Kupu Taurangi Hauora o Aotearoa
The Commission Supporting the health and disability sector to deliver safe and quality health care to all New Zealanders Works with clinicians, health providers and consumers to: • improve the quality and safety of services • increase consumer engagement and participation
It’s about… • ‘ Shining a light ’ on important quality and safety issues through public reporting • ‘Lending a hand ’ through making expert advice, guidance and tools available “Doing the right thing, and doing it right, first time”
The New Zealand Triple Aim Sector quality and safety outcomes
Driving quality improvement • Building capability • Supporting clinical leadership • Building on the success of existing initiatives • Sharing success stories
Our programmes Other focus areas • Medication Safety • Surgical Safety Checklist • • Infection Prevention and Control Trigger Tools • Falls • Reportable Events • Consumer Engagement • Mortality Review Committees • Health Quality Evaluation
Our focus Reducing harm from: falls healthcare-acquired infections medication Consumer surgery engagement Sector capability & clinical leadership Information, analysis and evaluation
We know what works Evidence tells us that with the right interventions: • patient falls that result in fractures can be reduced by up to 30 percent • CLAB rates can be reduced to fewer than one per 1000 bed days • surgical complications can be reduced by about a third • potentially adverse drug events can be reduced by a quarter
Patient Safety Campaign • A campaign to reduce patient harm is under development • It is led and coordinated nationally by the Commission, and led and implemented locally by the sector • Clinical and consumer champions will be the face of the campaign • It focuses on reducing harm from: – health care associated infections – surgery – medication – falls • Register your interest and have input into the campaign development: www.hqsc.govt.nz
Our website: www.hqsc.govt.nz • Register for our newsletter and fortnightly email updates • Contact us: info@hqsc.govt.nz
Improvement starts with knowledge and clarity • Well designed measures collect the right data, in the right parts of the system, at the right time • They help you understand what parts of the system to change and how
Three key roles of measurement • For UNDERSTANDING : to know how a system works and how it might be improve • For PERFORMANCE : monitoring if and how a system is performing to an agreed improvement/performance/managerial state or level • For ACCOUNTABILITY : allowing us to hold ourselves up to patients, the government and public to be openly scrutinised
Why measure? • Stimulation of improvement • Evaluation of what worked (or didn’t) • Judgement of overall quality • Prompting the important questions
Quality and Safety Markers Aim to stimulate change in priority areas (process) but also demonstrate the benefit in reduced harm and saved $ (outcome) • Answering the question of whether our interventions made any difference is crucial for us. • Completing projects successfully is not sufficient • Need to measure IMPACT (were HQSC interventions taken up; what changed in NZ healthcare as a result), and; • OUTCOME (what harm was avoided, what health status was improved, how much money was saved) ( note this will usually have a longer timescale )
Process and Outcome Measures Outcome measures the voice of the consumer/patient • What is the result ? • How is the system performing? Process measures the voice of the workings of the system • Are key changes being implemented in the system? • Are the parts/steps in the system performing as planned?
Quality and Safety Markers • Process measures – – practices that are shown to improve care and should (except for specific exclusions) always be undertaken – under the control of the provider – suitable for targets and league tables – therefore set a national threshold to be achieved with differential trajectories agreed between NHB and DHBs • Outcome measures – – outcomes that should be related to changed practice – harm avoided, cost reduced – not directly under the control of the provide so no targets or league tables used for these – contextualise process measures – quantify effects at a national level
Example QSM set for falls Process markers • Percentage of patients aged 75 and over that are given a falls risk assessment and implementation of appropriate falls prevention. - proposed national threshold 95% • Percentage assessments that result in a positive intervention to manage the risk of fall. (a subset used to contextualise the primary marker – no national threshold) Outcome measures • In hospital Fractured Neck of Femur (FNOF) per 1,000 admissions (age/sex standardised). • Mortality following in-hospital FNOF (actual lives lost and rate per 1,000 admissions). • Additional occupied bed days (OBDs) and associated cost following in hospital FNOF (actual OBDs and $s).
Quality Accounts Quality Accounts require health care providers to give an account for the quality of their services in a similar way to financial accounts showing how an organisation used its money.
Quality Accounts: what are they? • annual reports from service providers regarding the quality of the services provided, and how each provider is progressing in quality improvement, the consumer experience and health outcomes. • a mechanism that service providers are able to share their successes, learning and future improvements with the public and the wider sector. • designed to be published alongside annual financial accounts to demonstrate the equal value and status of quality and safety.
Quality Accounts: who is it for?
The Atlas: what is it for? • To prompt debate and raise questions about health service use and provision amongst clinicians, users and providers of health services about why any differences (variation) exist, and to stimulate improvement through this debate
The Atlas: what is it? • A web tool available through the Health Quality and Safety Commission’s website • Displays easy-to-use maps, graphs, tables and commentary that highlight variations by geographic area in: – The provision and use of specific health services – Health outcomes • Understanding and responding to variation information helps improve health quality
www.hqsc.govt.nz/our-programmes/health-quality- evaluation/projects/atlas-of-healthcare-variation/
Kupu Taurangi Hauora o Aotearoa Richard Hamblin Director Health Quality Evaluation
Quality Indicators • Introducing the proposed indicator set • Review each of the 11 ‘fast - track’ indicators • Seeking your views on the indicator set as a whole
What we seek to achieve Provide robust information to support achievement and measure progress in the whole NZ healthcare system against delivery of the outcomes articulated in the NZ Triple Aim framework
“the whole NZ healthcare system” This is not about reporting at a local level, it’s not a quasi-performance management tool for local services We want in time to cover as much of the sector as possible
Our primary objective Provide the public and the health and disability sector with a clear picture of the quality and safety of health and disability services in NZ as a whole, including – changes over time – (where possible) international comparisons
Organising principles New Zealanders live longer, healthier and more GOVERNMENT New Zealand’s economic growth is supported GOALS independent lives Improved health and equity Improved quality, safety and Best value from public health NZ TRIPLE AIM experience of care for all populations system resources OUTCOMES Services throughout the patient journey, across the health and disability sector SYSTEM LEVEL INDICATORS Equity Efficiency Safety Patient experience Effective Access/timeliness CONTRIBUTORY MEASURES
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