Quality Assurance Provider Services Perspective

1
Quality Assurance Provider Services Perspective

• Rebekah Cresswell
• Clinical Governance Lead
• Stockport Primary Care Trust
• 5th of December 2007

2
Aims of the Presentation

• Perspectives and Quality
• Clinical Governance Toolkit and Service Review
  Process in Stockport Provider Services
• Measurements of Quality

3
Perspectives

• When I was a boy of 14, my father was so ignorant
  I could hardly stand to have the old man around.
  But when I got to 21, I was astounded at how much
  the old man had learned in seven years.
• Mark Twain

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Quality Perspectives

• Product Based evidence based clinical
  effectiveness
• Innate Excellence often associated with
  healthcare, where the ability to treat someone is
  based on instinct and assessing a person
  holistically
• User Based customer satisfaction from a patient
  perspective
• Manufacturing based customer satisfaction from
  a funders perspective care delivered
  cost-effectively with minimal defects
• Value based quality at an acceptable price
• Garvin (1984)

5
Change Management

• Quality is closely linked with change
• Human commitment
• Barriers
• Ownership
• Timing ,etc.
• Freeman Walshe (2004) found that often
  clinical governance remains within the domain of
  management and for it to be effective and lead to
  sustainable change then it must be owned by
  frontline staff as well as managers.

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Context

• Commissioning a Patient Lead NHS
• New Relationship with Commissioners
• Quasi-market competition contestabilty
• Under the Spotlight for Best Value, Efficiency
  Quality
• New organisations emerging corporate
  citizenship

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The Service Review Package

• Clinical Governance Toolkit
• Service Review Proforma
• Index of Evidence
• Action Plans
• Service Review Panel
• Reporting Processes
• Quality Measures Database

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Clinical Governance Toolkit

• Covers each standard (core developmental)
• Explanation of each standard and relates it to
  practice.
• Useful websites for each standard
• Customised with information on education,
  training, strategies and policies for your Trust.
• Points for Consideration reflective questions
  for teams to ask themselves
• Evidence of how the service is meeting the
  standard

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Core Standard 1

• Health Care Organisations protect patients
  through systems that
• a) identify and learn from all patient safety
  incidents and other reportable incidents, and
  make improvements in practice based on local and
  national experience and information derived from
  the analysis of incidents
• and
• b) ensure that patient safety notices, alerts and
  other communications concerning patient safety
  which require action are acted upon within the
  required time-scales.

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Explanation of Core Standard 1

• The National Patient Safety Agency has been set
  up to promote best practice across the NHS. They
  are promoting an ethos of openness, which does
  not focus on blaming individuals, but on
  learning.
• Seven Steps to Patient Safety
• Step 1 Build a safety culture - Create a culture
  that is open and fair.
• Step 2 Lead and support your staff - Establish a
  clear and strong focus on patient safety
  throughout your organisation.
• Step 3 Integrate your risk management activity -
  Develop systems and processes to manage your
  risks and identify and assess things that could
  go wrong.
• Step 4 Promote reporting - Ensure your staff can
  easily report incidents locally and nationally.
• Step 5 Involve and communicate with patients and
  the public - Develop ways to communicate openly
  with and listen to patients.
• Step 6 Learn and share safety lessons - Encourage
  staff to use root cause analysis to learn how and
  why incidents happen.
• Step 7 Implement solutions to prevent harm -
  Embed lessons through changes to practice,
  processes or systems.
• Staff safety issues are covered under Core
  Standard 20a.

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Useful Websites

• Health Care Commission
• www.healthcarecommission.org.uk
• National Patient Safety Agency
• www.npsa.nhs.uk

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Education, Training, Strategies Policies

• Customise with local information regarding
  courses available, policies and strategies
  relating to risk
• For example
• Mandatory Risk Management and Fire Training
• Basic Life Support
• Risk Management Strategy (include link of where
  to find it), etc.

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Core Standard 1 Patient Safety Incidents
Alerts

• Points For Consideration
• Do you know the process for identifying and
  reporting patient safety incidents?
• How does your team ensure that everyone sees
  and acts on safety alerts and information?
• Are patients and carers informed about
  incidents appropriately?
• Has practice changed following any patient
  safety incidents?
• Are there named staff for ensuring any required
  action is taken?
• Can you show whether risk has been reduced
  since you introduced changes?
• Have you had satisfactory feedback about
  incidents you reported?

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Service Review Proforma

• Key Headings for a Summary of the Service
• Developments within the Service achievements,
  opportunities for development and current
  developments.
• Key Performance Indicators
• Realistic Measure of all the Core Developmental
  Standard

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Index of Evidence Action Plans

• Index of evidence
• Organise the information
• Cross-reference evidence
• Action Plans
• Templates based on SMART Principles

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Service Review Panel

• Guidelines
• Context
• Roles Responsibilities
• Evidence
• Patient Public Involvement

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Service Review Process

• Service notified of service review at least 3
  months prior to date.
• Evidence for the service review is handed in 3
  weeks prior to panel date.
• Pre-panel Meeting (1 hour)
• Service Review Panel (2 hours)
• Post-panel Meeting (half an hour) within 6
  weeks

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Reporting Processes

• Outcomes reported to Standards for Better Health
  Committee, which is sub-committee to the Provider
  Board.
• Associate Director Reports completion of the core
  standard action plans in 12 months to confirm
  implementation.

20
Quality Measures Database

• Results are entered numerically on database and
  is a good way of showing qualitative data in a
  quantitative way.
• Information is used to
• At glance shows levels of compliance with
  standards by service.
• Monitor progression against developmental
  standards.
• Set business objectives for the service.
• Quality assurance for commissioners and
  inspectorates.
• Performance management
• Benchmarking

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Next Steps

• Research Evaluation on
• Sustainability of the quality improvements
• Engagement of frontline staff, middle, senior and
  very senior managers in the process
• Usefulness of the information generated to
  Provider Services and Commissioners
• Research with supervision from the Manchester
  Business School

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References

• Freeman T., Walshe K. (2004) Achieving Progress
  Through Clinical Governance? A National Study of
  Health Care Managers Perceptions in the NHS in
  England. Quality Safety in Healthcare, Vol. 3,
  No. 5, pp 335-343.
• Garvin D.A. (1984) What Does Product Quality
  Really Mean? Sloan Management Review, Vol. 26,
  No. 1, pp 25-43
• Juran J.M. (1989) Juran on Leadership for
  Quality An Executive Handbook. New York, The
  Free Press.
• Streim et al (2003) Is Health Care a Special
  Challenge To Quality Management? Insights from
  the Danderyd Hospital Case. Quality Management
  in Health Care, Vol. 12, No. 4, pp 250-258
• Van der Heuval et al (2006) Quality Management
  Does It Pay Off? Quality Management in
  Healthcare, Vol. 15, No. 3, pp 137-149