Quality Improvement Scientific Symposium Agenda

PROGRAMME Time

Oceania

8:00am

Registration opens

9:00am

Karakia and welcome from the tangata whenua Peter Jackson, Te Āti Awa

9:10am

Welcome Dr Janice Wilson, chief executive, Health Quality & Safety Commission Still advocating for change – reflections of a consumer advocate

9:20am

Darlene Cox, executive director, Health Care Consumers’ Association Inc, Canberra, Australia •

Darlene has been a consumer advocate in Australia for over 20 years. In this presentation she will reflect on her personal experiences of health care and identify the challenges consumers and health services need to address if we are to improve the quality and safety of care.

10:00am

Morning tea

10:30am

How scientific improvement methods can increase the rigour of quality and safety work Dr Jean-Frédéric Levesque, chief executive, New South Wales Agency for Clinical Innovation We know health care systems constantly need quality and safety improvement programmes to address things like demonstrating the under-use of beneficial treatments, over-use of diagnostics and therapies, or inappropriate use of effective care. There is mounting evidence of the need to make innovations such as tele-health and remote monitoring the norm. There are increasing calls for the adoption of a more scientific approach to improvement, to enhance the ability of systems to provide high-quality care.

This presentation proposes combining rigour and pragmatism, through recourse to theories, science and learning, as a way to progress improvement and the science of improvement.

Time

Concurrent rapid fire sessions Oceania

11:10am

Rangimarie

A quality improvement approach to improving dental care for children at gateway assessments

Don’t be a drip; Reducing unnecessary cannulation in Dunedin Public Hospital emergency department

Dr Colette Muir, developmental paediatrician, Starship Children's Health

Dr Layla Hehir, registrar, Southern District Health Board (DHB)

Success can come from small scale quality improvement projects undertaken by frontline staff. The gateway service at Te Puaruruhau, the child protection unit at Starship, supports children and young people with Oranga Tamariki involvement with a multidisciplinary health and education assessment, to identify unmet health need. Over 3 years, a quality improvement project has increased the uptake of dental services from 8 percent to 98 percent, with 100 percent of Māori engaged in dental services until completion of treatment. Simple quality improvement techniques such as measuring baselines and PDSA cycles were utilised by involved professionals, with significant improvements in dental health. We learned that hard to reach is not impossible to reach and that frontline staff can make a difference.

The practice of intravenous (IV) cannulation is widespread in emergency departments. There has been criticism of the ‘just in case’ cannula and the ensuing risk of peripheral IV-associated bacteraemia. IV cannula related infection is a recognised complication of cannulation.

We used quality improvement methodology to reduce the number of unnecessary cannulae inserted.

This was a challenging and rewarding project requiring collaboration between specialties.

Our aim was minimising unnecessary intervention and optimising safety within the context of a busy emergency department.

This project can easily be replicated within other areas and we are passionate about sharing our experience.

11:25am

Time to move between rooms

11:30am

#endPJparalysis: Engaging Victorian hospitals to prevent functional decline

Manaaki waewae: Foot care at the front door

Eleanor Sawyer, project lead, care of older people clinical network, Safer Care Victoria

Amanda Johnstone, podiatrist, Bay of Plenty DHB

Combining a campaign with quality improvement methodology – how do we demonstrate improvement without killing the fun? This presentation will discuss the lessons learnt from the implementation of the #endPJparalysis campaign to prevent functional decline across 33 Victorian hospitals.

What do feet have to do with your emergency department? Walk on in and rest your weary soles to hear how podiatry, the most unlikely clinicial specialty, is stepping up and forging a niche in the emergency department of a small rural hospital. Podiatry is working collaboratively within the team to improve timely and equitable health services for The project used a collaborative model of those at risk of lower limb complications improvement with three improvement due to diabetes and critical ischemia in science workshops over six months. Rapid indigenous Māori living in the Eastern Bay PDSA cycles were used to implement the of Plenty. changes on each ward.

Benefits included the exchange of ideas between sites, assistance in overcoming challenges and the establishment of new quality networks between the clinicians.

Ongoing engagement in the project was a common problem, despite the catchy title.

We will discuss our tactics to maintain engagement throughout and beyond the project's lifespan.

11:45am

Time to move between rooms

11:50am

Illuminating inpatient hypoglycaemia Brian Corley, diabetes and endocrine registrar, Capital & Coast DHB Inpatient hypoglycaemia is a recurring, preventable complication of hospitalisation affecting patients with diabetes. It increases morbidity, mortality and length of stay. The diabetes inpatient improvement programme was a coordinated multidepartment initiative. It sought to reduce inpatient hypoglycaemia by focusing on updating organisational policies, creating custom blood glucose recording and insulin administration charts and providing education to create change. Using point-ofcare technology, the number of patients affected by hypoglycaemia were measured between 2017 and 2018 and demonstrated a 26 percent reduction in the number of patients affected over that time. This project and the tools used to implement and measure it could be implemented in other DHBs that avail of point-of-care blood glucose monitoring.

12:05pm

An ALPHA response in the emergency department Hayley Cowley, programme manager – service improvement unit, Bay of Plenty DHB Traditionally patients seen in the emergency department at Whakatāne Hospital only had access to members of the wider multi-disciplinary team (MDT); either on a formal referral basis from ED or once they had left the department and been admitted to a ward. This led to delays in identifying patients who would benefit from MDT intervention, increased risk of deconditioning and missed opportunities to discharge patients from the ED who would do well with community supports in place. Using the Model for Improvement methodology, the aim was to increase MDT input at the front door (ED) and give patients back time by improving care co-ordination. The early interventions lead to reductions of admission and lengths of stay. Patients and ED staff were very happy with the service and it has led to further initiatives and test of change.

Lunch Workshop

12:50pm

Exploring Te Tiriti o Waitangi in quality improvement Faciliated by the Health Quality & Safety Commission Participants will: •

gain an understanding of Te Titiri o Waitangi in context and how it may add value to quality improvement science

•

discuss A window on the quality of Aotearoa New Zealand’s health care 2019 and consider how Te Tiriti can be used as a framework for programme design and implementation in health care in Aotearoa.

•

apply a Te Tiriti framework to an improvement activity scenario.

Concurrent rapid fire sessions Oceania 1:45pm

Continence care with dignity and skin matter – acute adult inpatient continence management practice improvement Helen Costello, associate director of nursing – practice development, Captial & Coast DHB The need to improve adult patients’ experience of continence management in the acute hospital setting had a number of drivers. All drivers exposed what is often a silent area of patient harm associated with the most basic of needs. Feedback from patients and staff indicated an underestimated practice issue and inappropriate management for a range of reasons.

Rangimarie Safety in practice programme for primary care Michael Hammond, project manager, Waitematā DHB Safety in Practice (SiP) is an initiative designed to provide quality improvement tools and training to primary health care teams, to reduce preventable harm to patients. The programme focuses on fostering and building collaborative relationships across primary care. We accomplish this by providing primary care teams with the best possible quality improvement training and support them to establish meaningful and sustainable changes within their organisations.

This Continence with Dignity work programme arose from practice concerns about continence care at the end of life being burdensome for patients, families and staff. This reality and avoidable harm from incontinence associated dermatitis exposed care provisions that did not match need. Opportunities to address practice gaps have been reinforced through five continence focused improvement projects.

Improvements correlate with continence screening, assessment and optimal management including referral on discharge from the acute care setting.

Practice improvement lead by clinicians learning and using the IHI improvement methodology informed a framework for practice change.

2:00pm

Time to move between rooms

2:05pm

Implementation of pharmacist-led medication reviews to address polypharmacy and optimise medications in a geriatric population Natasha Nagar, pharmacist, Hutt Valley DHB

Improving cardiovascular disease risk assessments (CVDRAs) to at-risk young Māori and Pacific men Te Huri Arthur, clinical and quality improvement facilitator (Māori) and AnneMaree Delaney, clinical quality improvement facilitator, Tū Ora Compass Health Primary Health Organisation (PHO)

Pharmacist-led comprehensive medication reviews have a beneficial impact on geriatric patients. They help improve medication use and documentation of medication changes, and optimise therapeutic outcomes.

As our geriatric population continues to grow, a shift from focusing on polypharmacy into optimisation of drug therapy is needed. Sharing of successful projects in this sector can help other services implement similar research into their areas.

2:20pm

Time to move between rooms

2:25pm

The golden hour Ashvindev Singh, quality improvement advisor, Auckland DHB The golden hour: How do we recognise neutropenic sepsis for all adult haematology patients at Auckland City Hospital and achieve a 'door to needle' time of under 60 minutes via the emergency department. The application of Lean Six Sigma principles to unlock opportunities in operational excellence, clinical quality and patient safety.

The national health target was for 90 percent coverage among eligible groups.

Tū Ora consistently achieves this for other population groups, but there is a persistent equity gap for Māori and Pacific. Less than 60 percent of Māori and Pacific men aged 30–44 have received a CVDRA. We developed and tested innovative ways to reach this group in culturally appropriate ways.

Improving access to care and the journey Māori and whānau with diabetes and pre-diabetes Pauline Ansley, clinical manager, West Coast PHO The project is a collaboration between a general practice, the West Coast (WCPHO) and the local Māori provider, and uses a different approach to providing diabetes annual reviews for Māori than the traditional general practice model.

The main problems we sought to address are consistently low diabetes annual review rates, inequitable engagement, a significant number of people with poor diabetes control, all of which are overrepresented by Māori.

The Model for Improvement was used to develop and guide this project and iterative PDSA cycles were used to test interventions. Consumer participation was key throughout to help identify and test change ideas.

Preliminary data shows that people are getting their clinical needs addressed, there is an increase in engagement and there are additional benefits from the model impacting on the health and wellbeing of Māori.

2:40pm

Afternoon tea

Time 3:00pm

Oceania Smiling is a clinical intervention: exploration of a model of resonant leadership and engagement of nurses Dr Jenny Parr, chief nurse and director, patient and whÄ nau experience, Counties Manukau Health Senior managers are under pressure to deliver and improve high-quality, patientfocused care. Using quantitative design and social exchange theory, this presentation explores the effects of resonant leadership on perceived organisation support, leadermember exchange, nurse engagement and patient outcomes.

The findings identify modifiable factors to improve staff experience of work, the safety of patient care and ultimately patient satisfaction of their care.

3:30pm

Moving the measurement of performance in health care from a volume-based to a value-based perspective Dr Jean-FrĂŠdĂŠric Levesque The science of measuring and reporting on the performance of health care systems is rapidly evolving. Organisations are increasingly taking a systems approach to bring clarity to performance assessment and build a whole-of-system view of performance.

Existing performance frameworks are not fully aligned with these developments.

This presentation will cover the findings from a process to develop a values-based framework to measure performance in health care. Nineteen performance frameworks were identified and included in the review. A framework was developed that gauges performance in terms of coverage, accessibility, appropriateness, effectiveness, safety, productivity, efficiency, impact, sustainability, resilience, adaptability and equity.

4:10pm

Speaker awards Dr Janice Wilson

4:20pm

Summary and close Gillian Bohm, chief advisor, Health Quality & Safety Commission

4:30pm

Conference ends