Transcript Quality indicators in community aged care?

Influencing The Quality Of Aged Care:
The Board’s Role In Clinical
Governance
Alison Brown
Lead Consultant
Australian Centre For Healthcare Governance
August 2014
Overview
• What is quality in aged care services?
• How do we improve quality?
• The role of the board in service quality
'The only constant in life is change'
Do you provide quality aged care services at
your organisation?
•
No more than a third of evidence-based clinical guidelines are routinely adhered
to (based on clinician and patient self-report) (Mickan et. al. Postgrad Med J 2011;
87:670-679)
•
No more than 60% of patients at any one time receive the care deemed
appropriate by current science (based on case reviews) (Runciman et. al. Med J
Aust 2012;197: 100-105)
•
The national benchmark for hand hygiene is 70% (interim benchmark advised by
the Australian Commission on Safety and Quality in Health Care), In 2012 50 % of
hospitals were at or below the national benchmark (AIHW, Myhospitals)
Rate the quality of the services
at your organisation
1
Poor quality
service
10
Excellent quality
service
Board members’ self-assessment of performance compared
with a typical health service in Victoria
What does meeting
accreditation tell you?
Poor quality
services
Excellent quality
services
What does meeting
accreditation tell you?
Minimum
acceptable
standard
Poor quality
services
Excellent quality
services
‘…organisations should shift away from their
reliance on external agencies as guarantors of
safety and quality and toward proactive
assessment and accountability on their own’.
National Advisory Group on the Safety of Patients in England, 2013.
A promise to learn– a commitment to act: Improving the Safety of Patients in England
Clinical Governance, quality governance or governance of service quality can
be defined as :
the combination of structures and processes at and below board level to :
• ensure required standards are achieved
• investigate and take action on sub‐standard performance
• plan and drive continuous improvement
• identify, share and ensure delivery of best‐practice
• identify and manage risks to quality of care
Quality Governance in the NHS, 2011
What improves quality?
High performing services
1. Dissatisfaction with the current quality of care
2. A shared vision for achieving high quality care and appropriate leadership
structures
3. Strategic/operational plan actions translated into measurable quality of care
objectives
4. Accountabilities for providing safe care and improving care are clear
5. A focus on measurement, systems redesign and human behavior to improve
care.
Baker, G.R., et al, 2008, High Performing Healthcare Systems: Delivering Quality by Design. Longwoods Publishing, Canada.
• Hospitals with more active & engaged Boards appear to have
better patient outcomes - higher care scores; lower patient
mortality
• Large differences in board activities between high-performing
and low-performing hospitals
Jha and Epstein, 2009
Jiang et al 2009
The role of the board
Governing Body
Responsibilities for Quality
Staff Responsibilities for
Quality
• Creating a culture – leading and
promoting leadership of clinical
safety and quality
• Innovation and Designing
• Maintaining a high level
overview of service quality
• Monitoring
• Implementing
• Reviewing
• Ensuring quality structures and
systems are in place and
effective
• Communicating
The role of the board
Governing Body
Responsibilities for Quality
Staff Responsibilities for
Quality
• Creating a culture – leading and
promoting leadership of clinical
safety and quality
• Innovation and Designing
• Maintaining a high level
overview of service quality
• Monitoring
• Implementing
• Reviewing
• Ensuring quality structures and
systems are in place and
effective
• Communicating
What is Quality in aged care?
Structure
Process
Outcomes
Safe
Appropriate
Integrated
Person centred
Health
Personal care
Lifestyle
Care
environment
The dimensions of care that patients value include:
• Access to care
• Coordination and integration of care
• Transitions and continuity of care
• Respect for patient’s values, preferences and expressed needs
• Information and education
• Physical comfort
• Emotional support
• Family and friends
• Continuity of care and transition after discharge
(Picker Institute 2008)
Step 1: Define the goal
Dimensions of Quality
Person centred care
Quality Goals
Provide personalised care that is tailored to individual
needs is flexible and respects values , culture and choices
Safe
Safe care is provided and takes into account the persons
need to feel safe and trusting in their environment
Continuously monitor, evaluate and improve the
appropriateness of care
Appropriate care and
systems
Friendly, welcoming
environment
A welcoming environment is provided through a positive
organisational culture, appropriate infrastructure and
equipment.
National Aged Care Alliance domains of quality
1. Person centred interactions
2. Health and wellbeing
3. Engaging socially
4. Daily services
5. Physical environment
6. Organisational and governance
Step 2:Communicate the vision
Is this your current vision of quality?
Step 2:Communicate the vision
Quality and accreditation
Safe, coordinated, person centred,
effective services
Ensure that every member of staff that has
contact with clients/residents, or whose actions
directly impact on patient care, is motivated and
enabled to deliver quality care (effective, safe
and person‐centred care)
The role of the board
Governing Body
Responsibilities for Quality
Staff Responsibilities for
Quality
• Creating a culture – leading and
promoting leadership of clinical
safety and quality
• Innovation and Designing
• Maintaining a high level
overview of service quality
• Monitoring
• Implementing
• Reviewing
• Ensuring quality structures and
systems are in place and
effective
• Communicating
“Strong, effective board
oversight of patient care
quality and safety programs
is, without question, one of
the most fundamental
bench-marks of good
governance today.”
Step 3: Monitoring and Planning
Data
Where are we now?
Where do we need to
be?
Reporting framework
To measure service quality need a mixture of
• Quality System measures
• Process of care
• Outcomes of care (impact of care in the
community setting)
Impacts
and
processes
Safe
Appropriate
and Effective
Person
Centred
Coordinated
Incident Reporting Systems,
Risk Management Systems
Clinical Care Guidelines,
Credentialing and Scope of
Practice, Supervision,
Professional Development,
Performance Appraisal,
Evaluation of services &
programs
Interpreters, Health literacy,
Client feedback, Complaints,
Client satisfaction,
Consumer and community
participation, Informed
Consent
Referrals, Care planning,
Intake
Supporting
Systems
Quality indicators used in Vic PSRAC
• Prevalence of stage 1 to 4 pressure ulcers
• Prevalence of falls and related fractures
• Incidence of use of physical restraint
• Incidence of residents using nine or more
medications
• Prevalence of unplanned weight loss
Quality indicators in community aged care?
• ? Access
• ? impact indicators –QOL, life satisfaction,
ADL, PADL
• Appropriateness of Care
• Client experience
Key data for reporting framework
• Agreed dataset aligned to agreed dimensions of
quality and incorporating minimum standards
• Indicators aligned to strategic quality goals
• Indicators aligned to high risk areas
Reporting key questions
•
•
•
•
What to report?
Format: How much detail: trends , benchmark, action taken
How often?: Depends on the audience and content
Who is the target audience?: Exec, Quality , Audit Committee, Board
90
80
70
60
50
40
30
20
10
0
Team x
Team y
Team z
How effective are boards?
Governing Body
Responsibilities for Quality
Staff Responsibilities for
Quality
• Creating a culture – leading and
promoting leadership of clinical
safety and quality
• Innovation and Designing
• Maintaining a high level
overview of service quality
• Monitoring
• Implementing
• Reviewing
• Ensuring quality structures and
systems are in place and
effective
• Communicating
How effective are boards?
How effective are boards?
Barriers for Boards
• Insufficient resources
• Deficit of skills and expertise
• Inadequate intelligence
Summary
1. Invest in board clinical governance skills
2. Develop organisation wide awareness of what is a quality
service
3. Undertake Improvement planning
4. Develop Reporting Framework for measurement of quality
5. Report on achievements throughout organisation
For more information about board evaluations, clinical
governance and other resources go to:
healthcaregovernance.org.au
or
[email protected]