What does Quality Improvement look like for Outreach Service Providers?

Presented by:

Bennet Aladin & Tracy Johnson

What we’ll be covering

11:00- 11:30 am

• AGPAL Group of Companies

• Applicable Standards – Outreach Services

• Accreditation/Certification support

11:30 am – 12:30 pm

• Embedding continuous quality improvement

AGPAL Group of Companies

Not-for-profit health promotion

charities

The AGPAL Group Approach

• Our approach to accreditation is based on support and education

• We encourage services to use accreditation as a mechanism to drive continuous quality improvement, enhance capacity and improve safety and patient care

Why Accreditation?

The benefits of accreditation include:

– Improved patient safety

– Effective risk management

– Patient assurance that a high level of care is provided

– Building a culture of quality in the environment

– Developing staff skills and engaging them in continuous quality improvement

Typical Accreditation Process

Achieving Accreditation

To become accredited, a health service organisation must pass external assessments by:

• Conducting a self-assessment

• Participating in an on-site assessment conducted by an independent accrediting agency

• Taking steps to address shortcomings if Standards actions have not been met.

When all of the Standards are met, accreditation is awarded.

Applicable Standards – Outreach Services

Applicable Standards

Royal Australian College of General Practitioner (RACGP) Standards for general practices

National Safety and Quality Health Service (NSQHS) Standards

Human Services Quality Framework (HSQF)

National Disability Insurance Scheme (NDIS) Practice Standards and Quality Indicators

ISO 9001:2015

1.

2.

3.

4.

5.

RACGP Standards for general practices

• Developed by the RACGP

• Voluntary

• Incentivised - Practice Incentive Payment

• Meet definition of general practice*

• Peer-to-peer onsite assessment

• Three year accreditation cycle

• Outcome focused standards

1.

RACGP Standards for general practices

These Standards cover a range of areas including:

• Practice services

• Right and need of patients

• Safety, quality improvement and education

• Practice management, and

• Physical factors of the general practices.

1.

National Safety and Quality Health Service (NSQHS) Standards

• Developed and governed by the Australian Commission on Safety and Quality in Health Care (the Commission)

• Provide a nationally consistent statement about the level of care consumers can expect from health service organisations across Australia

2.

National Safety and Quality Health Service (NSQHS) Standards

• Commenced in 2011

• Now in 2nd edition

• 3 year accreditation cycle

• Mandatory – hospitals, licenced day procedure services, majority of public dental services

2.

National Safety and Quality Health Service (NSQHS) Standards

The Standards cover:

• Clinical Governance

• Partnering with Consumers

• Preventing and Controlling Healthcare-Associated Infection

• Medication Safety

• Comprehensive Care

• Communicating for Safety

• Blood Management

• Recognising and Responding to Acute Deterioration

2.

Human Services Quality Framework (HSQF)

• Human Services Quality Standards

• Written by Department of Communities, Disability Services and Seniors (DCDSS) QLD

• Independent third-party certification

• Continuous improvement framework

3.

HSQF Scope of Application

Organisations funded by:

• The DCDSS

• The Department of Child Safety, Youth and Women

• QLD Health

3.

HSQF Benefits

• A clear and consistent framework for planning, operating and improving services

• Reduction in administrative burden and compliance costs

• A holistic assessment of the organisation’s systems and processes

• The opportunity to position the organisation to deliver services in other areas of human services

3.

Human Services Quality Standards

The Standards cover the core elements for quality service provision:

• Respecting human rights

• Social Inclusion

• Participation

• Choice

3.

NDIS Practice Standards and Quality Indicators

• NDIS-registered disability service providers are required to be audited against the NDIS Practice Standards as part of the NDIS Quality and Safeguarding Framework

• These Standards enable providers to benchmark and assess their performance and demonstrate how they provide high quality and safe supports to NDIS participants

4.

NDIS Practice Standards and Quality Indicators

• The Framework was developed by the NDIS Quality and Safeguards Commission whose role includes regulating NDIS providers and promoting safety and quality services.

• Three year cycle

4.

NDIS Practice Standards –Verification or Certification?

• The auditing type required (Certification or Verification) is determined the NDIS Quality and Safeguards Commission

• Depends on the service provider’s corporate structure and the complexity of supports they deliver

• Verification involves a desk-top audit

• Certification requires multiple on-site audits

4.

NDIS Practice Standards

• The Core module covers the:

– Rights and responsibility for participants

– Governance and operational management

– Provision of supports, and

– Support provision environment.

• Supplementary modules also apply according to the types of supports and services NDIS providers deliver

4.

ISO 9001:2015

• Owned by the International Organization for Standardization (ISO)

• Can be applied to all organisations regardless of size and scope

• Well recognised by governments, commissioners and referrers

• ISO 9001:2015 certification - a mark of quality to identify technically competent, safe, efficient and consumer-focused services that meet regulatory requirements.

5.

ISO 9001:2015

• Establishing a quality management system requires the development of a quality policy and quality goals, quality manual, procedures, work instructions and records.

• ISO 9001:2015 is a three year cycle.

5.

ISO 9001:2015

The Standard includes:

• Requirements for a quality management system

• Responsibilities of management

• Management of resources

• Measurement, analysis, and improvement of the QMS through activities like internal audits and corrective and preventive action.

5.

Accreditation Process, Support & Resources

How we can support

QIP Accreditation Hub

Self-assessment - AccreditationPro

Dedicated team support

Expert Assessors

Resources and Publications

Education and Training

Embedding Continuous Quality Improvement

Objectives

• Discuss models which support continuous improvement

• Learn how to embed continuous quality improvement in your practice

• Outline how a CQI rhythm supports accreditation

Data Imperfections

• All data is wrong!

• Quality is merely achieving a reduction in variation

• So how varied are you now?

• Deciding where to go means knowing where you are starting

Data must drive quality care… Not replace it!

What is Quality?

Dimensions of Quality:

• Safe

• Effective

• Patient-centred

• Timely

• Efficient

• Equitable

Institute of Medicine: Crossing the Quality Chasm, a new health system for the 21st century, Washington,1990

“The degree to which health services for individuals and populations, increase the likelihood of desired health outcomes and are consistent with current professional knowledge”

Accreditation and Improvement

Know the standards

Allocate resources

Do self assessment

Implement improvement

Demonstrate quality during accreditation

QI Underpinnings

• Data and measurement

• Understanding business processes

• Improving reliability

• Demand, capacity and flow analysis

• Engaging staff

• Involving patients and families

The Health Foundation, Quality Improvement Made Simple, 2013

QI Approaches

• Business Process Reengineering

• Co-design

• Lean

• The Model for Improvement

• Six Sigma

• Statistical Process Control

• Theory of Constraints

• Total Quality Management/CQI

QI Formats in Healthcare

• Supervised Clinical Attachments

• PDSA Cycles

• Clinical Audits

• Clinician Research

• Evidence Based Journal Club

• Small Group Learning

• Business Process Reengineering

• Co-design

• Lean

• The Model for Improvement

• Six Sigma

• Statistical Process Control

• Theory of Constraints

• Total Quality Management/CQI

Activity

• Imagine one of your team asked you why quality improvement is important.

• What would you say?

- Take a minute to think about this, and write a short sentence answering the question….

Shift in Model of Care

ReactiveTreats patient

when they are sick

ProactiveSupports patients to stay well and engage

in preventive care

Improved patient experience and health outcomes

Population Management

Health Coaching

Complex Care

Management

Panel Management

Population Data

Model for Improvement

The thinking part of the Model for Improvement – the three questions

Driver Diagram

Reduce waiting time to see a

team member

Clinician availability

Time of Year

Patient booking habits

No show rate

Triage

Provider / patient management

Outcome Primary DriverSecondary

Driver

Flu/sport season

Holidays

TCA Peaks

Change Ideas

Group activities

On the day appointments

Promote prevention

Use students

The Quality Measurement Journey

• Aim (why are we measuring) e.g. improve patient experience

• Concept (what we are trying to improve) e.g. reduce waiting interval

• Measurement name (quantifiable) e.g. days to next appointment

• Operational definitions (specifics of how to measure) e.g. count of working days to next available appointment

• Data collection plan (details) – collect daily for 4 weeks and report across practice and by provider

• Data collection detail (practice reports?)

• Analysis (Excel charting to create run chart?)

• Action (what next?)

SMART Goals

• Specific

• Measurable

• Achievable

• Realistic

• Time bound

Activity

• How can you express your aim to improve the patient experience by reducing time to get into the clinic, as a SMART Goal?

Making Change Happen

Feature Description

Iterative cyclesThe PDSA snowballs into a learning cycle with a test, study and act method.

PredictionPredictions are made in the planning stage. When the study occurs in the PDSA the outcomes is compared to the prediction and learnings explored.

Small-scale testingStart small and grow as confidence develops, test before implementation.

Use of data over time Measure and review data over long periods of time to gain insight.

DocumentationMinimise variation by working a common process; learn from whose results are better and modify documentation to accommodate better practice.

Causes of Patient Harm

• Delayed or inadequate diagnosis

• Failure to provide appropriate treatment

• Treatment

• Over-treatment

• General harm

• Psychological harm

The Health Foundation: A framework for measuring and monitoring safety, 2014

PICO

• Population

• Intervention

• Comparator

• Outcome

Data Interpretation

Median

0

5

10

15

20

25

30

35

40

1 2 3 4 5 6 7 8 9 10

11

12

13

14

15

16

17

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19

2 0 21

22

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25

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30

Any Chart

Interpreting Run Charts

Rule 1 – Is there a shift?

Rule 2 – Is there a trend?

Rule 3 – Are there any astronomical values?

Rule 4 – Are there useful observations?

Slow Conclusions are Good!

• 15-20 patients

• 15-20 days

• 15-20 weeks

• 15-20 months

Variation

• Common cause variation (random variation)

– Due to regular or natural causes (e.g. taking holidays)

– Affects all the outcomes (e.g. whenever a provider is away on leave it happens)

– Is a predictable result

• Special cause variation

– Opposite to the above

– Something very unexpected happened!

Activity

Going back to our patient access and experience challenge…

• What information do you need before you start your improvement process?

• What information do you need to identify whether any improvements have been made?

• Who would be the people you need to engage to ensure success?

The Right Culture

• A reporting culture

• A just culture

• A flexible culture

• A learning culture

CQI for Clinicians

• Data Quality

• Clinical Dashboards

• Clinical Governance

• Rewards

• Clinical Planning

All require transparent data and people driven to analyse it

What gets Measured gets Monitored

Data Forms

CQI vs Accreditation

CQI Accreditation

Focuses on improving client care and outcomes

Focuses on improving organisational and clinical administration

Determined by local needs and priorities

Determined by national and international consensus

Internally assessed Externally assessed

Prospective and ongoing review Retrospective review

Data for dialogue Data for certification

Measures, including quality indicators, with changeable targets

Sets of standards

Results vary over time Yes/no result

Short cycles Long cycles

The Importance of Leadership

‘Commitment from the top down, involvement from the bottom up’

Leaders of successful change do three things well:

1. Set the vision including targets to be achieved

2. Empower people to make the changes

3. Support staff making those changes

Key Messages

Continuous Quality Improvement is a process

CQI is Everybody’s Business

Different people have different roles

CQI is built in not bolted on

Accreditation is just part of our CQI system

Thank you for your time For any support contact AGPAL

1300 362 111

educationandtraining@agpal.com.au

www.agpal.com.au

Questions, feedback & contact

Contact our Education and

Training team to learn more about

our offerings, packages and

tailored solutions to support your organisation

Bennet AladinManager, Health and Human ServicesNational Development Team

baladin@agpal.com.au

linkedin.com/in/bennetaladin/