Sandy Blake is the Clinical Lead for the National Reducing Harm From Falls workstream of the National Health Quality and Safety Commission in New Zealand, a role she manages on a part time basis whilst also in the position of Director Nursing, Patient Safety and Quality, Whanganui District Health Board.
Sandy kindly agreed to be interviewed by Tara Rivkin, who posed some questions on quality and safety put to HGI inSIGHT by HGI Executive Learning Set members. Sandy’s extensive experience in the area – she was previously Nursing Director of Patient Safety at Queensland Health, where she spent 22 years – make her an excellent authority on these issues. Her expertise shine through.
Who/what have been the major driver of the quality and patient safety agenda at Whanganui District Health Board?
There were two major drivers to the quality and safety agenda in Whanganui. Firstly the district had adverse publicity regarding the standard of care provided by a doctor and resulting poor outcomes for some patients. The scrutiny that followed identified weakness in the clinical governance structures. Secondly, the Board determined that patient safety was their top priority and, four years ago, the appointment of Julie Patterson as our chief executive to provide the leadership to make the necessary changes. Julie has a clinical background and a personal strong commitment to improving patient and system safety. This enabled her to gain support to enhance and improve Whanganui’s clinical governance systems and processes and to appoint a general manager of patient safety who reported directly to her and joined the executive management team.
If so, describe how the Whanganui District Health Board (of Directors) engage in clinical governance?
Clinical governance in Whanganui is a process governed by the board and extends from the board to the ward and to the wider district. The board demonstrates its role by expecting and requiring reporting against a number of quality and safety markers and a number of targets. Some targets are nationally imposed such as shorter time in emergency departments and severity assessment code (SAC) on clinical incidents. Some are board expectations such as numbers of complaints, numbers of deaths that are reviewed, and evidence that serious incidents and complaints are proactively managed. A full report from the centre of patient safety and quality is presented at every board subcommittee meeting and the chief executive includes quality and safety matters in her report to the board. Patient safety and quality is discussed at every board meeting and often stimulates much debate and, often, resolutions.
To what extent have changes made to quality and patient safety affected the overall patient experience?
The community can expect :
- that patients will have open and honest disclosure after analysis of incident or complaint as processes are now in place to ensure this occurs
- that when incidents that cause serious harm occur, a consumer is invited on the analysis team
- consumers to participate on clinical governance boards
- consumers to be on panel for senior appointments
- higher percentage of complaints managed in house and patient are more satisfied with response
- the use of TrendCare as an acuity workload tool for nursing ensures that the right number of nurses and allied health staff are available to provide patient care
- that credentialing processes are in place for medical staff and services
- that letters are sent to families of patients who have died in hospital explaining that we review all deaths as a quality exercise, asking them for feedback on the care and offering to answer any questions they may have
- that by following up patient concerns about care provided in a responsive manner and publishing examples of improvements in the local paper informs the community and is improving the trust they have in us
- that patients and families are more involved in care planning; care has improved using techniques such as bedside handover with the patient, the releasing time to care programme and rapid rounds and patient rounding.
Have you found there to be any impact on area wide health promotion as a result of changes in the way the district manages risk?
There are two aspects to his question. First, by sharing our processes with others we do influence other district health boards and learn from others. We have a number of examples such as our incident management system and the fact that the neighbouring district health board has now implemented the same system. The other aspect is how we influence and work in partnership with the wider community. An example of this was the conduct of the national care indicators survey across the hospital and all but one of the aged care sector rest/nursing homes in Whanganui. The audit focussed on falls, pressure areas, restraint, nutrition and continence and provided baseline data for a cross-continuum programme to address these areas of high harm.
If you were thinking ahead, what sorts of changes would you implement now so that it would have an overall positive effect in the health and safety of the people that live within your district health board?
The clinical governance board of the hospital meets every second meeting with the primary health organisation (which is a collaborative of general practitioners). I believe a model that includes the whole of the secondary, primary and aged care sector creating an overriding clinical governance board is the way for the future; a model that truly engages with the community where decisions are with them not for them, and where the community give feedback on changes; a system that is transparent so that all staff no matter what their role is in the organisation know how they can receive information and how they can escalate concerns and comments. The challenge is for us to continue to cultivate a culture that supports staff to report and learn and one that listens to patients and families and puts them first.