There is a need to ensure that all of our work as managers and leaders prioritises the safety of our patients and service users above all else and this represents a change in the culture of how we work and think, writes Dr. Philip Crowley, National Director Quality and Patient Safety Division, HSE.
There has been an increased and persistent focus in improving the quality and safety of healthcare over the last decade. While this focus has led to definite improvements in the provision of care in many areas more needs to be done. This is highlighted within reports published by both the HSE and HIQA into circumstances where care did not reach the expected standards for quality and safety. There is recognition within the Quality and Patient Safety Division of the need for continued support to the many senior leaders, managers, clinicians and administrative staff who have committed to building and embedding a safety and quality improvement agenda within their services.
Senior management and leadership need to engage with the operational front line through job shadowing (walk in my shoes) and other methods to ensure that the staff perspective and ideas for improvement fully inform the decision-making of the leadership and management teams.
Work within the Division is being aligned to set out a clear path for healthcare providers and their staff in improving staff experience at work and patient experience of care provided and ensuring better clinical outcomes for patients. This path consists of 6 steps that will support the continual growth of a strong safety and quality improvement agenda within all healthcare settings.
Step 1: Growing a safety culture for both patients and staff
There is a need to ensure that all of our work as managers and leaders prioritises the safety of our patients and service users above all else. This represents a change in the culture of how we work and think. This change requires leadership.
- Evidence of a safety culture needs to be visible at all levels throughout the service from the ward to the Board and from the community team to the management– a clear and committed focus on safety and quality improvement should be evidenced by its prominence in the minutes of all key meetings.
- Safety and quality improvement issues need to be high on the Board and management team agendas and this should be demanded by senior managers as well as clinicians and quality leaders. Regular review of safety information (including an analysis of serious incidents, complaints and performance indicators) and staff and patient experience data should be presented and discussed at all management team and board meetings.
- Consideration needs to be given to how safety is translated at ward or community team level – is quality and safety an agenda item for the weekly team meeting? Is there a daily Safety Pause being undertaken? This allows a 10 minute focus on safety everyday and provides an opportunity for frontline staff to stay informed, review events and make plans to ensure coordinated patient care.
Collectively we must ensure that the quality and timeliness of our investigation and management of serious incidents continually improves.
Step 2: Listening to and involving staff
Abundant research demonstrates that healthcare workplaces with high staff work satisfaction achieve the best patient outcomes and the best measures of patient experience. Senior management and leadership need to engage with the operational front line through job shadowing (walk in my shoes) and other methods to ensure that the staff perspective and ideas for improvement fully inform the decision-making of the leadership and management teams.
- Building a safety and quality improvement agenda depends on strong leadership that listens to all members of the healthcare team whether they have a clinical, managerial or administrative role.
- Management must actively seek feedback and ideas for improvement from all members of staff and use the tools available to do so e.g patient safety culture surveys, leadership walkrounds (see tools on HSE website) etc.
- Staff need to be assured that they will be properly supported in the aftermath of an adverse incident.
- Management must acknowledge and work to prevent burnout among staff and managers. Burnout is prevalent in most surveys of healthcare staff and adversely affects the ability of staff to deliver the quality of care they seek to provide.
Step 3: Listening to and involving patients
Patients and service users often know what is best for them. They understand their needs and priorities and healthcare providers and teams will only be able to effectively care for them if they truly listen and act on what they hear.
- Management at all levels should develop approaches to communicating with and listening to patients at individual patient care level, community team and ward level, Directorate and at Board level.
- There is a need to ensure that there are established patient forums/panels and that they are resourced to develop and pursue their own agenda.
- As a system we must engage with the recently formed Patient Safety Champions Network and learn from their constructive proposals that arise from their experience of adverse outcomes in our system.
- A key quality indicator must be the regular measurement and analysis of patient experience through surveys, focus groups, patient stories (survey tools are available through the advocacy unit in the HSE).
Step 4: Building reliability through reporting and learning from safety incidents
Collectively we must ensure that the quality and timeliness of our investigation and management of serious incidents continually improves. We must ensure that key staff are trained in incident management.
- There is a need to ensure that the systems and processes for integrated risk management are in place with a proactive joined up approach to identifying risk from community team and ward level to service level to inform safety improvement solutions.
- Reporting and analysis of incidents needs to be encouraged so that safety lessons can be learned and shared.
- The process of Open Disclosure needs to be supported (see policy and guidance on HSE website)
- All relevant national policies need to be implemented and audited.
Step 5: Measurement for Improvement
We currently measure a lot but have not yet developed an adequate set of quality indicators. This will improve this year and will form part of a proposed Quality Profile for all services.
- Everyone must ask for Data and seek to see trends over time and how performance compares with other providers
- Data at Board level, Data at Directorate level and data at ward and team level should be readily available.
Step 6: Local implementation of solutions.
Local staff will have many ideas for how to improve the work they do and for how managers can enable them to do a better job by making decisions that respond to the priorities of front line staff.
- Improvements start from small changes at ward and service level.
- Ask the questions: What wastes people’s time? What gets in their way every day? How do you know?
There are significant challenges that face the healthcare system. Seeking to improve the quality, safety and reliability of care during a time of reducing budgets, difficulties in staff recruitment and retention and constant change poses a significant challenge to all of us. Only by ensuring that all management and leadership puts an absolute priority on the safety and quality of care that we provide will we create the circumstances where all staff are enabled to ensure that their work creates the best outcomes for patients and the best work environments for staff.
This article is based on a presentation on Patient Safety and Quality Improvement, given by Dr. Crowley at a HMI Forum workshop in Waterford Regional Hospital on Patient Safety and Quality Improvement. earlier this month.