Quality Care Assistant - Efficient, Safe, and Patient-Centered

2. If only we had that package Nor is it… • Buying computers • Buying software • Having others put in all the data and you pushing the button • Extra work • Optional work Can’t you do it for me I’m too busy We don’t need to do that

3. What is quality?

4. Best care Rescue principle Responsive Empathic Quick Best patient care More efficient Least risk Satisfaction Least strife Smooth running Patient Managerial Professional Safe Best Smooth / No gaps Patient centred Best safest care Continual improvement Satisfied patient Advanced research Clinical freedom Responsive support

5. Gap models of service quality Expected service Gap 5 Perceived service Gap 1 Service delivery External communications Gap 4 Gap 3 Service standards Gap 2 Company perceptions of customer expectations

6. Improve patient outcomes Release money to provide better patient care Select and support only highest quality care Improve professional practice Promote MDT working Professional education Identify and stop bad practice Identify and eliminate waste Identify and promote good practice Clinical Audit

7. Implementation of CA Define Measure Analyse Improve Control Traditional improvement projects

8. Effectiveness Information for research Detailed, focussed and minutiae Info not usually collected Information for quality improvement Quickly gathered Rapid cycle Information for monitoring Technical data Lot of energy in getting agreement

9. Some misconceptions……It is not about cook book medicine

12. Measure activity Identify Standard Make appropriate changes Validate against standard

13. ACT Plan ACT Check Check Do Check ACT Do Plan Do Plan

14. Framework for clinical audit • Physical attributes of health care • Tangible, easily counted • Presence increases the chance of good quality care but does not ensure it (appropriate use…..) • Examples: equipment; medical records Structure • Care given by a practitioner / service • Health professionals identify process with quality • It describes what they do • Reflects their attitudes, knowledge & skills • Examples: prescribing habits, hospital referral rates, lab & x-ray use Process • Changes in patient’s current & future health status as result of intervention • Describe effectiveness of care • Difficult to measure…… • Example – lower incidence of specific disease; lower mortality; improvement of level of function, patient satisfaction Outcome

15. Continuous vs. Big Bang

16. Feedback Intervention Theory Emphasis on clinical performance task Specifying performance target Presenting information on how target can be reached Information on progress since last target Emphasis on recipient Discouragement Praise ???

17. Audit and Feedback +70% Change in practice after clinical audit – measured by adherence to specific guideline 0% -16% Jamtvedt et al 2006, Cochrane Database of Systematic Reviews

18. Why audit Measuring for compliance Measuring for research Measuring for improvement Win over the sceptics Sharing the experience True short cycle improvement

19. Good audit The right processes Prescribing practice The right objectives Continual self improvement The right measures Logistics of the prescribing actions The right actions Reinforcing concept / reinforming stakeholders

20. Challenges Understanding Good audit Professional competence Measurement of audit Sustaining audit

21. Joining up the dots Building CA into a central plank of monitoring Understanding context of CA Matching CA to strategic goals Making CA comfortable

22. Motherhood and apple pie • More education • More forms • More awareness • More research Recommendations “We (I) will do x, y and z in the next 6 weeks and we will know we have succeeded

23. Implementation of CA Define Measure Analyse Improve Control Traditional improvement projects