Great state. Great opportunity.

Department of Health

Embedding behaviours for quality

healthcareRebecca Kimble

GAICD, MBBS, FRANZCOG, Grad Cert IV Training & Assessment

Chair, Statewide Maternity and Neonatal Clinical Network, Queensland Health

Director, Queensland Clinical Guidelines, Queensland Health

Director, Obstetric Services, Royal Brisbane and Women’s Hospital, Queensland Health

Director, Statewide Paediatric & Adolescent Gynaecology Services, Queensland Health

Associate Professor, University of Queensland School of Medicine

Adjunct Associate Professor QUT Health Sciences Faculty

Assoc. Prof. Rebecca Kimble, Dr Brent Knack

4th Clinical Audit Improvement Conference Sydney 25th August 2014

THE NATIONAL ENVIRONMENT

FOR HEALTHCARE SERVICES

National imperative for embedding quality

behaviours

2

3

Clinicians

Policy Makers

Community

and

Consumers

Patients

Queensland Maternity & Neonatal Clinical

Network

Queensland Clinical Guidelines, Queensland Health 4

Queensland Clinical Guidelines

Program

www.health.qld.gov.au/qcg

Health Expenditure as a Proportion of

Gross Domestic Product (GDP)OECD Countries - 2011

9.2 9.1

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

Unite

d S

tate

s

Fra

nce

Ge

rma

ny

Neth

erl

an

ds

Sw

itze

rlan

d

Can

ada

Au

str

ia

Den

ma

rk

Be

lgiu

m

Ja

pan

Ne

w Z

ea

lan

d

Gre

ece

Po

rtu

ga

l

Sw

ed

en

Sp

ain

No

rway

Ita

ly

Unite

d K

ing

do

m

OE

CD

AV

ER

AG

E

Au

str

alia

Slo

ve

nia

Ice

land

Fin

lan

d

Irela

nd

Hun

gary

Slo

va

k R

ep

ublic

Czech

Re

pu

blic

Ko

rea

Isra

el

Lu

xem

bo

urg

Chile

Po

lan

d

Mexic

o

Esto

nia

Turk

ey

He

alt

h t

o G

DP

(%

)

OECD Health Statistics 2014 – Frequently Requested Datahttp://www.oecd.org/els/health-systems/OECD-Health-Statistics-2014-Frequently-Requested-Data.xls

6

Annual Growth of Health Expenditure and GDP (Australia)-

Rising Demand & Resource Constraints

0

2

4

6

8

10

12

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Gro

wth

(%

)

Year

Growth in GDP Growth in Government Healthcare expenditure(National Currency Units)

5.46.2

8.19.1

0

2

4

6

8

10

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Healt

h

Exp

en

dit

ure

as

Perc

en

tag

e o

f G

DP

Government Expenditure Total expenditure

OECD Health Statistics 2014http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT#

7

AIHW-Mortalities Inequalities Australia August 2014

AIHW Report August 2014 Maternal Mortality Australia

2006-2010

Australia

2006-2010

USA

2009

Indigenous

16.4 /100,000

African American

35.6/100,000

Overall

6.8 /100,000

Others

11.7/100,000

Cardiac

Mental Health

Sepsis

Obesity

Chronic Diseases

Trauma

Evidence Based Practices

• 30-40% patients do not receive care according to current scientific evidence

• 20-25% care medically unnecessary and potentially harmful

• Non-compliance: poor information

lack of support

practitioner resistance

13

Health Care Management Review, March 2011, 36(1),4-17

What needs to be achieved?

High quality

healthcare

Efficient and cost

effective service

delivery

Healthcare improvement is the pursuit of these goals

14

Transparency and

accountability in

governance

IMPROVING HEALTHCARE

SERVICES

Supporting the effectors of quality healthcare

15

Improving Healthcare:

What works ...?

• Good-willed, hard working, highly

qualified and autonomous clinicians

• Innovative ways to empower and

engage clinicians & consumers

(Clinical Network activities)

• Clinical Networks working together

to increase efficiencies

16

Queensland

Clinical

Guidelines

• Everyday decisions, collaborations and

communications of clinicians determine:

◦ Quality of healthcare

◦ Efficiency of service delivery

◦ Risk management – clinical and corporate risks

• Clinicians working in a clinical capacity hold most

power to effect quality, safety and expenditure

Improving Healthcare:Why are clinicians important…?

Corporate systems exist to lead, support and facilitate better decisions at the bedside

17

18

NSQHS Standard 1

Corporate systems that should exist to lead, support and facilitate better decisions at the bedside

19

Governance for Safety and Quality in Health Service Organisations

Statement of Intent:

Create integrated governance systems that maintain and improve

the reliability and quality of patient care, as well as improve patient

outcomes.

20

Queensland

Clinical

Guidelines

Corporate

Systems

Translation,

Decision support,

Internal controls

Clinician decisions

Australians

receiving healthcare services

Queensland Maternity & Neonatal Clinical

Network

Culture of clinicians and

policy makers• But… many clinicians are largely unaware of the

big picture

Perception:

• Clinician focus: Patient care, clinical safety

• Policy maker focus: Efficiency of service

delivery, risk management

A degree of disconnect between clinicians and policy makers

Aligning culture of

clinicians and policy makers

• Align using tools that concurrently shape

behaviour of clinicians and policy makers:

◦ Standards and policies

◦ Clinician engagement and leadership

◦ Consumer engagement

◦ Clinical networks

◦ Clinical guidelines

◦ Clinical audit

22

SHAPING BEHAVIOUR USING:

STANDARDS AND POLICIES

A tool for shaping not a stick for chasing

23

24

• Assurance for clinicians:

◦ Governance is focused on supporting frontline

improvements

◦ Deliver safe, high quality healthcare to

consumers

• Assurance for policy makers:

◦ Clinician skills and quality systems are able to

provide care according to current evidence

◦ Deliver safe, high quality healthcare to

consumers

Governance for Safety and Quality in Health Service Organisations

25

For most frontline clinicians:

•Details of standards & policy appear extraneous

•Deliver on the principles at the bedside

Using Standards to influence the

frontline

26

Australian Safety & Quality Framework

for Health Care

Australian Commission on Safety and Quality Health Care (2010)

27

My responsibility

Using Standards to influence the

frontline

Frontline clinician

Goal: Frontline clinicians consider evidence when making decisions

Expectation: Know the

standards about using

evidence

28

My responsibility

Using Standards to influence the

frontline

Frontline clinician

Goal: Frontline clinicians consider evidence when making decisions

Expectation: Consider

evidence when making

decisions

Queensland

Clinical

Guidelines

29

SHAPING BEHAVIOUR USING:

CLINICIAN ENGAGEMENT AND

LEADERSHIP

Building a majority of clinical leaders

30

Creating Strong Foundations for Clinician

Leadership

• Educate clinicians about teamwork and their

roles as leaders.

• Genuinely value clinician leadership networks

and teams that influence horizontally.

31

Clinician Engagement and

Leadership

• Culture: staff who are engaged and who have

high morale deliver a better patient experience,

fewer errors, lower mortality rates, less

absenteeism and better clinical outcomes

• Patient Focus: clinicians have the ability and

motivation to keep the needs of patients at the

forefront

32

Braithwaite J; Hyde P; Pope C, 2010, Culture and climate in

health care organizations, Palgrave Macmillan

http://www.palgrave.com/products/title.aspx?PID=353942

Clinician Engagement and

Leadership

• System Complexity: healthcare improvement is

complex and those with a deep understanding of

the system are best placed to improve it

• Microsystems: what makes a difference to

patients is the team who delivers their care. The

design and running of local teams and systems

is critical

33

Braithwaite J; Hyde P; Pope C, 2010, Culture and climate in

health care organizations, Palgrave Macmillan

http://www.palgrave.com/products/title.aspx?PID=353942

How to create a successful

improvement culture in health

• Make sure overall staff morale is good. Fix hot spots.

• Engage the clinicians and give them the leadership and management skills they need

• Use “respected colleagues” as change champions

• Use the right language : it’s all about the patient

• Use teams, groups, networks

• Get people to work across silos

34

SHAPING BEHAVIOUR USING:

CLINICAL NETWORKS

Co-ordinating clinical experts and their leadership

35

Clinical Networking

“Clinicians work best when they are encouraged to flourish in groupings of their own interests and preference, when they are empowered, not directed, and when they are nurtured and influenced by their peers, rather than controlled by others. This is a bottom up situation not readily amenable to top down solutions.”

36

Braithwaite J, Inaugural Australasian Network to Network Conference

Melbourne March 2010

Clinical Networking

“Clinical practice is shaped by the behaviours and attitudes of thousands of practising clinicians who every day make relatively independent decisions.”

Networks:

• Develop the ideas and knowledge of many

clinicians into a culture

• Co-ordinate clinician leadership and effort to

tackle big picture issues

• Advocate and communicate achievements

37

Braithwaite J, Inaugural Australasian Network to Network Conference

Melbourne March 2010

38

Clinicians

Policy Makers

Community

and

Consumers

Patients

Network Structure

Queensland Maternity and Neonatal Clinical Guidelines Program 39

Governance &

Policy Makers

Network

Co-ordinator

Clinical Chair /

DirectorConsumers

Clinical

Member

Network

Product

Development

Teams

Remote

Area

Private

Hospitals

External

Services

Developing culture with a network

Aligns behaviours by:

• Establishing consensus

• Providing evidence for decision making

• Integrating the consumer perspective

• Sharing and extending knowledge

• Communicating and advocating for

projects and programs

40

Developing culture with a network

41

Queensland

Clinical

Guidelines

Integrated electronic

medical record

Qld Maternity Early Warning Tool

Q-MEWT

Perinatal social and emotional wellbeing

screening

SHAPING BEHAVIOUR USING:

STATEWIDE CLINICAL

GUIDELINES

Translating evidence into best clinical practice

45

Queensland Clinical Guidelines

Program

www.health.qld.gov.au/qcg

Statewide Clinical Guideline approach

by Network

Topic Identified

by members

Evidence Informed

Statewide Clinical

Guideline

Awareness and

Marketing

Support clinician led

implementation

Robust Development Process

48

Implementation strategies

Scoping and review of the evidence

Working party consultation

Statewide consultation

Working party consultation

Queensland Health endorsement

Clinician endorsement

Communities, consumers

Clinicians

Policy makers

Patients

Queensland Maternity and Neonatal Clinical Guidelines Program 49

Queensland Clinical GuidelinesTranslating evidence into best clinical

practice

Queensland Clinical Guidelines, Queensland Health 50

• Clinical guidelines

• Flowcharts

• Education

• Audit

• Implementation

checklist

www.health.qld.gov.au/qcg

• Practical presentation of evidence and statewide

consensus

• Supports clinicians to meet strategic goals

• Facilitated evidence based decision making

• Integrates clinicians, policy makers and consumers

• Uses multiple concurrent strategies to align

behaviours for quality

51

Queensland Clinical GuidelinesTranslating evidence into best clinical practice

52

Engaging clinicians in quality

Dissemination

Awareness and Distribution• Notifications (email, newsletters, staff notices)

• Presentations & presence (education, professional events & forums)

• Accessible information (Posters, flowcharts, web site)

• Endorsement – organisational, expert, peer

• Clinical champions

• Responsiveness to clinician needs

• Up to date website

Clinical Governance• Table topics at local safety and quality meetings

• Clinician orientation

• Educational meetings (grand rounds etc)

• Opportunities for clinician involvement

QCG Statewide desktop icon

53

Education

Engaging clinicians in quality

• Guideline aligned education

• Expert clinician presenters and panels

• >1350 individuals over 2 years

• 60 sites

• Average 22 Sites per videoconference

0

5

10

15

20

25

30

35

40

Neo

Hyp

o29

/03/

201

2

BFI

26/0

4/2

012

Per

inea

l car

e31

/05/

201

2

Res

pD

istr

ess

28/0

6/2

012

IFS

26/0

7/2

012

VB

AC

30/0

8/2

012

No

rmal

Bir

th27

/09/

201

2

Neo

Re

sus

25/1

0/2

012

GB

S29

/11/

201

2

Per

inea

l car

e28

/02/

201

3

PPH

28/0

3/2

013

Jau

ndi

ce2/

05/2

013

NA

S23

/05/

201

3

VB

AC

27/0

6/2

013

Neo

sta

b25

/07/

201

3

IOL

29/0

8/2

013

Exam

inat

ion

of

new

bor

n27

/09/

201

3

New

born

hyp

ogl

ycae

mia

24/1

0/2

013

Ob

esit

y21

/11/

201

3

Dia

bet

es in

pre

gnan

cy27

/02/

201

4 SGA

1/05

/20

14

Nu

mb

er

of

faci

litie

s

Videoconference education session

Participation and reporting of attendance by session

Participating facilities (telehealth record) Facilities reporting participation

Importance of statewide approach

54

Queensland Clinical Guidelines Clinician Survey, 2011

Uses for clinical guidelines

55

28%

43%

52%

58%

67%

68%

Respondents agreed by %

Confirms clinical practice

Increased clinical knowledge

Summary of current evidence

Improved patient safety

Changes clinical practice

More confidence

70%Educational resource

(N=348)

Queensland Clinical Guidelines Clinician Survey, 2011

92%

87%

98%

98%

84%

87%

96%

91%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Participant agreement (%)

Participant agreement (%) regarding videoconference education sessions

Knowledge assessments were useful for my learning

Topic was relevant to my position

Knowledge gained has improved my confidence

Education sessions should continue in this format

Presenter displayed sufficient knowledge of the topic

Course content covered the objectives

Overall quality of the session was good

The session was well strctured and logical

56

Queensland Clinical Guidelines:

statewide videoconference education

N = 613 to 1385

Queensland Clinical Guidelines, March 2012-June 2014

Pre-videoconference knowledge

assessment scores

57

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NeoH

yp

o29/0

3/2

012

BF

I26/0

4/2

012

Perinea

l care

31/0

5/2

012

RespD

istr

ess

28/0

6/2

012

IFS

26/0

7/2

012

VB

AC

30/0

8/2

012

Norm

al B

irth

27/0

9/2

012

NeoR

esus

25/1

0/2

012

GB

S29/1

1/2

012

Perinea

l care

28/0

2/2

013

PP

H28/0

3/2

013

Jaund

ice

2/0

5/2

013

NA

S23/0

5/2

013

VB

AC

27/0

6/2

013

Neo s

tab

25/0

7/2

013

IOL

29/0

8/2

013

Exam

ination o

f ne

wborn

27/0

9/2

013

New

born

hypo

gly

caem

ia24/1

0/2

013

Ob

esity

21/1

1/2

013

SG

A1/0

5/2

014

Tra

um

a in

pre

gnancy

19/0

6/2

014

Pe

rce

nta

ge

of

Res

po

nd

en

ts

Videoconference (Date, Title)

>90% 60-89% <60%Score

Queensland Clinical Guidelines, July 2014

Online knowledge assessments

58

99.5%

99.0%

97.4%

99.5%

99.1%

99.1%

98.9%

98.9%

98.7%

99.0%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Percentage agreement (%) with statements about online knowledge assessments

Will assist me to apply guideline recommendations

Easy to use

Covers key aspects of the guideline

A useful self directed learning tool

Was easy to find on the QCG website

Provide access to appropriate guideline information

Could be completed in a reasonable timeframe

Improved my knowledge

Assisted to consolidate my understanding

Well structured and logical

N = 2217 to 2307

Queensland Clinical Guidelines, Jan 2013- June2014

Many elements

are required to

change behaviour

59

Queensland Clinical Guidelines, July 2014

Queensland Clinical Guideline:

Preterm labour (2009)

60

Introduction of fetal fibronectin test across Queensland (2006)

61

· Positive fFN and/or

· Evidence of cervical change and /or

· TVCL < 20 mm

Increased risk of delivery within 7 days

Consider tocolysis

Contraindications?

Gestation > 34 weeks

Labour too advanced

In utero fetal death

Lethal fetal anomalies

Suspected fetal compromise

Maternal BP < 90 mm Hg systolic

Placental abruption

Chorioamnionitis

Discuss with

Obstetrician and

Paediatrician

Nifedipine(CTG during tocolysis)

give 20 mg oral

If contractions persist after 30 mins:

Second dose 20 mg oral

If contractions persist after further 30 mins:

Third dose 20 mg oral

· Negative fFN and

· No evidence of cervical change and /or

· TVCL > 20 mm

Low risk of delivery within 7 days

Maintenance therapy

If blood pressure stable:

20 mg oral Nifedipine

every 6 hours for 48 hours

Review history

· medical

· surgical

· obstetric

Assess for signs & symptoms of PTL

· lower abdominal cramping

· pelvic pressure

· lower back pain

· vaginal spotting or ‘show’

· regular uterine activity

Physical examination

· vital signs

· MSU +/- M/C/S

· abdominal examination

· fetal heart rate +/- CTG

· sterile speculum examination

· exclude PROM

· fFN if not contraindicated

· high vaginal swab

· assess cervical dilatation by digital VE

· low vaginal /anorectal GBS swab

Do not perform fFN:

With ruptured membranes

Visual evidence of moderate bleeding

Cervical cerclage insitu

Consider

TVCL if available

Commence corticosteroids

YES

Transfer

In-utero transfer should not be attempted if

there is a risk of delivery during the transfer

· Call RSQ: 1300 799 127

Contractions

regular and

painful

Contractions

infrequent /

irregular

Persistent painful

contractions

· Admit and offer analgesia

· Administer steroids and commence tocolysis

(if not contraindicated)

· Commence prophylactic antibiotics for GBS

· Continuous fetal monitoring with CTG

· Transfer if necessaryDischarge home

with follow-up in

outpatients within

7 days

Admit for

observation.

Offer analgesia

Reassess in 2

hours

NO

Betamethasone11.4 mg IM

24 hours later:

Repeat dose 11.4 mg IM

Prophylactic Antibiotics

Penicillin 1.2 g IV bolus; then

600 mg every 4 – 6 hours

OR (if penicillin allergy)

Lincomycin 600 mg IV every 8 hours or

Clindamycin 900 mg IV every 8 hours

Cease if GBS screen negative

Queensland Maternity and Neonatal Clinical Guideline: Assessment and management of preterm

labour: Guideline No: MN09.6-V3-R11

· Positive fFN and/or

· Evidence of cervical change and /or

· TVCL < 20 mm

Increased risk of delivery within 7 days

Consider tocolysis

Contraindications?

Gestation > 34 weeks

Labour too advanced

In utero fetal death

Lethal fetal anomalies

Suspected fetal compromise

Maternal BP < 90 mm Hg systolic

Placental abruption

Chorioamnionitis

Discuss with

Obstetrician and

Paediatrician

Nifedipine(CTG during tocolysis)

give 20 mg oral

If contractions persist after 30 mins:

Second dose 20 mg oral

If contractions persist after further 30 mins:

Third dose 20 mg oral

· Negative fFN and

· No evidence of cervical change and /or

· TVCL > 20 mm

Low risk of delivery within 7 days

Maintenance therapy

If blood pressure stable:

20 mg oral Nifedipine

every 6 hours for 48 hours

Review history

· medical

· surgical

· obstetric

Assess for signs & symptoms of PTL

· lower abdominal cramping

· pelvic pressure

· lower back pain

· vaginal spotting or ‘show’

· regular uterine activity

Physical examination

· vital signs

· MSU +/- M/C/S

· abdominal examination

· fetal heart rate +/- CTG

· sterile speculum examination

· exclude PROM

· fFN if not contraindicated

· high vaginal swab

· assess cervical dilatation by digital VE

· low vaginal /anorectal GBS swab

Do not perform fFN:

With ruptured membranes

Visual evidence of moderate bleeding

Cervical cerclage insitu

Consider

TVCL if available

Commence corticosteroids

YES

Transfer

In-utero transfer should not be attempted if

there is a risk of delivery during the transfer

· Call RSQ: 1300 799 127

Contractions

regular and

painful

Contractions

infrequent /

irregular

Persistent painful

contractions

· Admit and offer analgesia

· Administer steroids and commence tocolysis

(if not contraindicated)

· Commence prophylactic antibiotics for GBS

· Continuous fetal monitoring with CTG

· Transfer if necessaryDischarge home

with follow-up in

outpatients within

7 days

Admit for

observation.

Offer analgesia

Reassess in 2

hours

NO

Betamethasone11.4 mg IM

24 hours later:

Repeat dose 11.4 mg IM

Prophylactic Antibiotics

Penicillin 1.2 g IV bolus; then

600 mg every 4 – 6 hours

OR (if penicillin allergy)

Lincomycin 600 mg IV every 8 hours or

Clindamycin 900 mg IV every 8 hours

Cease if GBS screen negative

Queensland Maternity and Neonatal Clinical Guideline: Assessment and management of preterm

labour: Guideline No: MN09.6-V3-R11

Queensland Clinical Guideline:

Preterm labour (2009)

Supporting bedside decision making

Obstetric Interhospital Transfers for False Labour (Q1 2003 - Q1 2012)

0

10

20

30

40

50

60

70

80

2003 Q1

2003 Q3

2004 Q1

2004 Q3

2005 Q1

2005 Q3

2006 Q1

2006 Q3

2007 Q1

2007 Q3

2008 Q1

2008 Q3

2009 Q1

2009 Q3

2010 Q1

2010 Q3

2011 Q1

2011 Q3

2012 Q1

2012 Q3

Quarter

Nu

mb

er

of

Ad

mis

sio

ns

False Del ivered False non-del ivered

Queensland Clinical Guideline:

Preterm labour (2009)

Statewide

Preterm Labour

clinical guideline

Statewide Memorandum

FFN testing

Queensland Clinical Guidelines, June 2013

63

Maternal in-patient cost of Interhospital transfers for False Labour

0

5

10

15

20

25

30

35

40

45

50

Q1

2003

Q3

2003

Q1

2004

Q3

2004

Q1

2005

Q3

2005

Q1

2006

Q3

2006

Q1

2007

Q3

2007

Q1

2008

Q3

2008

Q1

2009

Q3

2009

Q1

2010

Q3

2010

Q1

2011

Q3

2011

Quarter

Nu

mb

er

of

Ad

mis

sio

ns

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

Co

st

($)

Antenatal admissions Delivery Admissions Antenatal cost Delivery cost

post-guideline Period:

Q3 2009 - Q2 2011

Pre-guideline Period:

Q3 2006 - Q2 2008

Queensland Clinical Guideline:

Preterm labour (2009)

Queensland Clinical Guidelines, June 2013

SHAPING BEHAVIOUR USING:

CLINICAL AUDIT

Audit as an intervention

64

Clinical Audit to Change Behaviour

65

• Frontline clinicians

• Clinical champions

• Safety and Quality

• Consumers

• Policy makers

• Data specialist / statistician

• External stakeholders

• Many frontline clinicians

• Policy makers

• Statistician

• Data analyst

External

expertise &

support

Policy makers

Audit team

Data

collectors

Queensland Clinical Guidelines, July 2014

Clinical Audit to Change Behaviour

66

Make decisions considering:

· Evidence

· Interpretation

· Recommendations

Communicate decisions

Quality Assurance

Data Analysis

Design Audit

Build support for audit

Explain imperative

Support data collectors

· Explain design

· Answer questions

Communicate summary of results

Communicate interpretation of results

Make recommendations to policy

makers

Collect data

Respond to decisions

Receive interpretations and

understand implications

Appreciate clinical imperative

External

expertise &

support

Policy makers

Audit team

Data

collectors

Queensland Clinical Guidelines, July 2014

67

• Benefits:

◦ Aligns clinicians and

policy makers

◦ Suited to large audits

◦ Scales of economy

◦ Ownership of

outcomes

• Limitations:

◦ Longer time to

engage appropriate

stakeholders

◦ Co-ordination

overhead associated

with large audits and

many people

Clinical Audit to Change Behaviour

68

Queensland Clinical Guidelines and

Metro North Hospital and Health

Service

Point of Care Clinical Audit Project

March 2014

Pilot Project 2011 Obesity Guideline Clinicians’

feedback: Feasible within daily workloads,

worthwhile, would like to be involved again

Based on two Queensland Clinical Guidelines

> 200 frontline clinicians involved

3 Hospitals auditing @ same time 1x tertiary, 2 x regional

Point of Care & Retrospective audits

Project benefits

• Evidence that clinical practice largely aligns to

clinical guideline recommendations

(evidence for NSQHS Standard 1.7.2)

• Increased awareness and application of clinical

guideline recommendations

• Improvement in documentation of clinical care –

particularly around patient communication

• Identification of areas for clinical improvement 70

Participant Feedback

71

94%

85%

82%

70%

80%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Percentage agreement

Improved documentation

Given confidence to apply recommendations

Increased knowledge of the guideline

Valuable to clinical practice

Relevant to the clinicians

N=33

Queensland Clinical Guidelines, July 2014

Aligning goals using:

Clinical guideline based audit

• Build audit into regular clinical activity

• Engage clinicians

• Build leadership capability

• Generate evidence for evidence based

decision making72

• Build collaborations between clinicians,

consumers, policy makers & patients

• Multiple concurrent strategies are

required to build a culture of quality in

healthcare

• Leverage Networks, National Standards,

Statewide/ National guidelines and

audits73

Governance &

Policy Makers

Network

Co-ordinator

Clinical Chair /

DirectorConsumers

Clinical

Member

Network

Product

Development

Teams

Remote

Area

Private

Hospitals

External

Services

External

expertise &

support

Policy makers

Audit team

Data

collectors

Acknowledgements

74

• Queensland Clinical Guidelines, Queensland Health:

◦ Assoc. Prof. Rebecca Kimble

◦ Ms Jacinta Lee

◦ Ms Lyndel Gray

◦ Dr Brent Knack

• Statewide (Queensland) Maternity and Neonatal Clinical Network

Funded by: Health Systems Innovation Branch, Queensland Health

Contact details: E: Guidelines@health.qld.gov.au | URL: www.health.qld.gov.au/qcg

75

Feedback and contact details:

E: Guidelines@health.qld.gov.au | URL: www.health.qld.gov.au/qcg

Funding:

Queensland Clinical Guidelines is supported by the Health Systems Innovation Branch, Queensland Health.

Copyright:

© State of Queensland (Queensland Health) 2014

This work is licensed under a Creative Commons Attribution Non-Commercial No Derivatives 3.0 Australia licence. In essence, you are free to copy and communicate the work in its current form for non-commercial purposes, as long as you attribute the Queensland Maternity and Neonatal Clinical Guidelines Program, Queensland Health and abide by the licence terms. You may not alter or adapt the work in any way. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en

For further information contact Queensland Clinical Guidelines, RBWH Post Office, Herston Qld 4029, email guidelines@health.qld.gov.au, phone (+61) 07 3131 6777. For permissions beyond the scope of this licence contact: Intellectual Property Officer, Queensland Health, GPO Box 48, Brisbane Qld 4001, email ip_officer@health.qld.gov.au, phone (07) 3234 1479.

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