Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Race and health wikipedia , lookup
Social determinants of health wikipedia , lookup
Infection control wikipedia , lookup
Health system wikipedia , lookup
Health equity wikipedia , lookup
Reproductive health wikipedia , lookup
International Association of National Public Health Institutes wikipedia , lookup
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 Page 5 of 11 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 Page 6 of 11 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 Page 8 of 11 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. Page 10 of 11 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 Page 11 of 11 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Executive Summary Q1 Q2 Q3 Q4