environment for all
health and disability services to learn about and implement initiatives that are
derived from the Lean Thinking method. Many health services have already
taken the trip across to Australia or down to Canterbury, to learn the method
separately. This would allow all services to learn together and learn from each
other and achieve breakthrough improvement.
Prepared by: Communio
Page 7 of 11
Executive Summary
Scoping the Priorities for Quality in the Health and Disability Sector
PRIORITY 4
Infection
prevention and
control
The programme has three main components:
1. Surveillance of procedure-related and surgical site infections.
2. Implementation of a Clean Care is Safer Care (hand hygiene)
Programme (including the use of alcohol hand rub)
3. Intravenous catheter sepsis intervention.
Component 1 must take first priority. The surveillance system will enable the
measurement of success of the other two components. The second component
should however be commenced shortly after the commencement of the
implementation of the surveillance system and component 3 could be delayed
for 12 months if necessary.
All components should be developed and implemented over 24 to 36 months.
Together they will form the basis of an ongoing national infection prevention
and control system for New Zealand that can be extended beyond DHBs to all
health and disability providers.
COMPONENT 1
COMPONENT 2
36 months
SURVEILLANCE
SYSTEM
HAND HYGIENE
“Talking wall” strategy
Alcohol hand rub
Consumer empowerment
strategy
NSW / ACHS surveillance
system
Policy development
Education
COMPONENT 3
IV SEPSIS
Ongoing
Modified Breakthrough
programme for ICUs
Prepared by: Communio
Ongoing national
infection prevention and
control system
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Executive Summary
Scoping the Priorities for Quality in the Health and Disability Sector
PRIORITY 5
Education and
training
The education and training in quality improvement methods programme is
designed for two groups – existing workforce and health professional
undergraduates.
The proposed programme has two key components:
1. The development of a “bundle” of national education and training courses
for health care workers employed in DHBs comprising;
 Advanced knowledge and skills for quality improvement - a suite of
learning modules including:
o whole system thinking
o incident management
o quality improvement method
o facilitation and coaching
o culture change and leadership
o communication, including working in teams
o human factors
o consumer participation
 The following health care professionals would be targeted:
o Senior Management
o Senior Clinicians
o Quality & Risk Managers
o Other Health Professionals
2. The development of a “bundle” of national education and training courses
for tertiary institutions involved in undergraduate training of health
professionals introducing:
 The rationale and concepts relating to quality improvement including:
o incident management
o quality improvement processes
o communication, including working in teams
o human factors
o consumer participation
o practical based assignments
 The following schools would be targeted:
o Medical
o All other health science programmes including nursing, and
allied health.
Prepared by: Communio
Page 9 of 11
Executive Summary
Scoping the Priorities for Quality in the Health and Disability Sector
PRIORITY 6
Consumer
participation
The consumer participation programme has two components:
1. The establishment of a national consumer health entity which is a central
focal point for consumers and community comprising:
 Design and set up of a national entity through a cross sector, multiagency and consumer collaboration (including a second National
Consumers’ Summit)
 Governance by a Consumers Health Council
 Partnership model for Maori
 Government funding
 Public access to information on:
o Consumer rights and responsibilities
o Consumer issues
o Consumer groups and representatives
o Treatment guidelines and options
o Reporting of health service performance
2. The development and delivery of training and education for:
 consumer representatives
 health professionals (to prepare the ground for effective engagement
with consumers)
Programme
timeframes
Prepared by: Communio
It is recognised that these six priority programmes represent a great deal of
work for all involved in the provision of health and disability services. It will
therefore be necessary to have a rolling programme for implementation of the
various programmes. It is suggested that work could begin on three
programmes as early as February 2007, and that the commencement of other
programmes is staggered over the next 18 months. The following diagram
indicates a possible 5 year programme. The timeframes are indicative and the
actual dates on which the programmes should start and finish should be
decided when the scope of the entire programme, including the budget is
defined. It will be important to get started as early in 2007 as possible.
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Executive Summary
Scoping the Priorities for Quality in the Health and Disability Sector
2007
ID
Task Name
Start
Finish
Q1
1 Incident Management
1/01/2007
30/12/2008
522d
2 Hand Hygiene
1/01/2007
30/06/2008
391d
3 Infection Surveillance System
2/07/2007
30/12/2009
653d
4
IV Sepsis Collaborative
1/01/2009
30/06/2010
390d
5 Medication Collaborative
2/07/2007
30/12/2008
392d
6 Medication Bar Coding
1/01/2009
30/12/2011
782d
7 Flows Collaborative
1/01/2008
30/12/2009
522d
8 Consumer Policy
1/01/2010
31/12/2012
782d
9 Education Forum
1/01/2009
1/07/2009
130d
10 Education program
1/07/2009
30/12/2013
1174d
11 EpiQual Secretariat
1/01/2007
28/12/2012
1565d
Prepared by: Communio
2008
2009
2010
2011
2012
Duration
Q2
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Q3
Q4
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Q3
Q4
Q1
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Q3
Q4
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Q3
Q4
Q1
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Q3
Q4
Executive Summary
Q1
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Q3
Q4