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Quality & Safety

A column by Maureen Flynn

I am really pleased to be invited by the Professional Development Centre of the INMO to develop a new quality and safety column for WIN. There are a number of exciting quality and safety resources which we plan to profile over the coming months. Our aim is to foster wholeheartedly the growth and development of all staff, especially with regard to their ability and opportunity to improve the processes within which they work.

This column focuses on the quality assessment and improvement (QA+I) resources, launched by the HSE in June.

The National Standards for Safer Better Healthcare were launched by the Minister for Health in June 2012. The Standards describe a vision for high quality, safe healthcare and provide a framework for services to organise, manage and deliver safe and sustainable healthcare. The standards can be sourced via www.hiqa.ie

The HSE Quality and Patient Safety Directorate formed a National Standards Implementation Team to plan and lead this process and to develop the support mechanisms to enable successful implementation.

A Safer Better Healthcare Acute Care Collaborative, co-chaired by Dr Mary Browne and Cornelia Stuart, was established to facilitate the development of this approach within the acute sector. Membership of the Acute Care Collaborative included representation from frontline services, voluntary hospitals, independent hospitals and regional Quality and Patient Safety teams.

Work to introduce QA+I resources has culminated in the development of a webenabled tool, which is complemented by eight workbooks and a practical guide to support acute hospitals in undertaking assessments against the National Standards.

In the development of the tools the National Standards were translated into essential elements of quality which are practical, specific, tangible quality outcomes; the essential elements provide greater clarity and focus for service providers as to what they can expect to see in their services. Four levels of quality for each essential element were developed which set out what a service should have in place for each level of quality.

Quality continuum
Given that the National Standards for Safer Better Healthcare are relatively new to the healthcare system, it is recognised that implementing these standards may be challenging and require significant effort by services. Therefore a guiding principle of the assessment is to create a process of continuous quality improvement progressing towards full implementation.

Verifying your selected level of quality
A list of examples of evidence is provided within the QA+I tool to support hospitals in verifying their selected level of quality for each essential element. This list is intended as a guide and services can add in additional evidence that better supports their selected level. The tool also contains an ‘additional information’ section that allows services to provide context and rationale on the selected level of quality for each essential element.

Quality improvement plan
The key output of the assessment process within the QA+I tool is the development of a quality improvement plan. Following assessment of each essential element, agreed actions to improve quality will be recorded in this improvement plan. The plan is then implemented and monitored through governing arrangements within each individual hospital. Following completion of the first assessment, the focus will be on implementing and monitoring progress of the quality improvement plans with progress reports being developed and submitted to governing committees every quarter.

Assessment reports
The QA+I tool has the capacity to develop assessment reports for each assessment team. The report includes analysis of the results from the assessment. This analysis will illustrate the percentage of essential elements which achieved

  1. emerging improvement;
  2. continuous improvement;
  3. sustained improvement; and
  4. excellence.

At a glance, assessment teams will be able to determine the areas requiring focused and targeted effort by the service.

Opportunity to get involved
Each hospital/group has established standards assessment team(s) (and in the future primary care services will also set up teams). Now is the opportunity for you to be involved. Look out for notices or ask your line manger how you can get information on your services approach. The QA+I resources are available on the HSE website at www.hse.ie/go/qps

For further information on the QA+I electronic tool contact:cathy.keany@hse.ie

Maureen Flynn is the director of nursing (national lead for quality and safety governance development) at the Office of the Nursing and Midwifery Services Director, Quality and Patient Safety Directorate, Health Service Executive

The INMO and the HSE are signatories to Patient Safety First - the initiative through which healthcare organisations declare their commitment to patient safety. Through participation in this initiative, those involved aspire to play their part in improving the safety and quality of healthcare services. This commitment is intended to create momentum for positive change towards increased patient safety. For further information see www.patientsafetyfirst.ie

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