Quality and Risk Context and Progress Faculty of Public Health Medicine

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Quality and Risk Context and ProgressFaculty of
Public Health Medicine

• Dr. Mary Hynes
• National Hospitals Office
• December 2007

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International context

• First, do no harm
• To Err is Human Building a Safer Health System
• An organisation with a memory (2000)
• Building A Safer NHS For Patients (2001)
• Growing interest in patient safety and a will to
  change
• Growing evidence base re successful interventions
• High impact safe practices identified

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Context

• Setting up of the Health Service Executive in
  January 2005
• Change in structures
• Change in culture
• Affects all parts of the system delivering
  personal health and social services
• Quality and Risk highly visible in new structures

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HSE Structure
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Some Things Stay the Same!

• Finite resources
• Innovations in science, technology and
  communications
• New demands
• High expectations
• High level of public and media interest in health
  matters

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Serious Incidents

• Irish context
• Contamination of blood products
• Lourdes Hospital Inquiry
• Report into the death of Mr. Pat Joe Walsh
• Leas Cross Review
• Review of circumstances leading up to the death
  of Jacqueline Rushton
• Missed diagnosis of breast cancer Rebecca
  OMalley and Barringtons Hospital/Galway
  Pathology patient
• Portlaoise symptomatic breast disease

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Key Players

• Health Information and Quality Authority
• Clinical Indemnity Scheme
• Irish Medicines Board
• Health and Safety Authority
• Irish Medical Council
• An Bord Altranais
• Dental Council
• Pharmaceutical Society of Ireland
• National Hemovigilance Office
• Commission on Patient Safety and Quality Assurance

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Priorities Identified

• Hospital hygiene
• Decontamination of Reusable Invasive Medical
  Devices (RIMD)
• Healthcare Associated Infection
• Healthcare Records Management

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Decontamination Project

• The main aim of the NHO Decontamination Project
  is to improve the quality of decontamination of
  RIMD in the hospital setting by

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Aims Decontamination Project

• Carrying out a comprehensive review of
  decontamination services in acute hospitals
• Supporting hospitals in developing action plans
  to ensure that appropriate arrangements are in
  place to improve, where necessary,
  decontamination practices
• Developing national standards and recommended
  practices for decontamination of RIMD
• Making recommendations on an audit and monitoring
  programme for decontamination
• Making recommendations on training programmes for
  staff in decontamination facilities

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Healthcare Associated Infection Action Plan

• Public education campaign
• Standard setting and audits
• Healthcare worker education and training
• Focused target areas for surveillance
• Antimicrobial prescribing
• Improving personnel and physical infrastructure
• Governance and performance management

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Healthcare Records Management Project

• The main aim of the NHO Healthcare Records
  Project is to improve the quality of clinical
  information in the hospital setting by

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Aims Healthcare Records Management Project

• Develop standards and recommended practices for
  records management in acute hospitals
• Develop an audit and monitoring programme to
  support continuous quality improvement
• Make recommendations on training programmes for
  staff in relation to medical records management
• Carry out a comprehensive review of medical
  records management in acute hospitals in the HSE
• Support hospitals in developing action plans to
  ensure that appropriate arrangements are in place
  to improve, where necessary, healthcare records
  management

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NHO Standards Development

• An extensive literature search
• Consideration of the opinion of experts
  knowledgeable in the subject
• Collate available standards, policies and
  procedures from the NHO hospitals
• Contact health professional organisations
• Consider the available current best practice,
  both in Ireland and internationally
• Merge findings into a draft document for
  distribution and consultation with key
  stakeholders

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Quality and Risk Standard
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Culture of Safety

• Informed culture
• Reporting culture
• Just culture
• Learning culture

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Challenges

• Range of issues
• Learn from the experience of others
• Dissemination of good practice
• Enduring Organisation-wide improvement
• Risk of local and temporary results
• Employee scepticism
• Frustration

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Success Factors

• Move from discussing change to effective action
  based on solid diagnosis
• Involvement of senior opinion leaders
• Dedicated support structures for implementing
  change
• Built in sustainability

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• There is nothing more difficult to carry out,
  nor more doubtful of success, nor more dangerous
  to handle than to institute a new order of
  things.
• Machiavelli