National Quality Improvement Programmes

National Quality Improvement Programmes
The most important quality improvement activities are frequently those activities that are planned and undertaken by the staff who delivers services directly to consumers. However, health care has become increasingly complex and a strategic, consumer-focused, approach to quality improvement at all levels within the system is vital.

The Quality Improvement Committee (QIC) has initiated a coordinated national approach to quality improvement to address quality and safety problems within public hospitals because the greatest risks are in this part of the health care system. The initiatives were developed by QIC in 2007 and business cases were submitted to the Minister of Health for funding. The Minister agreed to fund the business cases and devolved the development and national implementation of the programmes to the DHBs and the Ministry. The Ministry is responsible for actioning the National Review of Mortality Review Committees and the DHBs are collectively accountable to the Minister for delivery on the remaining four programmes.

The funding for each of the four programmes managed by the DHBs has been devolved to a lead DHB on behalf of all the DHBs. The lead CEO for each programme has been appointed as champion by the DHB CEO Group. This is in line with the Minister’s expectations.

The Minister has made the delivery of this programme a priority. All 21 DHBs have 0.25% of their funding at risk for the 2008/09 financial year dependent on satisfactory participation of their DHB in the programme. All DHBs have signed up to the programme in their District Annual Plans this year. These plans are the formal contract between the DHBs and the Crown.

Information on the five projects or programmes is provided below:

View also: National Quality Improvement Programme Oversight Arrangements (Word, 48 KB)

Newsletters - Updates on the National Quality Improvement Programme

For updates on the National Quality Improvement Programme, refer to the newsletters page.

Optimising the Patient Journey
This programme is based on a national collaborative approach to implementing effective processes in all DHBs for optimising the flow of patients and improving their journey through the health system. A key mechanism for improving the quality of patient care, particularly in hospitals, is to look at the patient’s journey through the system as a whole. This analysis is taken from both the patient’s perspective and from a whole system perspective, in order to optimise the flow of patients and allocation of resources at every step of the journey.

The programme will focus on improving the patient’s journey within the inpatient setting, from before the patient’s entry (i.e., attendance at the Emergency Department or at outpatient medical and surgical services) until the patient is discharged from that episode of care. The programme will also focus on the management of patients with chronic diseases who present at the hospital for treatment, and on the flow of patients from the community/primary care setting through to the hospital setting.

Lead DHB: Counties Manukau District Health Board

Lead CEO: Geraint Martin

Contact: Suzanne Proudfoot, Suzanne.Proudfoot@middlemore.co.nz

Project Scope: Optimising the Patient Journey project scope (Word, 173 KB)

Website: www.patientjourney.org.nz

Resources:

Newsletter - Optimising the Patient Journey

National Healthcare Incident Management
The complexity of healthcare means that accumulated simple errors can lead to major system failures and harm to patients. All human operators can make errors at times, but the system of care is not always designed to identify errors and prevent consequent patient harm. A systematic approach to identifying and analysing common causes of system failure allows the redesign of patient care processes to eliminate repeated harm. Furthermore, a standardised approach to the management of major incidents can ameliorate patient risk and harm by swiftly mounting the most effective response.

It is essential to develop the right culture and environment within which all components of incident management can occur. A fundamental component of the culture that is to be achieved is one that is caring and compassionate and one in which the disclosure of adverse events is open and truthful.

About 10-15 percent of hospital admissions are associated with an adverse event. While all DHBs have systems for identifying and responding to such event, their approaches are inconsistent and the national guidelines on managing reportable events has been implemented in various ways. Some DHBs are developing their own information systems for managing incidents, whereas others have identified ‘off the shelf’ systems for this purpose. Some DHBs train staff in incident management, including open disclosure and the process of root cause analysis, whereas others provide no training.

Incidents vary from simple errors, without patient harm, up to major reportable events associated with permanent harm or death of a patient. A uniform incident management system needs to classify the magnitude or severity of incidents and define a hierarchy of responses. System learning comes from aggregated data from large numbers of low-level events and the in-depth investigation (including root cause analysis) of cases or serious patient harm.

Incident management is a key strategy being used by health services for managing the risks of clinical care as well as for managing corporate risks. When implemented correctly, incident management is an effective mechanism for systematically identifying and managing problems and failures in the system and for informing the development of preventive strategies. It also guides the immediate response to incidents, with the purpose of minimising risk and further harm.

Lead DHB: Waikato District Health Board

Lead CEO: Craig Climo

Contact: Maureen Robinson, maureen.robinson@communio.com.au

Project Scope: National Healthcare Incident Management project scope (Word, 202 KB)

Website: http://nzsip.communiogroup.com

Resources:

A series of videos are available from NZIP at the link below
A National Approach to the Management of Healthcare Incidents

Newsletter - NZ Incident Management System

Infection Prevention and Control
Infections that have been contracted in the health care system are a significant problem worldwide. Reducing these infections has been identified as a priority because of the disease burden and the economic burden that these infections create. At any one time, over 1.4 million people worldwide are suffering from infections acquired in hospital and up to 10% of patients admitted to modern hospitals in the developed world acquire one or more infections.

Healthcare associated infections in England are estimated to cost ₤1 billion a year. In the United States, the estimate is between US$ 4.5- 5.7 billion per year. Surgical site infections:

account for about 14% of possible adverse events threatening patient safety in hospitals in developed countries
occur in at least 5% of the patients undergoing surgical procedures every year
prolong hospital stay on average by 7.4 days, at an average cost of $1000 per day.

The importance of this issue in New Zealand has been highlighted in the Controller and Auditor-General’s Report in 2003. The Controller and Auditor-General reported on the management of hospital-acquired infections in public hospitals in New Zealand and described and assessed systems for managing these infections in public hospitals.

One of the leading causes of healthcare-associated infections is the failure to comply with hand hygiene because the lack of hand hygiene contributes to the spread of multi-resistant organisms and is recognised as a significant contributor to outbreaks of infection. “The potential benefit of successful hand hygiene promotion outweighs its costs, and widespread promotion should be supported”. The excess use of hospital resources associated with only four or five serious healthcare-associated infections may equal the entire annual budget for hand hygiene products used in patient care areas.

The cost to patients is also significant in terms of prolonged recovery, delays in returning to employed work and/or usual activities as well as costs related to assistance and extra appointments and follow-up needed during this time that is not covered by health or support services. These costs are often invisible costs that are not included in economic calculations.

Lead DHB: Auckland District Health Board

Lead CEO: Garry Smith

Contact: Henry Dowler, henry.dowler@hankstar.co.nz

Project Scope: Infection Prevention and Control project scope (Word, 196 KB)

Website: www.infectioncontrol.org.nz

Resources and news: Visit the website above to view newsletters and other information.

Safe Medications Management
Medication is one of the most common therapeutic interventions used in the health care system, and medication errors in hospitals or the community are common. Approximately 1.6 percent of people admitted to hospital may experience an adverse medication event. Of these events, the majority are preventable and occur inside hospitals. Preventable adverse events have a significant impact on consumers. About 3.1 percent result in death and 8.3 percent in permanent disability.

Several strategies have been proven to be effective for reducing the rate of errors in medication management. They include:

the use of a standardised medication chart across a whole organisation or sector
reconciling, effectively and continually, a patient’s medication list, particularly when the patient is transferring from one part of the health system to another
the introduction of some safety mechanisms around the use of high risk drugs
verifying medications at the bedside, using bar-coded point-of-care systems
using an electronic prescribing system

The Government announced in Budget 2007 that $10.2 million has been made available to improve patient safety using bedside verification of drugs. This project is often incorrectly referred to as the ‘barcode project’. Rather than just involving barcoding of patients and medication, it involves a co-ordinated range of components aimed to address parts of the medication administration sequence because many of these components need to be improved. In addition, the new systems and processes will need to be introduced and linked to each other.

Lead DHB: Hutt Valley District Health Board with support from South Canterbury District Health Board

Lead CEO: Chai Chuah and Chris Fleming

Contact: Clare Kirk , Clare.kirk@huttvalleydhb.org.nz

Project Scope: Safe Medication Management project scope (Word, 158 KB)

Website: www.safemedication.org.nz

Resources:

Newsletter - Safe Medication Management Programme

Meeting minutes of the Steering Group

National Review of Mortality Review Committees
In November 2006, the Minister asked for advice on the priorities for national quality improvement programmes to support the appointment of the revamped national Quality Improvement Committee. In response, a paper identifying the priorities for Quality in the Health & Disability Sector was submitted to the Minister. This was provided to the Quality Improvement Committee for consideration in February 2007 which agreed to take up the six priorities and added an additional priority. At subsequent meetings, the committee recognised the need for an enhanced model for working with DHBs to implement the national projects. It is within this national model that this project “National Mortality Review Systems” operates.

This project has been established to enhance the national mortality review systems in NZ, with the view to reducing the number of preventable deaths. The project consists of two parts:

The establishment of a National Peri-operative Mortality Review Committee
The establishment of local DHB Child & Youth Mortality Review Groups (CYMRG) - supported by local co-ordinators & a national co-ordinator

Lead Agency: Ministry of Health / Sector Capability and Innovations Directorate

Lead Deputy Director General: Margie Apa

Project Scope: National Review of Mortality Review Committees project scope (Word, 283 KB)

Websites: www.pmmrc.health.govt.nz, www.cymrc.health.govt.nz

Page last updated: 15 September 2009.