Queensland Health Queensland Health

Quality Improvement & Enhancement Program (QIEP)Quality Improvement & Enhancement Program (QIEP)

1999-20031999-2003

Quality & Safety Program (QSP)Quality & Safety Program (QSP)

2003-20042003-2004

………….and ….2005 and beyond ……….and ….2005 and beyond ………

16 February 2005

Meeting the National Agenda & Setting QH’s agenda

July 1998 - June 2003

Australian Health Care Agreement Part 5:

Quality Improvement and Enhancement $120 million

QH Quality Improvement and Enhancement Program Quality of Health Services Framework developed for

Queensland Health Australian Health Care Agreement (AHCA) 2003-2008

Schedule C $144 million for QLD. QH Safety and Quality Program

National and State priorities

1998 1999 2000 2001 2002 2003 2004 2005

AHCA

QLD QIEP

Safety & Quality Council

AHCA

QLD S & Q P

2006

QLD QSP

Quality of Health Services Framework developed

PREMIS ES UNDERPINNING DELIVERY OF HEALTH SERVICES BY QUEENS LAND HEALTH Consumer involvementConsumers will be given the opportunity to make decisions regarding their health care, and into the operations of thehealth service where possible

AccessAccess to health services should be equitable, on the basis of patient need, regardless of age, gender, ethnicity, socio-economic group, or geography

AppropriatenessSelection of a health service intervention should be based on available evidence and consumer need

SafetyConsumers and providers should be assured of safety during the delivery of any health service, with a deliberate effort tominimise risk in service delivery processes

EffectivenessThe desired outcome of a health service intervention should be outlined by consumers and providers. The servicedelivered should aim for that desired outcome

EfficiencyValue for money is important in the provision of health services. Resources must be allocated to provide the greatestbenefit to consumers

QUEENS LAND HEALTH POLICY FOR IMPLEMENTATION OF QUALITY SYSTEMS

Queensland Health will adopt management systems for both clinical and non-clinical services that comply with the requirementsof the relevant Quality System standards. This will ensure that management processes designed to achieve QueenslandHealth’s goals are documented, are adhered to, achieve reliability and repeatability, and are readily explainable to all affectedparties. Management systems will be assessed to ensure compliance with the requirements of the relevant Quality Systemsstandards. Queensland Health will develop the competence of staff to respond to innovative service developments whileremaining conscious of the need to work within quality assured management systems that ensure achievement of our goals.

The management systems will be based on the following Quality System standards:

Health Services Evaluation and Quality Improvement Program (EquIP) with the Australian Council on Healthcare Standards (ACHS); or Australian Health and Community Service Standards (AHCSS) with the

Quality Improvement Council (QIC) formerly known as Community Health Accreditation & Standards Program (CHASP); or

AS/NZS ISO 9000 series standards; or other quality standards/systems/processes endorsed by Queensland Health

Laboratories NATA accreditationEnvironmental management ISO 14001Corporate Office AS/NZS ISO 9000 seriesInformation systems development ISO 9001 seriesDesign of safety critical systems IEC 1508and software

Queensland Health services will be managed in accordance with Queensland Government Standards and requirements includingstandards for financial management, risk management and workplace health and safety.

All Queensland Health facilities will report annually on their compliance with this policy.

QUEENSLAND HEALTH

1999GOOD HEALTH AND BETTER

HEALTH SERVICES

2004Our mission:

Helping people to better health and well-being.

Our mission will be achieved by:

Providing a comprehensive health system as oneorganisation.

Focusing the purpose and role of Queensland Health on: Prevention, health promotion and early intervention; Evidence-based clinical practice; Partnership with all health care providers (including

private sector and non-government bodies); and Managing the public health risks to Queenslanders.

Maintaining a high quality of health care.

Prioritising resource allocation to meet demonstratedneed and principles of equity.

Encouraging individual responsibility for health care.

Implementing the principles of the Charter of PublicService in a Culturally Diverse Society.

Fostering research and education to continuouslyimprove health services.

Partnerships and collaboration with other agencies andgovernments.

Key values: Trust and respect for people

Performance accountability

Integrity and professionalism.

Quality of Health Services

It is expected by the community that Queensland Health willprovide health services which are safe, efficient, and effectiveto address the needs of the consumer of health care. To thisend, it is important that the staff of Queensland Health aregiven the opportunity to enhance their knowledge and skills,to have information available to them to deliver and monitorservices and to involve consumers in the management of theirown care and the planning and delivery of health servicesgenerally.

Processes associated with the delivery of care should also besubject to evaluation to ensure services are coordinatedacross the various providers, and that such interaction isundertaken in the best interests of the consumer in thecontext of efficiency, effectiveness, and accessibility.

The intention of this document is to provide a clear guide tothe range of principles endorsed by Queensland Health whichpromote a safe, efficient, and effective health service. It alsoallows Queenslanders to understand the range of healthservice initiatives which will ensure services being providedare focussed on a quality outcome.

A number of quality assurance and improvement mechanismsare already in place in Queensland Health. It is imperativethat these existing mechanisms be incorporated into the newframework as appropriate.

The framework will be utilised to ensure that all QueenslandHealth organisational development and improvementactivities are coordinated and targeted to key priorities, withthe emphasis being on information and education.

(Dr) R L StableDirector-GeneralSeptember 1999

Goals:

The provision of a high quality health service whose qualitycan be demonstrated to its customers (consumers), its staff,its funders, and the people of Queensland .

An organisation which continually improves its services.

How will this be achieved ?Policies and procedures and management structures are inplace to ensure health services are provided at a consistentlyhigh standard across the State.A coordinated improvement program is in place to ensure thatservices become even better.

How will this be demonstrated?Performance of health services measured against pre-determined criteria is reported regularly and in a timelyfashion. Interested individuals can judge Queensland Healthagainst the expectations Queensland Health has set .

SvOutPlaceObject

Effectiveness

AppropriatenessSafety

Efficiency

Consumerinvolvement

Access

Clinical & non-Clinical Risk Management

Consumer Participation

Reducing Variation in Health Service

Delivery

Information Management

Distance Management

Quality Systems

Change Management

Program Delivery

Incident Monitoring

Infection Control

Prevention of Falls

Risk Management

Consumer Participation

Informed Consent

Patient Complaints &

Surveys

Clinical Audit Processes

Clinical Pathways

Credentials & Clinical

Privileges

Medical Quality

Processes

Clinical Informatics

Quality Use of

Medicines

Rural & Remote

Telehealth

Accreditation Review

Measuring Quality in the

Non-Government Health Sector

QHPSS Quality Pathology System

Education in Quality

Clinician Development

Program

Central Zone Projects

Northern Zone

Projects

Southern Zone

Projects

Australian Council on Safety &

Quality in Health Care

Corporate Management of

Program

Central Zone Quality

Coordination

Northern Zone Quality

Coordination

Southern Zone Quality

Coordination

Clusters

Program Areas

Measured Quality

Please note: All 22 “content” Program Areas in the QIEP are not represented – this diagram is indicative of the structure which would apply to all

QUALITY COUNCILGovernance Committee for

Quality Improvement & Enhancement Program (QIEP)

PROGRAM AREA

SPONSOR

PROGRAM AREA

SPONSOR

PROGRAM AREA

SPONSOR

Program Area Manager (and Quality Reviewer)

Program Area Manager(and Quality Reviewer)

Program Area BoardProgram Area BoardProgram Area Board

Program Area Manager (and Quality Reviewer)

Direct reporting relationship

Communication relationship

QUALITY STRATEGY TEAM

PROGRAM MANAGER

What’s been achieved to date:What’s been achieved to date:1. implementing improved systems to manage the

quality of our services and report on performance (Objective from Quality of Health Services Framework 1999-2004)

Clinical audit

Quality pathology service

Balanced scorecard measurement approach

Credentials and clinical privileges

Collaboratives for Healthcare Improvement

Incident monitoring system

Patient complaints

1. implementing improved systems to manage the quality of our services and report on performance (Objective from Quality of Health Services Framework 1999-2004)

Clinical audit

Quality pathology service

Balanced scorecard measurement approach

Credentials and clinical privileges

Collaboratives for Healthcare Improvement

Incident monitoring system

Patient complaints

Achieved:Achieved:

2. Encouraging the community to actively take responsibility for its health and well being by being well informed and being involved in decision making

Informed consent

Consumer and community engagement

Zonal projects - Clinical pathways and networks

2. Encouraging the community to actively take responsibility for its health and well being by being well informed and being involved in decision making

Informed consent

Consumer and community engagement

Zonal projects - Clinical pathways and networks

Achieved:Achieved:

3. Developing a culture of quality through continuous staff education

Clinician development

Risk Management

Quality Use of Medicines - Adverse Drug Event Project

Prevention of falls

3. Developing a culture of quality through continuous staff education

Clinician development

Risk Management

Quality Use of Medicines - Adverse Drug Event Project

Prevention of falls

Achieved:Achieved:

4. Improving coordination of health services and programs and collaboration between health service providers and other government and non-government agencies

Telehealth

Pathology - point of care testing

Measuring quality in the non-government sector

Clinical Pathways

Central and Southern Networks

4. Improving coordination of health services and programs and collaboration between health service providers and other government and non-government agencies

Telehealth

Pathology - point of care testing

Measuring quality in the non-government sector

Clinical Pathways

Central and Southern Networks

Achieved:Achieved:

5. Developing client and patient-centred information systems to facilitate the delivery and evaluation of health services

Clinical Information System

QH Pharmacy Information System

CHRISP (infection surveillance & prevention)

5. Developing client and patient-centred information systems to facilitate the delivery and evaluation of health services

Clinical Information System

QH Pharmacy Information System

CHRISP (infection surveillance & prevention)

Achieved:Achieved:

6. Providing evidence based health services which are outcome focused and encourage innovative practice

Rural and remote program

– Primary Clinical Care Manual

– Trained indigenous health workers

Quality Use of Medicines

– Rural and Isolated Practice - regular visits, training, network

Clinician development

Infection Control

6. Providing evidence based health services which are outcome focused and encourage innovative practice

Rural and remote program

– Primary Clinical Care Manual

– Trained indigenous health workers

Quality Use of Medicines

– Rural and Isolated Practice - regular visits, training, network

Clinician development

Infection Control

15 projects continued to December 2004 - to Finalise standardised tools and procedures Roll out information systems to next group of

hospitals Finish training and implementation Improve communication with patients and

families

to June 2004

Safety & Quality Program 2005 - 2010The 2005-2010 Program should:

build upon what was established in 1999-2004

align with QH’s other strategic priorities

align with national quality and safety priorities as appropriate

move away from a project-oriented approach to mainstream the functions such as:

performance reporting and organisational and clinician development activities

reinforce the foundation of performance measurement and reporting (eg. Measured Quality)

Meeting the National AgendaApril & July 2004 AHMC Meetings S & Q targets set

National Targets from the April 2004 AHMC

10 tips for consumers July 2004 Right side surgery June-September 2004 Incident mgt system December 2004 Risk mgt plan December 2005 Sentinel event reportingDecember 2005 Medication chart June 2006 Pharmaceutical review January 2007

Safety & Quality Program 2005 - 2010

Aligned with ISAP objectives

Increased use of clinical evidence-based decision making

Queensland Health endorses a range of principles, objectives, strategies and practices to promote a safe, efficient, and effective health service.

It aims to ensure organisational development and improvement activities are coordinated and targeted to key priorities, emphasising information exchange, education, clinical innovation and reform.

Safety & Quality Program 2005 - 2010

Continuously improving key business processes Reforming the accessibility, provision and quality

use of medicines Continuing to systematically examine the

performance of our hospitals on key indicators Monitoring the safety of key clinical processes in

hospitals by establishing a statewide system for reporting sentinel events and adverse clinical outcomes

Innovation Branch, IWR Directorate Role & Purpose

To position Queensland Health as an innovative, adaptable and change ready organisation which drives and supports health care improvement.

Identifies opportunities to create and disseminate new ideas and innovations, aligned to strategic priorities and leads the development of tangible and sustainable improvement responses.

Priority 2 Culture of Safety

Priority 1 Improve standardisation of system and clinical practice

Alignment of Priorities with Structure

Priority 5 Workforce Design Workforce Education

Priority 3 Workforce improvement: climate and morale, staff health Learning Services: leadership development Priority 4 Innovation

Priority 3 Exploit full potential Skills Development Centre

Patient Safety Centre

Clinical Improvement

Centre

Workforce Reform

InnovationSkills Development

Centre

National

National Safety & Quality Action Plan AHMC Targets

State Qld Government Priorities & Election Commitments

Department (Strategic)

QH Strategic Plan, including Strategy Map & Scorecard (ISAP)

Department (Support)

QH Safety & Quality Strategic Plan, including Strategy Map & Scorecard

Branch / Service

Business Planning

Individual Performance Appraisal & Development Planning

OUR PLANNING FRAMEWORK

Queensland Health Strategic Plan 2005–

2010 & Balanced Scorecard

Safety & Quality Strategy & Scorecard

Other Support Strategy maps &Scorecards

38 District Health Service Balanced Scorecards

SUPPORT STRATEGIES & SCORECARDSSUPPORT STRATEGIES & SCORECARDS

SUPPORT BUSINESS PLANSSUPPORT BUSINESS PLANS

Workforce Strategy & Scorecard

Strategy Framework

Safety & Quality Strategic Plan 2005-2010

Scope To guide all services within Queensland Health towards

safer healthcare delivery

Benefits greater capacity to minimise the risk of unintended harm in

healthcare better planning for future needs including increasing capacity to

continuously improve health service delivery; greater alignment between strategy and business planning

processes and improved performance monitoring; improved strategic focus to improve health service delivery

Queensland Health Strategy MapAugust 2004

Healthier staff

Healthier people & communitiesHealthier partnerships Healthier hospitals

Healthier resources

Pay

ing

fo

r h

ealt

hC

on

sum

er

Promoting a healthier Queensland

our vision Leaders in health — partners for lifeour mission Promoting a healthier Queensland

C1. Achieve whole-of-

government approach to quality of life

C2. Increase confidence

in health system

C3. Increase knowledge

and skills for health

C4. Improve access to

primary health care

C5. Reduce impact of chronic disease including

on Indigenous peoples

C6. Smooth transition between

community services, hospitals

and GPs

C7. Ensure safe and

quality health outcomes

C8. Appropriate access to

specialist services across

Queensland

IP1. Improve community

participation in the planning and delivery

of health services

IP2. Proactive marketing and

education aboutQH services

IP3. Progress shared priorities with

government and non-government sector

IP4. Inform and skill

health consumers

IP5. Reduce risk factors in high risk consumers

IP7. Increase use of clinical evidence-

based decision making

IP8. Continuously improve key

business processes

WF4. Right information at the right time at the right place in the right medium

WF1. Encourage innovationand targeted research

WF2. Develop values-basedorganisation

WF3. Recruit, develop and retain an appropriately skilled workforce

P1. Balanced budget

P2. Leverage other sectors P3. Maximise revenue

Inte

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pro

cess

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wo

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IP6. Primary prevention targeting areas of high return IP9. Effective

service and workforce planning

Draft Safety & Quality Strategy Map 2004 - 2007

Healthier staff

Healthier processes Healthier services

Healthier resources

Pay

ing

fo

r h

ealt

hC

ust

om

er

our vision Leaders in health – partners for lifeour mission Promoting a healthier Queensland

Inte

rnal

pro

cess

esL

ear

nin

g &

Gro

wth

Promoting a healthier Queensland

P1. Balanced budget

LG3. Workforce skilled in continuous quality improvement

C4. Culture of safety & quality

LG5. Right information at the right time at the right place in the right medium

C1. Standardise processes for high risk areas

IP1. Operationalise national &

state agendas

LG2. Competency basedrecruitment & selection

IP9. Implement key decision support systems to inform

decision making(clinical & business)

IP6. Standardise process of incident management

IP5. Partner with educational institutions & professional bodies

P2. Identify revenue opportunities

LG1. Support mechanisms to share learnings

C3. Use of evidenced based management

IP3. Identify gaps in communication

processes

C2. Improve key business processes

LG4. Engage clinical & business leaders

C5. Use of information technology to support

safety & quality

IP4. Eliminate rework, duplication & waste

IP2. Prioritise areas of high impact

IP8. Develop a reporting culture

IP7. Managers/leaders demonstrate a culture

of safety & quality

November 2004 v 5