STREETWISE IN SOUTH AUCKLAND

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STREET-WISE IN SOUTH AUCKLAND CLINICAL
GOVERNANCE AND CLINICAL LEADERSHIP
Peter J Gow BMedSc FRACP FAFRM Head of
Department Rheumatology Clinical Director
Rehabilitation Chairman Clinical Board South
Auckland Health
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SUMMARY

• Clinical Leadership
• Quality Measurement
• Clinical Governance
• Evolution of Quality Activities
• Criteria for a Successful Outcome

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GETTING HEALTH BACK ON TRACKNZMJ Editors
September 2000

• ...many doctors who found it easy (and often
  profitable) to drift with the managerialist
  ideology, thus allowing it to prosper. ....The
  belief that it is better to work within a system
  is clearly not tenable when that system is
  fundamentally flawed. ...Health professionals
  were deliberately excluded in decision making,
  because they were accused of provider capture

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CLINICAL LEADERSHIP AT SOUTH AUCKLAND HEALTH
Board of Directors Audit Committee CMO Clin
ical Board Chairman Executive Management
Group CMO / Deputy CMO DNP / Deputy
DNP Clinical Board Chairman Clinical
Board Clinical Directors Nursing
Representatives CMO / DNP /
DMP CEO CRU Managers Academic
Head GP Representative Allied Health
Representative RMO Representative
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QUALITY MEASUREMENT-THE BALANCED SCORECARD
Clinical Quality
Delivery Quality
CQ
DQ
Productivity
Financial
P
F
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CLINICAL GOVERNANCE IN NORTH THAMES DEFINITION
AND CONCEPTS

• Clinical Governance can be defined as the
  means
• by which organisations ensure the provision of
  quality
• clinical care by making individuals accountable
  for
• setting, maintaining and monitoring performance
• standards.

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COMPONENTS OF CLINICAL GOVERNANCE
D O H A First Class Service 1998

• Clear lines of responsibility and
  accountability
• for the overall quality of clinical care
• A comprehensive programme of quality
• improvement activities
• Clear policies aimed at managing risk
• Procedures for all professional groups to
• identify and remedy poor performance

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QUALITY STRUCTURE - SOUTH AUCKLAND HEALTH
BOARD OF DIRECTORS
Chief Executive Officer
Chairman Clinical Board / Director of Nursing
Practice
External Auditor of Clinical Standards
Quality Facilitator
Clinical Board
Executive Management Group
CQI Committee
South Auckland Health Services
Patient and Staff Safety Group
Key relationships
Reporting lines
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LEADERSHIP AT SAHModified from Kouses and Posner

• Leadership is the art of inspiring others to
  commit to, and strive for, shared aspirations

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LEADERSHIP IN QUALITY IMPROVEMENTPam Garside

• Vision
• Changes for quality improvement should be driven
  by a vision of what is to be accomplished
• Culture
• The culture of the organisation needs to be
  receptive to change for change to be embraced and
  to actually occur
• Process
• focussed attention is needed on the process of
  implementation of change

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QUALITY LEADERSHIP AT SAH - A TRIBUTE TO LESTER
LEVY CEO 93-97

• Safety Audits in Medicine and Surgery
• Clinical Board -interdisciplinary
  -multicultural
• Dedicated Funding for Clinical Audit
• External Auditor of Clinical Standards

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EVOLUTION OF QUALITY ACTIVITIES AT SOUTH
AUCKLAND HEALTH

• Clinical Board
• Clinical Policies
• Complaints and Incidents
• Credentialling
• Clinical Indicators

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CONTINUOUS QUALITY IMPROVEMENT
NB CQI still needs standards, but improvement
driven rather than just to meet standards
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EVOLUTION OF QUALITY ACTIVITIES AT SOUTH
AUCKLAND HEALTH (CONTD)

• CQI Committee
• Accreditation
• Quality Framework
• Quality Plans

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ASPECTS OF CLINICAL GOVERNANCE
Kelsey 1999

• Continuous professional development
• Evidence based medical practice with guidelines
• and care pathways
• Quality measures and outcome measures
• Clinical audit and research
• Appraisal and peer review
• Adverse events recording
• Complaints procedure
• Patient experience

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CONTINUOUS QUALITY IMPROVEMENT I.H.I.
Define problem Organise Team
Perform Analyses
Develop Action Plans
Measure Outcomes Hold the Gains Continuously
improve
Implement Solutions
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BARRIERS TO QUALITY MANAGEMENT Donald Berwick

• Lack of Time
• Lack of Trust
• Too much Territoriality and Tradition
• Lack of Training

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LEADERSHIP IN QUALITY IMPROVEMENTPam Garside

• The Vision Thing
• Align the Culture
• Involve
• Train and Develop
• Communicate
• Pay Attention to the Process
• ALL REQUIRE LEADERSHIP

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CLINICAL SKILLS OF QUALITY MANAGEMENT
Berwick et al. BMJ 1992 304304

• The ability to perceive and work effectively
• in interdependencies.
• The ability to work in teams.
• The ability to understand work as a process.
• Skill in collecting, analysing, and displaying
• data on outcomes of care.
• Skills in designing health care practices.
• Skills in collecting, aggregating, analysing
  and
• displaying data on processes of work.
• Skills in collaborating exchanges with
  patients.
• Skills in working collaboratively with lay
  managers.

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INTERVENTIONS TO PROMOTE BEHAVIOURAL CHANGE AMONG
HEALTH PROFESSIONALS

Bero et al 1998
Consistently effective interventions

• Educational outreach visits
• Reminders (manual or computerised)
• Multifaceted interventions
• Interactive educational meetings

Interventions of variable effectiveness

• Audit and feedback
• The use of local opinion leaders
• Local consensus processes
• Patient mediated interventions

Interventions that have little or no effect

• Educational materials
• Didactic educational meetings (such as lectures)

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QUALITY IMPROVMENT IN HEALTH CARE
Peter J Gow 2000
Where we want to be
Leadership
Vision Values
PERFORMANCE
Incentives
Process
Measurement
Where we are now
TIME
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How good you are doesnt say how good you
could be
Donald Berwick