Quality and safety the

national context

RCSI Masterclass
6-11-12

Dr. Philip Crowley, National Director Quality Improvement

The challenge that faces us

 Budget
 Medical and nursing recruitment and retention
 Limited measurement of quality
 Media and morale
 New divisions – focus vs integration
 Fire fighting (comfortable) Vs process, practice and
care improvement
Nursing and Midwifery Developments

 Expanding roles
 Nurse and Midwifery Prescribing (medicinal products
and X-ray)
 Advanced practice (eg EDs, sexual assault, chronic
disease mangement)
 Driving key safety initiatives
 NEWScores/IMews
 Collaboratives, pressure ulcers, falls
 Measuring Care (Nursing and midwifery) metrics
 Leading Quality Improvements
Mid Staffs and nurse leadership
 Presented to HSE leadership team X 2
 Communication to system re acting up
 Audit:
 229 CNM2/CMM2 posts acting up
 = 14%

 Ongoing support for developing CNM/CMM2

competency
 Moderate levels of empowerment, time to lead?

 And DoNs, ADoNs, CNM3???

Flipping Healthcare

Move from
“What’s the matter?”
to
“What matters to you?”

 The patient is not the problem (Muir Gray)

 “Minimally Disruptive Medicine” (Victor Montori)
 Having conversations with the patient, understanding patients (not just
their diseases) and their lives
 Patient goal setting

Source: Barry MJ, Edgman-Levitan S. ”Shared Decision Making – The Pinnacle of Patient-Centered
Care.” N Engl J Med. 366;9. pp 780-782. Montori, VM. “Shrinking the health care footprint.” Minnesota
Physician. XXV(1). April, 2011
Quality led by Staff

 Staff experience – seek and value feedback and ideas

for improvement
 Quality and safety Walk-rounds
 Enable people to do a better job
 ‘Walk in my shoes’
 Do reinvent the wheel
 QI Tools

Driver Diagram Run Chart

Greatest impact at ward level

Conditions
Leadership National
Patient involvement
Clinical Governance
Education & Learning:
Collaboratives

- Measurement
Trust
EWS

- QI Methods
Guidelines

Pathways

Ward

Quality Improvement of Patient care

Increasing capacity for QI

Now over 200 staff

trained in QI from the
Diploma, Scottish
Patient Safety and
CAWT Programmes.
Pressure Ulcer to Zero Collaborative

73% Reduction in Pressure

Ulcers
Collaborative methodology

February
Final Celebratory
April June
Event
Overall Collaborative trend over time
25

20

15

10

0
February March April May June July August
Overall key learning was Key learning was the
Teamwork – the benefits importance of
of working with a working together,
team/group and good collaboration
the visual impact of and communication.
keeping data’

Comments
If managers support
QI initiatives, teams can
It’s all about teamwork achieve great results.
and communication with
a smile. Great team
building experience
My only advice or request
is if you could organise
the kind of learning sessions
often, that would be a great
help and encouragement.
Academic Hospital Groups
Academic Hospital Groups

Can we move from “teaching hospitals” to “learning

hospitals” and care settings?

Where learning together about how we can improve

quality and safety is at the heart of what we do
Clear roles for Quality and Safety
 Board
 Providing direction and leadership

 Overseeing/obtaining assurance on clinical care

quality and safety (Board Q +S committee)
 Executive
 Operationally managing clinical care quality and
safety (Executive Q+S committee)
 Staff
 Delivering quality safe compassionate care

 Contributing improvement solutions

How can QI division support you?

Quality Improvement
Division

Patients and Quality Quality data Strategy and

Staff Improvement analysis and innovation
partnership Capacity audit
building
Quality Improvement

“We have two jobs: our job and the job

of improving our job”

Donald Berwick
 Philip Crowley

Philip.crowley@hse.ie
www.hse.ie/go/qps