turning the world blue - vha.org.au

1 Improving Care turning the world blue Euan M Wallace CEO, Safer Care Victoria Carl Wood Professor of Obstetrics and Gynaecology, Monash university better healthcare High quality healthcare is .. Safe: Avoids harm to patients. Effective: Provides evidence-based care based to all who could benefit, and not to those not likely to benefit. Patient-centred: Provides care that is respectful of and responsive to individual patient preferences, needs, and values; ensuring the patient guides decisions. Timely: Reduces waits and sometimes harmful delays. Efficient: Avoids waste, including of equipment, supplies. Equitable: Provides care that does not vary in quality because of personal characteristics.

2 US National Academy of Medicine Safe: Avoids harm to patients. Effective: Provides evidence-based care based to all who could benefit, and not to those not likely to benefit. Patient-centred: Provides care that is respectful of and responsive to individual patient preferences, needs, and values; ensuring the patient guides decisions. Timely: Reduces waits and sometimes harmful delays. Efficient: Avoids waste, including of equipment, supplies. Equitable: Provides care that does not vary in quality because of personal characteristics. High quality healthcare is .. US National Academy of Medicine safetysolutionsEMRN ationalinterventionsMonitoring andreporting of patientsafetyBuilding a positivesafety cultureExpert rating What are the leading interventions to reduce patient harm?

3 OECD 2017 patient harm is 14th leading cause of global disease burden (similar to TB or malaria) medical error is 3rd most common cause of death in US about 15% of total hospital activity and expenditure is on (avoidable) patient harm in Canada this equates to 500,000 bed days or four large hospitals Medical error and avoidable patient harm Makary and Daniel, BMJ May 2016 Author Country Share of public hospital spending Brown (2002) New Zealand 32% Rafter et al (2016) Ireland 4% Etchells et al (2012) Canada Jackson (2009) Canada 14% Health Policy Analysis (2013) Australia Ehsani et al (2006) Australia (Vic) Zsifkovits et al (2016) Europe 6% Hoonhourt et al (2009) Netherlands most adverse events are preventable patient harm is 14th leading cause of global disease burden (similar to TB or malaria) medical error is 3rd most common cause of death in US about 15% of total hospital activity and expenditure is on (avoidable) patient harm in Canada this equates to 500,000 bed days or four large hospitals Medical error and avoidable patient harm Makary and Daniel, BMJ May 2016 Author Country Share of public hospital spending Brown (2002) New Zealand 32% Rafter et al (2016) Ireland 4% Etchells et al (2012) Canada Jackson (2009) Canada 14% Health Policy Analysis (2013) Australia Ehsani et al (2006) Australia (Vic)

4 Zsifkovits et al (2016) Europe 6% Hoonhourt et al (2009) Netherlands most adverse events are preventable Issue 2017 2016 2015 Financial challenges Governmental mandates Personnel shortages Patient safety and quality Patient satisfaction Physician-hospital relations Access to care Technology Population health management Reorganization (ACHE Survey 2017) Health service CEO priorities Issue 2017 2016 2015 Financial challenges Governmental mandates Personnel shortages Patient safety and quality Patient satisfaction Physician-hospital relations Access to care Technology Population health management Reorganization (ACHE Survey 2017) Health service CEO priorities Scheduled flight Barcelona to Dusseldorf, 24th March 2015 Dep GMT, GMT Within hours of crash BEA team (7 people)

5 Were on site 3 days after the crash the co-pilot s home was visited Within 1 week the flight recorder had been recovered 2 wks after the crash the pilot s medical history was known Within 2 months (May) all airlines had changed policy 13th May 2016 final BEA Report issued Germanwings flight 9525 Aviation security changes Flight / event Response Palestinian hijackers (1970) introduction of metal detectors at checking Pan-Am 103 (1988) improved baggage security (5% to 100% screening) airport security staff independent of carrier 9/11 (2001) categorisation of airports (capability framework) reinforced, locked cockpit doors increased armed air marshalls no sharp objects (tweezers, scissors, knives, box-cutters), plastic cutlery enhanced ID checks (multiple photo ID, pre-screening, risk profiling) Richard Reid AA63 (2001) no shoes, belts, jackets off, pat down, scanning 2006 thwarted attack (UK) 100mL liquid limit Germanwings 9525 (2015) minimum 2 persons in cockpit at all times Thwarted attack (2017) no carry-on laptops from some origin ports Umar Farouk Abdulmutallab ?

6 ?????????? selection of health service inquiries .. hospital / service report year $ patient needs registration & credentialling culture leadership governance complaints outcome monitoring incidents Bristol Kennedy 2001 King Edward Douglas 2001 Campbelltown Walker 2004 Bundaberg Davies 2005 Rockhampton Davies 2005 Hervey Bay Davies 2005 14 NHS (Eng) Keogh 2013 Mid Staffs Francis 2013 Furness, UK Kirkup 2015 Bacchus Marsh Wallace 2015 Victoria Duckett 2016 To err is human, to forgive divine Alexander Pope Errare humanum est, sed in errare perseverare diabolicum.

7 Lucius Annaeus Seneca Manuel Dom nguez S nchez To err is human, to cover-up is unforgivable, to fail to learn is inexcusable. Sir Liam Donaldson high performing have specific and quantified goals for improving care use systematic, transparent measurement and reporting of progress use an established method of quality improvement (in a sustained manner) have clinical leadership, teamwork and engagement at all levels have a culture in which patient care quality and safety are valued continually reduce fear in the workforce use the workforce to design and re-design work and processes have a commitment to listening and learning from patients and carers Improving quality in the English NHS.

8 King s Fund 2016 high performing have specific and quantified goals for improving care use systematic, transparent measurement and reporting of progress use an established method of quality improvement (in a sustained manner) have clinical leadership, teamwork and engagement at all levels have a culture in which patient care quality and safety are valued continually reduce fear in the workforce use the workforce to design and re-design work and processes have a commitment to listening and learning from patients and carers Improving quality in the English NHS. King s Fund 2016 Patient outcomes mortality rates readmission rates hospital acquired complications (falls, HAIs, PE, pressure injury) medication errors Wellbeing outcomes patient satisfaction quality of life patient mood depressive symptoms symptom burden at end of life positive workplace and organisational culture Mapping a safety culture in Victorian public healthcare (VMIA 2012)

9 1 in 4 Victorian hospital staff would not attend their own hospital for care Oppositional cautious controlling flexible hierachical reasoned resistant Generative curious encouraging experimental forceful inquiring nurturing Defensive cautious conforming controlling directive hierarchical resistant Uniform appreciative considered controlling competitive flexible hierarchical psychological safety low high cognitive diversity high low 40% vs 15% 33% vs 10% 24% vs 5% (Alison Reynolds and David Lewis, HBR 2018) organizational attributes setting culture deciding not only how to act but .. how NOT to act disrupt unhelpful behaviours strengthen and sustain psychological safety commit to new routines focus on the team, performance will follow Failing to create a generative team leads to.

10 Lack of deep understanding fewer creative options diminished commitment to act increased anxiety and resistance reduced morale and wellbeing Successful teams blend of different problem-solving behaviours enjoy collaboration look for problems to solve maintain discipline break rules invent meet mistakes with curiosity share responsibility for outcomes (Alison Reynolds and David Lewis, HBR 2018) open lack of fear The three eras of healthcare: from heroism to professionalism Don Berwick Era 1: the age of heroism Era 2: the age of accountability -using measurement to drive compliance -doesn t work -creates professional anger and community distrust -leads to loss of information and gaming -remains the dominant era Era 3: the age of professionalism culture (intrinsic motivation) compliance (external measurement) oppositional generative defensive uniform oppositional generative defensive uniform oppositional generative defensive uniform reaching era 3.