Slide 1

Advancing Patient Safety through Leadership and Accreditation Philip Hassen Immediate Past President, ISQua March 13, 2013 Slide 2 Objectives 1. Increase understanding of the importance of leadership as a key factor in advancing safety and improvement. 2. Build greater understanding about need for change. 3. Understand how the accreditation process can enable change and improvement. 4. Provide a Canadian example about how to advance quality & safety for patients. 2 Slide 3 Why do we need to improve? 1. Why do we need to improve? 2. What is the role of leadership? 3. How accreditation enables change & improvement? 4. How Canada has advanced safety & improvement? Our current methods of organizing and delivering care are unable to meet the expectations of patients and their families because the science and technologies involved in health care - the knowledge, skills, care interventions, devices, and drugs have advanced far more rapidly than our ability to deliver them safely, effectively, and efficiently. The Robert Wood Johnson Foundation 1996 Slide 4 4 Why do we need to improve? Medicine used to be simple, ineffective &relatively safe. Now it is complex, effective, and potentially dangerous. Sir Cyril Chantler Slide 5 One in ten adults contract infection in hospital One in ten patients receive wrong medication or wrong dose More deaths after experiencing adverse events in hospital than deaths from breast cancer, motor vehicle accidents and HIV combined Why do we need to improve? In Canada and most developed countries... Slide 6 Why do we need to improve? World Health Organization Facts Adverse Events 1.4 million Hospital Acquired Infections 1.3 million die from unsafe injection Cost - $6 29 billion Developing Countries 20 times higher Up to 70% of syringes reused Cost Lives and Suffering 6 Slide 7 7 Slide 8 8 Slide 9 9 Slide 10 10 Slide 11 Without change there is no innovation, creativity, or incentive for improvement. Those who initiate change will have a better opportunity to manage and lead the change that is inevitable. - William Pollard- 11 Slide 12 Leadership and Culture 1. Why do we need to improve? 2. What is the role of leadership? 3. How accreditation enables change & improvement? 4. How Canada has advanced safety & improvement? Foundational to every organization which has made significant advances in quality and safety in health care, there exists a culture which instills the importance of patients, residents, clients and families they serve. The key role of staff is service delivery and safety improvement while realizing the strategic imperative of leadership. Slide 13 Leadership is A set of processes that creates organizations in the first place and defines what the future should like and inspires people to make it happen Establishing direction by developing vision & leading by values Aligning people & building commitment Inspiring people to overcome obstacles to bring about change Communicating more in actions & in words through dialogue Source: J. Kotter. Leading Change. 1996 13 Slide 14 Research has shown that people consistently select four characteristics to describe the leaders they would choose to follow Honest Forward Looking InspiringCompetent Kouzes, J. & Posner, B. (2007, p. 29). The Leadership Challenge (4th Ed). Slide 15 Culture and Leadership Engage management and senior decision makers Focus safety not just as another program but as a key priority Improve worklife/workforce and working conditions Build partnerships with patients & families 15 Slide 16 Leadership is A good leader inspires people to have confidence in the leader; a great leader inspires people to have confidence in themselves. Author Unknown 16 Slide 17 Competence Professional focus | Knowledge | Skills | Behaviors | Methods & Tools Leadership Character & Competence Stephen Covey, 1990, Principle-Centered Leadership Leaders Character Personal Focus |Values | Integrity | Courage | Creativity 17 Slide 18 Leadership is a learnable, teachable and measurable set of behaviours & practices Kouzes, J. & Posner, B., 2007, The Leadership Challenge Model the way Inspire shared vision Challenge the process Enable others to act Encourage the heart 18 Slide 19 Winning companies know that, like athletes, no matter how good or bad a persons inherent leadership skills are, they can be improved with coaching and practice (Noel Tichy) 19 Slide 20 Leadership Checklist Build a safety culture Listen and support staff Integrate risk management activities Promote reporting Involve patients/clients, families and the public Learn and share safety lessons Implement solutions to prevent harm Source: Charles Vincent, 2006 20 Slide 21 1. Why do we need to improve? 2. What is the role of leadership? 3. How accreditation enables change & improvement? 4. What Canada has advanced safety & improvement? Accreditation is a self-assessment and external peer review process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve the health care system. Accreditation : Enabler of Change Slide 22 External Evaluation Improvement & Change Regulatory Licensing International Organization for Standardization (ISO) European Foundation of Quality Management Accreditation Slide 23 What is Accreditation? Strategic change and risk management tool Proactive and continuous Transparent and rigorous analysis of service provision Addresses current and future patient needs facilitated by: Independent third party Quality Improvement focus Objectivity 23 Slide 24 Accreditation Is a process Not an event What is Accreditation? 24 Slide 25 Accreditation of healthcare services is in demand in many countries: By government, funders, patients and communities They all want to know that care is SAFE That treatment is effective That limited resources are used efficiently Why the demand? Slide 26 Accreditation supports... Quality improvement Patient safety Risk management Change management 26 Slide 27 Does accreditation make a difference? Better communication and collaboration Stronger teams Increased credibility and accountability 27 Slide 28 25 Benefits (examples) Provides a Risk Mitigation System Strengthens interdisciplinary team effectiveness Improves communication Promotes measurement and use of indicators improvements Is not clear whether it increases patient satisfaction Captures data Value and impact of accreditation: A literature review by Accreditation Canada (2011) Slide 29 Does improving quality save money? A review of research into productivity and the economics of continuous quality improvement (CQI) Unsafe care is expensive Improving clinical co-ordination saves money CQI can reduce costs for some processes vretveit 2009. The Health Foundation. Slide 30 1. Why do we need to improve? 2. What is the role of leadership? 3. How ISQua Accreditation enables change & improvement? 4. How Canada has advanced safety & improvement? Slide 31 Why ISQua Accreditation? International Accreditation Programmes (IAP) are varied in approach and content ISQua accreditation helps to standardise by providing current evidence based standards, self-assessment, peer review and consistent application all organisations despite maturity level assessed against the same standards Slide 32 Accrediting the Accreditors International Accreditation Programmes (IAP) Standard Organization Surveyor Training Programme Slide 33 IAP Awards to Date 38 organizations 81 sets of standards 15 surveyor training programmes Setting exemplary standards Slide 34 Accreditation Bodies 1951-2009 October 2010International survey results34 Shaw et al, 2010 International Survey of Accreditation Organisations 2009 Slide 35 IAP International Reach Australia Brazil Canada Columbia Croatia Czech Republic Denmark Dubai Egypt France Hong Kong India Indonesia Japan Jordan Kazakhstan Korea Kyrgyzstan Malaysia Netherlands New Zealand Norway Philippines Saudi Arabia South Africa Spain Taiwan Thailand United Kingdom United States Slide 36 IJQHC SIG Conference Special Interest Group in Quality of Social Care for Older Persons New Education Fellowship Experts Other ISQua Healthcare & Patient Safety Activities Slide 37 Strategic Alliances World Health Organisation (WHO) Health Technology Assessment International (HTAi) Canadian Patient Safety Institute (CPSI) University Research Consortium (URC) International Hospital Federation (IHF) Slide 38 Accreditation : Canadian Example 1. Why do we need to improve? 2. What is the role of leadership? 3. How does accreditation enable change & improvement? 4. How Canada has advanced safety & improvement? Slide 39 2012 Canadian Health Accreditation Report Required Organizational Practices (ROPs): Emerging Risks, Focused Improvements www.accreditation.ca www.accreditation.ca 39 Slide 40 40 Slide 41 41 Is quality and safety improving in Canada? Patient Safety... Slide 42 Canadian Example Accreditation Canada working with Canadian Patient Safety Institute Some Results: Ventilator Associated Pneumonia Acute In-Hospital Myocardial Infarction Surgical Site Infections Central Line Infections Medication Reconciliation 42 Slide 43 43 Between Nov/05 and Oct/07, teams decreased VAP rate per 1000 ventilator days by more than 50 per cent VAP rate dropped from an average 10.48 to 5.21 43 Canadian Patient Safety Institute Ventilator Associated Pneumonia (VAP) Slide 44 44 Acute Myocardial Infarction (AMI) Mortality among AMI inpatients has decreased from 9% in 2005, to 4% in 2007 Of the 7640 AMI patients for whom data was submitted in the first 2 years, 640 died In the following year, the morbidity rate decreased to, 247 of 4063 patients The number of patients dying after admission to the hospital with a heart attack has decreased by almost 50% 44 Canadian Patient Safety Institute Slide 45 45 Surgical Site Infections Teams decreased the number of post-operative infections in clean surgical patients from six to four percent in the first 18-months Surgical infections declined 45 Canadian Patient Safety Institute Slide 46 46 Central Line Associated Bloodstream Infections Teams reported a reduction in rate of central-line associated bloodstream infections per 1000 central line days from an average of 3.2 for the first 17 months to 1.78 over the next 19 months - 44% reduction Teams have reduced the rate of central-line associated bloodstream infections 46 Canadian Patient Safety Institute Slide 47 47 Medication Reconciliation Discrepancies occur when prescriber has unintentionally changed, added or omitted a medication a patient was taking prior to admission By completing best possible medication histories and by implementing the process of medication reconciliation, the rate of unintentional discrepancies has decreased by 50 per cent since the initiative was introduced The average rate of discrepancies decreased from 1.02 in 18 months to an average rate of 0.61 discrepancies Adverse drugs events are being reduced through medication reconciliation 47 Canadian Patient Safety Institute Slide 48 What is Hospital Standardized Mortality Ratio (HSMR)? 48 HSMR tracks changes in hospital mortality rates in order to: Reduce avoidable deaths in hospitals Improve quality of care Developed in the UK in mid-1990s by Sir Brian Jarman of Imperial College Used in hospitals in several countries (i.e. Canada, UK, Sweden, Holland and USA) Slide 49 HSMR - Canada The distribution of HSMR for facilities with at least 2,500 HSMR cases The purple bars reflect fiscal year 2008-2009 The blue bars reflect fiscal year 2004-2005 The chart refers to HSMR, formerly referred to as HSMR All Cases The chart in the 2007 HSMR public report is for HSMR excluding Palliative Care which has been discontinued 49 Conclusion: Canadian Hospitals saw a reduction of approximately 20-25% lower mortality over a 4 year effort. Slide 50 Advancing Patient Safety through Leadership and Accreditation 1. Increase understanding of the importance of leadership as a key factor in advancing safety and improvement. 2. Build greater understanding about need for change. 3. Understand how the accreditation process can enable change and improvement 4. Provide a Canadian example about how to advance quality & safety for patients. 50 Slide 51 51 We are on a journey - a journey that will take enormous efforts to change. It is clear that improvement in patient safety and quality will take time, but the time for change is now. Our patients, residents, families and communities depend on providers to start now and commit to the difficult yet achievable work ahead (Hassen & Dingwall, 2008) Slide 52 Thank you! Mission Inspiring, promoting and supporting continuous improvement in the quality and safety of healthcare worldwide