Clin Governance / Risk Mgmt / Quality

Recommendations for a National CQI Framework for Aboriginal and Torres Strait Islander Health – 18 December 2014

Posted on January 20, 2015. Filed under: Aboriginal TI Health, Clin Governance / Risk Mgmt / Quality, Primary Hlth Care |

Recommendations for a National CQI Framework for Aboriginal and Torres Strait Islander Health – 18 December 2014

“This report provides advice to the Commonwealth Department of Health about the relevance and potential shape of a national framework for Continuous Quality Improvement (CQI) in Aboriginal and Torres Strait Islander primary health care (PHC).”

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Managing quality in community health care services – King’s Fund – 4 December 2014

Posted on December 18, 2014. Filed under: Clin Governance / Risk Mgmt / Quality, Community Services | Tags: |

Managing quality in community health care services – King’s Fund – 4 December 2014

“Community health care services provide vital care out of hospital for millions of people. From children’s services to care for older people and end-of-life support, the community sector plays a key part in meeting the challenges facing our health and care system. This report presents findings from a small-scale study into how quality is managed in community services. It explores how community care providers define and measure quality and recommends important next steps to support better measurement and management of quality.”

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Health IT Enabled Quality Improvement: A Vision to Achieve Better Health and Health Care – Office of the National Coordinator for Health Information Technology [US] – 13 November 2014

Posted on November 17, 2014. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: , |

Health IT Enabled Quality Improvement: A Vision to Achieve Better Health and Health Care – Office of the National Coordinator for Health Information Technology [US] – 13 November 2014

Media release: Health IT Enabled Quality Improvement: A Vision to Achieve Better Health and Health Care – 13 November 2014

“This paper describes ONC’s vision for advancing the use of health IT to support transformational improvement in health care quality and value. It invites health IT stakeholders – clinicians, consumers, hospitals, public health, technology developers, payers, researchers, policymakers and many others – to join ONC in shaping the future with a renewed focus on health and care quality as the “why” that aligns with the “what” of interoperable health information systems.”

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AHRQ Quality Indicators™ Toolkit for Hospitals: Improving Performance on the AHRQ Quality Indicators. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.

Posted on October 27, 2014. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

AHRQ Quality Indicators™ Toolkit for Hospitals: Improving Performance on the AHRQ Quality Indicators. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.

“The QI Toolkit is designed to help your hospital understand the Quality Indicators (QIs) from AHRQ and use them to successfully improve quality and patient safety in your hospital. The AHRQ QIs use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time. This toolkit focuses on the 18 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs).”

… continues on the site

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Posted on October 14, 2014. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , , |

Cause for concern: second annual statement – Quality Watch, The Health Foundation & Nuffield Trust – 10 October 2014

“Our second annual statement, Cause for concern, offers an independent assessment of the current quality of NHS health and social care services in England. We observe that while care quality has improved since a decade ago, the last year has seen progress in some areas slow down or begin to reverse.”

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Focus on: allied health professionals – Nuffied Trust and QualityWatch – 30 September 2014

Posted on October 1, 2014. Filed under: Allied Health, Clin Governance / Risk Mgmt / Quality | Tags: , |

Focus on: allied health professionals – Nuffied Trust and QualityWatch – 30 September 2014

“This QualityWatch report, published in partnership with the Health Foundation, explores how best the quality of care delivered by allied health professionals can be measured, and presents the key findings from the available data.”

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White Paper: The new era of thinking and practice in change and transformation – NHS Improving Quality – 4 July 2014

Posted on August 8, 2014. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

White Paper: The new era of thinking and practice in change and transformation – NHS Improving Quality – 4 July 2014

“This new White Paper from NHS Improving Quality examines leading trends in change and transformation from multiple industries across the world.

As leaders of health and care we operate in a world where change needs to happen at a faster rate and become more disruptive – our thinking and actions need to challenge the status quo, which will not serve us for the future.

Many of the ways we go about improving health and care (in the NHS and elsewhere) were designed in a different mindset for a different set of circumstances. Given the radical and complex nature of our transformational challenge, these ‘tried and tested’ methods increasingly won’t deliver what we need to deliver for patients.

In this White Paper, we identify the profound implications and opportunities for leaders of health and care. They include a fundamental rethink about what organisational and system change means, including:

Who does it (many change agents, not just a few)
Where it happens (increasingly ‘at the edge’ of organisations and systems)
The skills and mindsets that change agents need.”

… continues on the site

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Evaluating our hospital inspection model: Report by Manchester Business School and The Kings Fund – 30 July 2014

Posted on August 1, 2014. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

Evaluating our hospital inspection model: Report by Manchester Business School and The Kings Fund – 30 July 2014

Evaluation helps hospital inspection development – Care Quality Commission – 30 July 2014

“A report we have published today evaluates the first two waves of our new style hospital inspections.

The report covers inspections carried out in 18 hospital trusts between September 2013 and April 2014.

The evaluation, by researchers from Manchester Business School and The King’s Fund was commissioned by us as part of our ‘learning by doing’ approach.

The authors found that the new approach commands strong credibility, in particular through the use of specialists to inform assessments, and the granular detail of ratings within services rather than at provider level, with the report stating:

“Overall CQC’s new acute regulatory model receives more or less universal endorsement from stakeholders, not least from the hospitals themselves, and is seen as transformative in comparison with the form of regulation it replaces. It is regarded as much more credible, authoritative, rigorous and in-depth and much less likely to miss any issues of significant concern.”

The new inspection method was evolving even as the evaluation was carried out, and will continue to evolve. The report will inform that evolution.”

… continues on the site

 

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Fundamental standards: improving quality and transparency in care – [England] Department of Health – 7 July 2014

Posted on July 8, 2014. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety |

Fundamental standards: improving quality and transparency in care – [England] Department of Health – 7 July 2014

“The government has announced legislation which introduces fundamental standards for health and social care providers. Subject to parliamentary approval, they will become law in April 2015.

The new measures are being introduced as part of the government’s response to the Francis Inquiry’s recommendations and are intended to help improve the quality of care and transparency of providers by insuring that those responsible for poor care can be held to account.”

… continues on the site

The Care Act 2014 (Commencement No.1) Order 2014

Care Bill [HL] Committee Stage Report – Commons Library Research Paper

 

 

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Public Sector Governance: Strengthening performance through good governance – Australian National Audit Office – 26 June 2014

Posted on July 2, 2014. Filed under: Clin Governance / Risk Mgmt / Quality |

Public Sector Governance: Strengthening performance through good governance – Australian National Audit Office – 26 June 2014

“Effective governance can make a real difference to the performance of public sector entities and to the outcomes sought by government. This is a compelling reason for all public sector entities to periodically review and refine their approaches to governance. Reflecting the public sector environment, governance arrangements need to position entities to achieve the best results for the government and Australian community, consistent with legislative and policy requirements. At the same time, they must focus each public sector entity on its performance to encompass the efficient and effective delivery of its responsibilities in a sustainable manner.

Achieving effective governance depends on developing and maintaining appropriate and accepted governance structures and frameworks; it also depends heavily on the application of appropriate governance choices and a commitment to making them work. It is the positive interaction between the ‘hard’ and ‘soft’ elements of governance—the structural and people elements—that leads to improved performance. In this respect, strong leadership is a critical driver for success; it can ensure appropriate governance arrangements are in place and foster ownership of the entity’s goals and strategies by its staff.

This guide replaces the Australian National Audit Office’s (ANAO’s) 2003 Public Sector Governance Better Practice Guide. Public sector governance has matured since the ANAO’s earlier guide; this guide’s substantially revised content reinforces the fundamental elements required for good governance and builds on them to address contemporary governance issues and challenges. In particular, greater attention is given in this guide to the importance of leadership, engaging in beneficial stakeholder relationships, and working collaboratively across entity, jurisdictional and sector boundaries to enhance policy outcomes. The guide emphasises the importance of a highly performing public sector, particularly in the light of fiscal constraints and public expectations for continuous improvements to public sector services, more transparent processes and increasing levels of engagement with citizens and other stakeholders. The release of the revised guide has been timed to align with the implementation of the substantive provisions of the Public Governance, Performance and Accountability Act 2013 (PGPA Act) in 2014–15.”

 

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OECD health-care quality indicators for Australia 2011-12 – AIHW – 12 May 2014

Posted on May 13, 2014. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

OECD health-care quality indicators for Australia 2011-12 – AIHW – 12 May 2014

“This report summarises information Australia provided in 2013 to the Organisation for Economic Co-operation and Development’s Health Care Quality Indicators 2012–13 data collection and compares data supplied by Australia in 2013 to data Australia supplied in previous years, and to data reported by other OECD countries in the OECD’s Health at a glance 2013: OECD indicators.”

ISBN 978-1-74249-571-2; Cat. no. PHE 174; 83pp

Media release: Indicators show mixed results for health-care quality – AIHW – 12 May 2014

“A new report from the Australian Institute of Health and Welfare (AIHW) shows that across many indicators for health-care quality, Australia performs well, but there is room for improvement in some.

The report, OECD health-care quality indicators in Australia 2011-12, profiles the information Australia provided in 2013 to the Organisation for Economic Co-operation and Development covering quality in primary care, hospital acute care, and mental health-care, as well as information on cancer care, hospital patient safety and patient experience.”

… continues on the site

 

 

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NLM [US National Library of Medicine] Eligible Hospital Clinical Quality Measure Value Sets – Value Set Authority Center Publishes Annual Update for 2014

Posted on April 14, 2014. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics, Medical Records |

NLM [US National Library of Medicine] Value Set Authority Center Publishes Annual Update for 2014

“Eligible Hospital Clinical Quality Measure Value Sets

The National Library of Medicine (NLM) Value Set Authority Center (VSAC), in collaboration with the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS), has published the annual update for the 2014 Eligible Hospital Clinical Quality Measure (CQM) Value Sets. The update includes revised value sets to address deleted and remapped codes in the latest terminology versions, as well as new codes for addressing CQM logic corrections and clarifications. The Centers for Medicare & Medicaid Services (CMS) updates these electronic reporting specifications annually to ensure that the specifications align with current clinical guidelines and terminologies, and that they remain relevant and actionable within the clinical care setting.

The VSAC offers a Downloadable Resource Table, accessible from the Download tab on the VSAC Web page, that provides prepackaged downloads for the most recently updated and released 2014 CQM Value Sets, as well as for previously released versions. Access to the Value Set Authority Center requires a free Unified Medical Language System® Metathesaurus License. NLM also provides the Data Element Catalog that identifies data element names (value set names) required for capture in electronic health record technology certified under the 2014 Edition of the ONC Standards and Certification Criteria.”

… continues on the site

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A Quality Framework and Suite of Quality Measures for the Emergency Department Phase of Acute Patient Care in New Zealand – NZ Ministry of Health – 28 March 2014

Posted on April 3, 2014. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine |

A Quality Framework and Suite of Quality Measures for the Emergency Department Phase of Acute Patient Care in New Zealand – NZ Ministry of Health – 28 March 2014

“This publication suggests a quality framework including a common suite of measures. DHBs will be expected to use these measures to improve the acute patient journey, thereby improving patient experience.

Emergency departments and district health boards all currently monitor a range of different measures. The only mandatory common measure to date has been the Shorter stays in Emergency Departments health target. This publication provides a suite of common measures.

This publication is a product of the National Emergency Departments Advisory Group.”

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Evaluating the Care Quality Commission’s acute hospital regulatory model: emerging findings – Care Quality Commission – 14 March 2014

Posted on March 26, 2014. Filed under: Acute Care, Clin Governance / Risk Mgmt / Quality | Tags: , |

Evaluating the Care Quality Commission’s acute hospital regulatory model: emerging findings – Care Quality Commission – 14 March 2014

“In September 2013, the Care Quality Commission asked a team from Manchester Business School and the King’s Fund to undertake a formative evaluation of CQC’s new acute hospital regulatory model.

The design of the new acute hospital regulatory model is described in the inspection framework [1] and guidance, and in other CQC documents such as the logic model [2]. It is an almost complete departure from the approach used by CQC in recent years. The key differences– as described in those documents and to us in interviews – are:”

… continues on the site

Review of our new approach to inspecting hospitals – Care Quality Commission – 19 March 2014

“We commissioned the Kings Fund and Manchester Business School to carry out this evaluation and will use this information to improve the way it inspects. The full report will be published in May.

The paper published today explored whether the new approach provides a better analysis of the performance of an acute hospital – whether:

the measures used are valid and reliable.
the data is meaningful.
it adds significantly to what is already known.
it helps to not just assess performance but to understand the causes of performance variation.

It also explored:

whether the new model works in practice.
how the inspections are prepared, carried out and reported.
whether it could be done more effectively.

Author Professor Kieran Walshe presented themes from the paper at our board meeting today. The report says:”

… continues on the site

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Electronic health record programs: Participation Has Increased, but Action Needed to Achieve Goals, Including Improved Quality of Care – GAO [US] – March 2014

Posted on March 10, 2014. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: |

Electronic health record programs: Participation Has Increased, but Action Needed to Achieve Goals, Including Improved Quality of Care – GAO [US] – March 2014

Government Accountability Office

“What GAO Recommends

GAO recommends that HHS develop a comprehensive strategy to better ensure the reliability of CQM data collected using EHRs and develop and use outcome-oriented performance measures to monitor progress toward goals. HHS agreed data reliability and performance monitoring are important but neither agreed nor disagreed with GAO’s reco

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Reducing Overuse and Misuse: State Strategies to Improve Quality and Cost of Health Care – Robert Wood Johnson Foundation – 14 January 2014

Posted on February 17, 2014. Filed under: Clin Governance / Risk Mgmt / Quality, Health Systems Improvement, Patient Safety | Tags: |

Reducing Overuse and Misuse: State Strategies to Improve Quality and Cost of Health Care – Robert Wood Johnson Foundation – 14 January 2014

Full text of the issue brief

“Overuse and misuse of health care services are problems that affect both quality and cost of care. Experts estimate that perhaps one-third of all U.S. health care spending produces no benefit to the patient–and some of it actually results in harm.”

… continues on the site

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Regulating quality and safety of health and social care: International experiences – RAND – 2014

Posted on February 11, 2014. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Regulating quality and safety of health and social care: International experiences – RAND – 2014

“This report is concerned with ‘standards of quality and safety’ within health and social care systems. Care standards are intended to support efforts in maintaining and improving the quality of care; they have been developed across countries, although the ways in which they are implemented and applied differs between nations. Taking a range of six countries, we review the regulatory mechanisms that have been implemented to ensure that essential standards of care are applied and are being adhered to, and consider the range of policy instruments used to encourage and ensure continuous quality improvement. We report on Australia, England, Finland, Germany, the Netherlands and the USA. The report is intended to inform policy thinking for the Department of Health and others in developing the regulation of safety and quality of health and social care in England. It was prepared as part of the project ‘An “On-call” Facility for International Healthcare Comparisons’ funded by the Department of Health in England through its Policy Research Programme.”

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The Francis Report one year on – Nuffield Trust – 6 February 2014

Posted on February 6, 2014. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety | Tags: , |

 

The Francis Report one year on – Nuffield Trust – 6 February 2014

 

“Summary

 

To mark the first anniversary of the publication of the report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (the Francis Inquiry), the Nuffield Trust has published a new piece of research exploring its impact.

 

This study has been published to coincide with an event hosted by the Trust on 6 February 2014, exactly a year after the Francis Inquiry reported.

 

The study offers a snapshot into how acute trusts have responded to the Francis Inquiry Report. It is aimed at policy-makers, national statutory bodies, acute trusts, health representative groups and trade unions, patient groups and charities, and health service commissioners. Robert Francis QC, who acted as an adviser to the research, has written a foreword to the study.”

 

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Equality counts – Care Quality Commission [UK] – 30 January 2014

Posted on January 31, 2014. Filed under: Clin Governance / Risk Mgmt / Quality, Health Mgmt Policy Planning | Tags: |

Equality counts – Care Quality Commission [UK] – 30 January 2014

“Our progress on promoting equality

We’ve published our annual equality information report, called ‘Equality counts’, which sets out how we have promoted equality and tackled inequality both for people who use health and social care services and for our staff.”

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Using clinical communities to improve quality – The Health Foundation – December 2013

Posted on December 20, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Systems Improvement | Tags: |

Using clinical communities to improve quality – The Health Foundation – December 2013

“Gaps are often found between how healthcare should be delivered, as defined by high-quality evidence, and the care that patients actually receive. Closing these gaps is an important priority for health systems everywhere. But finding the right structures to facilitate improvement is not easy.

This report introduces an approach – the clinical community – used by the Health Foundation’s Closing the Gap through Clinical Communities programme to support and secure improvements in health systems across multiple sites. The programme supported 11 clinical communities to come together around shared goals, to learn from each other but with the latitude to develop and apply local solutions. The programme has led to a range of improvements in the quality of care which continue to be sustained today.

Drawing on the evaluation of the programme, the report outlines ten key lessons for getting the approach to work in practice and avoiding potential pitfalls:”

… continues on the site

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Findings and Lessons From the AHRQ Ambulatory Safety and Quality Program – Agency for Healthcare Research and Quality (ACHS) – August 2013

Posted on December 11, 2013. Filed under: Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: , |

Findings and Lessons From the AHRQ Ambulatory Safety and Quality Program – Agency for Healthcare Research and Quality (ACHS) – August 2013

Extract from the executive summary

“A large and growing number of clinical services are delivered in ambulatory care settings such as physician offices, hospital-based outpatient clinics, and public health and other types of clinics. Patients seen in ambulatory settings vary widely in terms of health status and the types and severity of illnesses. Ambulatory care is often logistically complex, depending upon coordination and exchange of information both within and across organizations to address patients’ interrelated medical care and social support needs. Ambulatory care providers must also help patients navigate effectively and efficiently through the health care system to achieve optimal outcomes, in accordance with patient preferences. Appropriate implementation and use of health information technology (IT) systems such as electronic health records (EHRs), personal health records (PHRs), and health information exchange (HIE) systems can support the delivery of ambulatory care. These systems can provide clinicians with information and decision support, engage patients and support self-management, and facilitate communication among clinicians and between clinicians and patients.

In 2007, the Agency for Healthcare Research and Quality (AHRQ) launched the Ambulatory Safety and Quality (ASQ) program to foster research on how to improve the safety and quality of ambulatory health care in the United States. This report is the fifth in a series of reports highlighting findings and lessons from the health IT-focused ASQ program initiatives. It summarizes the experiences and findings from those initiatives, organized according to key aspects of ambulatory care that can be supported and improved through the use of health IT.”

… continues

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Australasian Clinical Indicator Report for 2005 to 2012 – ACHS – 14th ed -October 2013

Posted on December 6, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Australasian Clinical Indicator Report for 2005 to 2012 – ACHS – 14th ed -October 2013

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Leading Improvement Across the Continuum: Skills, Tools and Teams for Success – American Hospitals Association – October 2013

Posted on October 29, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Leadership |

Leading Improvement Across the Continuum: Skills, Tools and Teams for Success – American Hospitals Association – October 2013

Health Research & Educational Trust. (2013). Leading Improvement Across the Continuum: Skills, Tools and Teams for Success. Chicago, IL: Health Research & Educational Trust.

“As health care leaders implement diverse improvement projects, from reducing hospital-acquired infections to reducing obesity prevalence, they must identify the appropriate strategies for success across many different settings. This guide provides two new frameworks, the Improvement Continuum and the Leadership Action Model, for conceptualizing and planning improvement activities.

The Improvement Continuum describes four categories of improvement activities: topic or microsystem, care coordination, defined population and community health. For each of these categories, the framework describes the skills, tools and teams that lead to successful improvement efforts. The guide also includes a Leadership Action Model, a framework for how to use the Improvement Continuum. Equipped with these frameworks, leaders will be better able to design and implement improvement efforts of varying scope across diverse topics.”

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Public Health Practice: Evaluating the Impact of Quality Improvement: Adopting QI methods to improve the delivery of services – Robert Wood Johnson Foundation – 30 September 2013

Posted on October 22, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Public Hlth & Hlth Promotion | Tags: , |

Public Health Practice: Evaluating the Impact of Quality Improvement: Adopting QI methods to improve the delivery of services – Robert Wood Johnson Foundation – 30 September 2013

“Thirteen health departments implemented 32 quality improvement (QI) projects and worked with evaluators to assess the results, gather lessons, and build evidence on the use of QI in public health and as a tool to prepare for accreditation.”

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Leading Improvement Across the Continuum: Skills, Tools and Teams for Success – American Hospital Association – October 2013

Posted on October 22, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Leading Improvement Across the Continuum: Skills, Tools and Teams for Success – American Hospital Association – October 2013

Health Research & Educational Trust. (2013). Leading Improvement Across the Continuum: Skills, Tools and Teams for Success. Chicago, IL: Health Research & Educational Trust.

“As health care leaders implement diverse improvement projects, from reducing hospital-acquired infections to reducing obesity prevalence, they must identify the appropriate strategies for success across many different settings. This guide provides two new frameworks, the Improvement Continuum and the Leadership Action Model, for conceptualizing and planning improvement activities.

The Improvement Continuum describes four categories of improvement activities: topic or microsystem, care coordination, defined population and community health. For each of these categories, the framework describes the skills, tools and teams that lead to successful improvement efforts. The guide also includes a Leadership Action Model, a framework for how to use the Improvement Continuum. Equipped with these frameworks, leaders will be better able to design and implement improvement efforts of varying scope across diverse topics.”

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QualityWatch [England] Annual Statement 2013 – 10 October 2013

Posted on October 18, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

QualityWatch [England] Annual Statement 2013 – 10 October 2013

“Each year of the QualityWatch programme we will produce a range of reports and analyses, and once a year we will publish a summary report which draws together all of the analysis we have conducted throughout the year. Our first annual statement: Is the quality of care in England getting better? QualityWatch Annual Statement 2013, is not intended to be comprehensive. Instead, it provides an overview of our initial research into the quality of care services.”

News release: A decade of quality in health

Blog: Time for QualityWatch

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Leaving Against Medical Advice: Characteristics Associated With Self-Discharge – Canadian Institute for Health Information (CIHI) – 1 October 2013

Posted on October 2, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine, Medicine | Tags: , |

Leaving Against Medical Advice: Characteristics Associated With Self-Discharge – Canadian Institute for Health Information (CIHI) – 1 October 2013

“People who leave the hospital or an emergency department against medical advice tend to do so before their treatment is complete and often end up returning within a short time frame.

A new study from the Canadian Institute for Health Information (CIHI) shows that, compared with people who completed their treatment, those who left inpatient care against medical advice were more than twice as likely to be readmitted to hospital within a month and three times as likely to visit an emergency department within a week.

Leaving Against Medical Advice: Characteristics Associated With Self-Discharge also found that more than three out of five people who left inpatient care and returned to an emergency department within a week were admitted to inpatient care upon their return.”

… continues on the site

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The Impact of Conformance and Experiential Quality on Healthcare Cost and Clinical Performance – Harvard Business School – 27 September 2013

Posted on October 1, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics, Patient Participation |

The Impact of Conformance and Experiential Quality on Healthcare Cost and Clinical Performance – Harvard Business School – 27 September 2013

by Claire Senot, Aravind Chandrasekaran, Peter T. Ward, and Anita L. Tucker

“Executive summary.  This study examines the relationship between hospital’s focus on both conformance and experiential dimensions of quality and their impact on financial and clinical outcomes. Conformance quality measures the level of adherence to evidence-based standards of care achieved by the hospitals. Experiential quality, on the other hand, measures the extent to which caregivers consider the specific needs of the patient in care and communication, as perceived by the patient. These are important dimensions to investigate because hospitals may face a tension between improving clinical outcomes and maintaining their financial bottom-line. However, little has been known on the joint impact of these dimensions on hospital performance in terms of cost and clinical quality. The authors’ study, which examined data from multiple sources for the 3,458 U.S. acute care hospitals, is a first step towards understanding these relationships.”

… continues on the site

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Health IT-Enabled Quality Measurement: Perspectives, Pathways, and Practical Guidance – AHRQ – September 2013

Posted on October 1, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: |

Health IT-Enabled Quality Measurement: Perspectives, Pathways, and Practical Guidance – AHRQ – September 2013

Roper RA, Anderson KM, Marsh CA, Flemming AC. Health IT-Enabled Quality Measurement: Perspectives, Pathways, and Practical Guidance. (Prepared by Booz Allen Hamilton, under Contract No. HHSA290200900024I.) AHRQ Publication No. 13-0059-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2013.

“This report examines the intersection of health IT and quality measurement, reflecting the expectation that health IT-enabled quality measurement can make quality improvement possible. It is presented to share information, stimulate discussion, assist communication among stakeholders, facilitate understanding, and to provide guidance on potential infrastructure enhancements that could be pursued, individually or collectively. Five appendixes to this report summarize the input received as well as catalog the efforts of many organizations who are engaged in efforts to improve quality through health IT.”

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Quality and Safety in the NHS: Evaluating Progress, Problems and Promise – Lancaster University Management School – 10 September 2013

Posted on October 1, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety |

Quality and Safety in the NHS: Evaluating Progress, Problems and Promise – Lancaster University Management School – 10 September 2013

Extract from the executive summary:

“The NHS in England is facing challenges and changes as great as any in its history. These include increasing demand, population demographics, changes in disease type and frequency, technological changes, and a major structural and culture change programme, all in a context of national economic austerity. In such circumstances, ensuring that organisational cultures remain focused on improving high quality and safe patient care is all the more important. The research programme reported here was initiated by the Department of Health Policy Research Programme to assess the extent to which NHS organisations in England have cultures in which the most important values are those of providing and improving high quality and safe patient care. The programme used a combination of methods, including interviews, surveys and ethnographic case studies, to assess the extent to which organisational cultures and values support high-quality care and patient safety. It aimed to determine how to secure a sustainable focus on quality and safety, how quality improvement happens, how change in the right direction can be accelerated, and how innovation can be encouraged”

Media release: Nationwide study brings NHS ‘dark spots’ to light

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Hunt sets out tough new approach to turn around NHS hospitals – 19 September 2013

Posted on September 20, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety | Tags: |

Hunt sets out tough new approach to turn around NHS hospitals – 19 September 2013

“Health Secretary Jeremy Hunt today set out the Government’s plans to help prevent future failures of care and safety at NHS hospitals.

In the wake of the scandal over standards at Mid Staffordshire NHS Foundation Trust and subsequent Keogh Review which looked at 14 NHS Trusts with high mortality rates, 11 of those Trusts have already been placed in ‘special measures’.

Now, the Health Secretary has set out a new approach to ensure progress at those NHS Trusts, which could be applied to any NHS Trust that is placed in special measures under a new, tougher inspection regime:”

… continues on the site

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Implementing a Health 2020 vision: governance for health in the 21st century. Making it happen – WHO – September 2013

Posted on September 20, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Implementing a Health 2020 vision: governance for health in the 21st century. Making it happen – WHO – September 2013

“The WHO Regional Office for Europe commissioned this report to support the implementation of the Health 2020 policy framework. It builds on a study on governance for health in the 21st century, conducted for the WHO Regional Office for Europe. This report provides policy-makers with examples from around the world of how whole-of- government and whole-of-society approaches have been implemented, along with a set of tools to manage the complex policy process.

These policy examples were selected with a view to the four policy priority areas of Health 2020 and with the following criteria in mind: they provide useful lessons, often illustrate best practices, cover a wide variety of different contexts and countries and, as far as possible, have been implemented and, ideally, evaluated. The report aims to contribute, in particular, to the Health 2020 strategic policy objective of “improving leadership and participatory governance for health”. It is conceived as a living document that will be continually enriched with new examples and analysis.”

ISBN 978 92 890 0043 7

 

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After Francis: making a difference – House of Commons Health Committee – published 18 September 2013

Posted on September 19, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety | Tags: |

After Francis: making a difference – House of Commons Health Committee – published 18 September 2013

Future of the NHS rests on wholesale shift to an open culture warn MPs

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Quality improvement made simple – The Health Foundation – August 2013

Posted on September 17, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Quality improvement made simple – The Health Foundation – August 2013

“Improving quality is about making healthcare safe, effective, patient-centred, timely, efficient and equitable. In the history of the NHS, there has never been a greater focus on improving the quality of health services.

This guide focuses on one important element of the quality agenda: quality improvement. It looks in particular at what are known as organisational or industrial approaches to quality improvement. These aim to bring about a measurable improvement by applying specific methods within a healthcare setting.

This is not a ‘how to’ guide. Instead, it offers a clear explanation of some common approaches used to improve quality, including where they have come from, their underlying principles and their efficacy and applicability within the healthcare arena.

It is written for a general healthcare audience and will be most useful for those new to the field of quality improvement, or those wanting to be reminded of the key points.

Updated in 2013, this is the second edition of Quality improvement made simple.”

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Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis – Institute of Medicine – 10 September 2013

Posted on September 12, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Oncology | Tags: , |

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis – Institute of Medicine – 10 September 2013

“In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. By 2022, it is projected that there will be 18 million cancer survivors and, by 2030, cancer incidence is expected to rise to 2.3 million new diagnoses per year. However, more than a decade after the IOM first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Therefore, the IOM convened a committee of experts to examine the quality of cancer care in the United States and formulate recommendations for improvement. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents the committee’s findings and recommendations.

The committee concluded that the cancer care delivery system is in crisis due to a growing demand for cancer care, increasing complexity of treatment, a shrinking workforce, and rising costs. Changes across the board are urgently needed to improve the quality of cancer care. All stakeholders – including cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industries – must reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality cancer care delivery system. Working toward the recommendations outlined in this report, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.”

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Picker Institute Europe launches free Friends and Family Test resources – 29 August 2013

Posted on September 2, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Participation | Tags: |

Picker Institute Europe launches free Friends and Family Test resources – 29 August 2013

“To coincide with the publication of the second set of national data for the NHS Friends and Family Test (FFT), the Picker Institute have today launched a new set of online resources to support healthcare staff in using FFT results. The resources include accessible, impartial guidance and interactive calculators to help professionals to understand how to use and interpret the data.”

 

 

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Compromised Wounds in Canada – Canadian Institute for Health Information – 29 August 2013

Posted on August 30, 2013. Filed under: Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality, Diabetes | Tags: , , |

Compromised Wounds in Canada – Canadian Institute for Health Information – 29 August 2013

“People with diabetes admitted to hospitals are nearly six times more likely than other patients to have wounds that don’t heal properly, reports the Canadian Institute for Health Information (CIHI).

In fact, diabetes doubles the risk of infections after operations and makes patients nearly 40 times more likely than other patients to develop wounds due to poor blood circulation.

This chronic illness was linked to more than 2,000 foot amputations in 2011–2012, many of which could have been avoided if proper wound care management and prevention had been in place.

CIHI’s unique study looked at persistent or “compromised” wounds—not only those infected or otherwise not healing, but also bed sores—among Canadians in hospitals, receiving home care and in long-term care during that same period.

“Compromised wounds are a burden to our health system,” said Kathleen Morris, CIHI’s Director of Health System Analysis and Emerging Issues. “They can be extremely painful and cause mobility problems and distress for patients.”

While any Canadian can be subject to a poorly healing wound, Compromised Wounds in Canada highlights the increased risks associated with chronic illnesses such as diabetes. It also reveals clear opportunities to reduce the frequency of occurrence.”

… continues on the site

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Lining Up: How do improvement programmes work? – Health Foundation – August 2013

Posted on August 29, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Lining Up: How do improvement programmes work? – Health Foundation – August 2013

“This learning report looks at lessons from the Health Foundation’s Lining Up research project – an investigation into interventions to reduce central line infections. It explores the reasons why potentially promising improvement programmes might fall short when implemented in a new setting.

The Lining Up researchers set out to explain what lay behind the achievements of the successful Keystone programme conducted in the US state of Michigan, and then explore what happened when an initiative it inspired, Matching Michigan, was launched in England.

Researchers found that not only were there differences in the design and implementation of the programmes, but also that an array of contextual influences, including local factors and the legacy of previous initiatives, had a major impact.

The report shows that successful replication and spread of improvement initiatives depends on a deep understanding of how and why programmes work and the contexts into which they are introduced. It also highlights the importance of understanding what has contributed to the success of an improvement intervention in any given setting, and paying attention to more than simply the technical components of effective improvement programmes.”

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Findings and Lessons From the Improving Quality Through Clinician Use of Health IT Grant Initiative – AHRQ – released August 2013

Posted on August 19, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: , |

Findings and Lessons From the Improving Quality Through Clinician Use of Health IT Grant Initiative – AHRQ – released August 2013

“This report summarizes the extent to which the projects addressed the areas of interest of the IQHIT initiative and identifies practical insights regarding the use of health IT to improve clinical decisionmaking and care coordination in the ambulatory setting. It presents illustrative project findings in an effort to inform research discussion and provide guidance to other entities implementing health IT systems that help clinicians improve the quality of patient care. As the researchers continue to disseminate findings from these projects, additional lessons may become evident.”

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Do not attempt cardiopulmonary resuscitation (DNACPR) indicator – Healthcare Improvement Scotland – July 2013

Posted on August 2, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , |

Do not attempt cardiopulmonary resuscitation (DNACPR) indicator – Healthcare Improvement Scotland – July 2013

“The purpose of this document is to specify a minimum high level measure or ‘indicator’ for healthcare services in Scotland on do not attempt cardiopulmonary resuscitation (DNACPR) decision-making and communication.

Our DNACPR indicator focuses on four areas of improvement:

. all resuscitation attempts are carried out in line with the national resuscitation guidelines of the Resuscitation Council (UK) and the Scottish Government DNACPR Adult and CYPADM policies.
. all recognised expected deaths have a DNACPR/CYPADM decision documented in line with national policy
. the NHSScotland DNACPR or CYPADM form is completed correctly for every DNACPR decision, and
. all advance/anticipatory care plan templates must include a field about resuscitation status and DNACPR/CYPADM decision.”

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Is it possible to incorporate quality into hospital pricing systems? – Deeble Institute Evidence Brief – 22 July 2013

Posted on July 25, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics | Tags: , |

Is it possible to incorporate quality into hospital pricing systems? – Deeble Institute Evidence Brief – 22 July 2013

“Australia has recently implemented an activity-based funding system for public hospitals. Policymakers and providers are keen to ensure that the price paid for health care services stimulates improvements in quality and safety, but some remain sceptical that this can be achieved through pricing mechanisms.

There are four main ways of linking quality and safety to hospital pricing in the context of activity based funding:”

… continues

 

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Review of Ornge Air Ambulance Transport Related Deaths – Office of the Chief Coroner for Ontario – July 2013

Posted on July 25, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Systems Improvement | Tags: , |

Review of Ornge Air Ambulance Transport Related Deaths – Office of the Chief Coroner for Ontario – July 2013

“It is our privilege to submit this report on the review of deaths in which concerns related to air ambulance transport were identified. The Expert Panel makes 25 recommendations in the areas of:
• Decision Making
• Response Process
• International Transports
• Communication
• Aircraft/Equipment
• Staffing
• Paramedic Training/Education/Certification
• Investigation/Quality Assurance
This Review arises from concerns expressed by Ontarians regarding our air ambulance system, and specifically, whether operational issues related to air transport might have caused or contributed to a fatal outcome in some cases. The motto of the Office of the Chief Coroner is, “We Speak for the Dead to Protect the Living;” therefore, these concerns were reviewed and addressed with the utmost diligence by the Office of the Chief Coroner.”

… continues on the site

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Consultant treatment outcomes now published online – NHS England

Posted on July 25, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Surgery | Tags: , |

Consultant treatment outcomes now published online – NHS England

“NHS England is committed to making more information available about how services and professionals are performing. The aim is to drive up the quality of care in the NHS and help people choose the treatment that suits them best.

This initiative is a central part of NHS England’s ambition to ensure every patient gets high quality care, and to build improved services for the future.

On NHS Choices you’ll find links to information about individual consultants in a number of clinical areas. You can look at their results for a range of operations and treatments to help you make decisions about your care.

Prof Sir Bruce Keogh, National Medical Director of NHS England, said: ‘This is a major breakthrough in NHS transparency.

‘We know from our experience with heart surgery that putting this information into the public domain can help drive up standards. That means more patients surviving operations and there is no greater prize than that.’

The reporting of the data was led by Prof Ben Bridgewater from the Healthcare Quality Improvement Partnership (HQIP). Prof Bridgewater is a practising heart surgeon who leads the successful cardiac consultant-level reporting which paved the way for this work.”

… continues on the site

Everyone counts: Publication of Consultant clinical outcomes: Frequently Asked Questions

Your choices: consultant choice – the data

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NHS Hospital Data and Datasets: A Consultation – NHS England – 22 July 2013

Posted on July 25, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics, Patient Safety | Tags: |

NHS Hospital Data and Datasets: A Consultation – NHS England – 22 July 2013

News:  NHS England and the Health and Social Care Information Centre launch a consultation on hospital data to raise standards and improve patient safety

“NHS England and the Health and Social Care Information Centre (HSCIC) today published NHS Hospital Data and Datasets: A Consultation to explore how better extraction of information from hospitals’ data systems could help raise standards, improve safety, and reduce inequalities in patient care.

The Hospital Data and Datasets Consultation asks for views on what information should be extracted from hospitals in future to support the commissioners of health care services, and how to minimise any extra burden on hospitals.

The potential new data requirements being consulted upon include extracting information about tests and investigations performed, nursing care delivered, and medicines prescribed.

High quality data will underpin the transformation of the NHS, ensuring that it becomes truly patient centred and clinically led. Collecting and sharing accurate information with providers, commissioners, patients and the public will help to assess safety issues and identify areas where outcomes and patient experience can be improved.”

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Quality and Safety in European Union Hospitals – QUASER

Posted on July 24, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety |

Quality and Safety in European Union Hospitals – QUASER

A Research-based Guide for Implementing Best Practice and a Framework for Assessing Performance (QUASER)

QUASER Guide for Hospitals: A research-based tool to reflect on and develop your quality improvement strategies

and the

QUASER Guide for Payers: A research-based tool to assess and facilitate quality improvement strategies in hospitals

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2013 Annual Progress Report to Congress: National Strategy for Quality Improvement in Health Care [US] – July 2013

Posted on July 24, 2013. Filed under: Clin Governance / Risk Mgmt / Quality |

2013 Annual Progress Report to Congress: National Strategy for Quality Improvement in Health Care [US] – July 2013

Submitted by the U.S. Department of Health and Human Services

“The initial National Quality Strategy, published in March 2011, established three aims and six priorities for quality improvement (see Figure 1). The National Quality Strategy’s first annual progress report to Congress, published in April 2012, elaborated on these six priorities and established long-term goals and national tracking measures to monitor quality improvement progress. The 2012 report also identified three strategic opportunities for improvement, which cut across all six priority areas. This second annual report provides updates on public and private payers’ collaborative efforts to align quality measures, progress against national tracking measures (where possible) and establishment of aspirational targets (as needed), private-sector successes in each of the six priority areas, and progress on each of the three strategic opportunities.”

 

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Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report – 16 July 2013

Posted on July 23, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report – 16 July 2013

The Keogh Mortality Review – published reports and documentations

Professor Sir Bruce Keogh KBE

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Changing Care, Improving Quality – The NHS Confederation, The Academy of Medical Royal Colleges, National Voices – 5 June 2013

Posted on June 13, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

Changing Care, Improving Quality – The NHS Confederation, The Academy of Medical Royal Colleges, National Voices – 5 June 2013

Extract from the executive summary:

“One of the greatest challenges facing the health service today is the need to redesign services to meet the needs of patients, improve the quality
of care and achieve better value for society. There is growing support among patient groups, clinicians and managers for the potential benefits of ‘reconfiguration’ in health services, which focuses on making large-scale changes to provide care in the right place at the right time.

The Academy of Medical Royal Colleges, the NHS Confederation and National Voices have come together to examine the case for radical, far-reaching change across the NHS. This partnership brings together important views from those who know the healthcare system best,  gathering evidence from over 50 face-to-face interviews and a series of workshops and meetings.

This report outlines what we learned from these crucial conversations and aims to support those engaged locally in making a decision on whether to reconfigure services and, if so, how to make change happen. We have identified six key principles to consider as a foundation for most reconfiguration plans”

… continues

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Inclusion Criteria [for clinical practice guidelines to be included in the US National Guideline Clearinghouse] – June 2013 Agency for Healthcare Research and Qualit

Posted on June 11, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , , , |

Inclusion Criteria [for clinical practice guidelines to be included in the US National Guideline Clearinghouse] – June 2013  Agency for Healthcare Research and Quality

“Effective June 2014, NGC will employ the 2011 definition of clinical practice guideline developed by the Institute of Medicine (IOM).1

Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.

For more information, please refer to the Frequently Asked Questions. We invite you to send your comments to info@guideline.gov.

Revised Criteria for Inclusion of Clinical Practice Guidelines in NGC

Effective June 2014: In order for NGC to accept a submitted clinical practice guideline, the guideline must meet all the criteria below. In addition to the guideline, developers must provide NGC with documentation of the underlying systematic review*.”

… continues on the site

 

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Health and wellbeing boards: A practical guide to governance and constitutional issues – Local Government Association [UK] – May 2013

Posted on May 27, 2013. Filed under: Clin Governance / Risk Mgmt / Quality |

Health and wellbeing boards: A practical guide to governance and constitutional issues – Local Government Association [UK] – May 2013

“This guide is a joint publication by the Local Government Association (LGA) and the Association of Democratic Services Officers (ADSO). The content has been shared with the Department of Health (DH) and the Department for Communities and Local Government (DCLG). The purpose of this document is to provide a guide to governance and constitutional issues arising from the legislation, including the Health and Social Care Act 2012 and the regulations under section 194 of that Act. “

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The regulation and oversight of NHS trusts and NHS foundation trusts – 20 May 2013

Posted on May 21, 2013. Filed under: Clin Governance / Risk Mgmt / Quality |

The regulation and oversight of NHS trusts and NHS foundation trusts – 20 May 2013

“Joint statement on changes to regulation and oversight of NHS trusts and NHS foundation trusts proposed in response to the Francis report.

This joint policy statement provides further information on the changes to the regulation and oversight of NHS trusts and NHS foundation trusts proposed in the government’s initial response to the Mid Staffordshire NHS Foundation Trust Public Inquiry (the Francis report) and related clauses in Part 2 of the Care Bill. It is produced by the Department of Health, the Care Quality Commission, Monitor, NHS England and the NHS Trust Development Authority.

The Francis report highlighted a lack of clarity over which part of the regulatory, commissioning and supervisory system is responsible for taking decisive action in response to a failure in quality of care.

The government’s initial response, ‘Patients First and Foremost’, sets out that it will develop a single failure regime to provide a clear and co-ordinated regulatory approach to identifying and dealing with failures of quality with a more clearly defined and timely end point for failed hospitals. This statement puts these changes and the clauses in Part 2 of the Bill in a broader context.”

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The drive for quality – How to achieve safe, sustainable care in our Emergency Departments – College of Emergency Medicine [UK] – 14 May 2013

Posted on May 17, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine | Tags: |

The drive for quality – How to achieve safe, sustainable care in our Emergency Departments – College of Emergency Medicine [UK] – 14 May 2013

“Emergency care systems in the UK & Ireland are facing their biggest challenge in well over a decade as they aim to cope with unsustainable workloads and a lack of sufficient numbers of middle grade doctors and Consultants in Emergency Medicine to deliver consistent quality care. Both the Care Quality Commission and NHS England have recognised the scale of the crisis and the need for urgent action.

In this report, the first of its kind, The College calls for fundamental change in the way we design, fund and run our emergency care systems. Ten recommendations are made across 4 domains that must be considered and adopted by national policy makers, commissioners, clinicians and Trust Boards in order to return our systems to stability and help deliver the quality of care that our patients expect when they seek our help in an emergency. ”

… continues on the site

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Patterns of Maternity Care in English NHS Hospitals 2011 / 12 – Royal College of Obstetricians and Gynaecologists – May 2013

Posted on May 14, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Obstetrics | Tags: , , |

Patterns of Maternity Care in English NHS Hospitals 2011 / 12 – Royal College of Obstetricians and Gynaecologists – May 2013

“The Clinical Indicators Project is a programme of work that aims to develop clinically relevant, methodologically robust performance indicators for obstetric and gynaecological care using currently available data. This information will be used to inform quality improvement initiatives and provide comparative benchmarking for women’s health services across the UK.

This project is being carried out in collaboration with the London School of Hygiene and Tropical Medicine.

The first report on Patterns of Maternity Care in English NHS Hospitals is now available.

The report presents a series of eleven indicators that can be used to compare the performance of English maternity units. It is the first of what will be an annual account by the RCOG of variation in care delivered to women during childbirth.

The report uses Hospital Episode Statistics (HES) data from 2011/12 that is routinely submitted by each NHS hospital. For the first time, this data has been analysed in a way that enables fairer comparisons to be made between hospitals. The researchers have risk-adjusted for factors which are beyond the control of the hospital, such as the age and medical history of the mother.

The indicators reveal considerable variation among maternity units in England.”

… continues on the site

Press release: RCOG release: New report reveals wide variation in practice and outcomes among English maternity units

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Countering the biggest risk of all: attempting to govern uncertainty in healthcare management – Good Governance Institute – May 2013

Posted on May 14, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Mgmt Policy Planning | Tags: , , |

Countering the biggest risk of all: attempting to govern uncertainty in healthcare management – Good Governance Institute – May 2013

by Paul Moore   ISBN 978-1-907610-19-6

Extract from the introduction:

“I advance in this report a simple model for the governance of risk in healthcare settings, wherein it is proposed that effective assurance and resilience are dependent upon, or proportional to:
(i) clarity of organisational purpose and objectives;
(ii) effective treatment and monitoring of risk; and
(iii) robust accountability. Organisational culture and the behaviour of leaders also play a vital role in the development of good governance, as highlighted by Francis (2013a, 2013b, 2013c) and many others.

The Good Governance Institute (GGI) supports organisations to enhance their capacity to govern and control, but is increasingly asked what tools or techniques could be deployed to help boards protect their organisations against a broad set of high-consequence risks. This report enables the advancement of a new governance paradigm – a simplification, rationalisation and realignment of the basic elements of the clinical governance concept. Thus a new model is presented for countering the biggest risk of all – failing to make risk visible and failing to adapt to protect everything of value.”

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Gripes, grumbles and grievances: the role of complaints in transforming public services – Nesta – April 2013

Posted on April 29, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

Gripes, grumbles and grievances: the role of complaints in transforming public services – Nesta – April 2013

by Richard Simmons and Carol Brennan

“Complaints are not often associated with innovation and creativity. When we think of complaints, we tend towards negative association – frustration, failure, poor service, something to be dealt with promptly and filed away. Receiving lots of complaints is seen as something to be wary of, not celebrated.

But getting complaints is much better than not getting complaints – they show that people think it’s worth complaining and that they will be listened to, and that they believe that they have power to influence the system. They are a good sign of democracy in action.

This report looks at the role of complaints in transforming public services.”

Nesta blog entry on complaints in public services – 25 April 2013

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Quality Governance: How does a board know that its organisation is working effectively to improve patient care? – Monitor – 22 April 2013

Posted on April 29, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Quality Governance: How does a board know that its organisation is working effectively to improve patient care? – Monitor – 22 April 2013

“Overview of guidance

This guidance has been developed to support the Quality Governance Framework and its samples of good practice and does not seek to replace it.

In particular, this guidance should support NHS foundation trusts in making the Corporate Governance Statement required under our new licence conditions.

It can also support aspirant NHS foundation trusts in making their board statement on quality governance as part of Monitor’s assessment process.

It is particularly relevant and timely in the context of the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry which was published in February 2013. Its recommendations highlight the importance of quality governance and quality assurance arrangements within the NHS.”

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Our strategy and business plan – Care Quality Commission [UK] – 18 April 2013

Posted on April 22, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Our strategy and business plan – Care Quality Commission [UK] – 18 April 2013

“We are making radical changes to the way we inspect and regulate services to make sure they provide people with safe, effective, compassionate and high-quality care, and to encourage them to make improvements.

We will make sure that above all else, we are always on the side of people who use care services and always put their interests first.

The changes we’re making include:”

… continues on the site

 

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Which way to quality? Key perspectives on quality improvement in Canadian health care systems – Health Council of Canada – 25 March 2013

Posted on April 3, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Which way to quality? Key perspectives on quality improvement in Canadian health care systems – Health Council of Canada – 25 March 2013

“While many Canadians believe we have one of the best health care systems in the world, recent international rankings for health care quality place Canada in the middle or at the bottom of the pack. This report calls for the establishment of common and measureable goals to achieve quality improvement in Canada’s health care systems.”

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National Committee for Quality Assurance [US] sets up accreditation for practitioners to become certified as a Patient-Centered Medical Home Certified Content Expert for physician specialists outside of primary care

Posted on April 2, 2013. Filed under: Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality | Tags: |

National Committee for Quality Assurance [US] sets up accreditation for practitioners to become certified as a Patient-Centered Medical Home Certified Content Expert for physician specialists outside of primary care

Media commentary on this from HealthData Management

 

 

 

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Understanding and measuring outcomes: the role of qualitative data – Institute for Research and Innovation in Social Services (IRISS) – March 2013

Posted on March 27, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Research | Tags: , |

Understanding and measuring outcomes: the role of qualitative data – Institute for Research and Innovation in Social Services (IRISS) – March 2013

This guide has been developed to support the collection and use of personal outcomes data. Personal outcomes data refers to information gathered from people supported by health and social services and their unpaid carers about what’s important to them in their lives and the ways in which they would like to be supported. The guide is divided into three parts.

Part 1 explores the links between an outcomes approach and qualitative data, why qualitative data is important and what it can achieve

Part 2 outlines a practical approach exploring collecting, recording, analysing and reporting qualitative data about personal outcomes

Part 3 highlights different approaches to qualitative analysis through case studies of people using qualitative data about outcomes for the first time”

… continues on the site

The Outcomes Toolbox – The Learning Exchange

“This toolbox, developed by IRISS in partnership with Coalition of Care and Support Providers in Scotland (CCPS), brings together a range of resources and knowledge relevant to an outcomes-focused approach in the social services.”

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Patients First and Foremost – Government publishes initial response to the Mid Staffordshire NHS Public Inquiry Report – 26 March 2013

Posted on March 27, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety | Tags: , |

Patients First and Foremost – Government publishes initial response to the Mid Staffordshire NHS Public Inquiry Report – 26 March 2013

The policy paper response: Patients First and Foremost: the Initial Government Response to the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry

Francis response includes Ofsted-ratings – eHealthInsider – 26 March 2013

Lis Evenstad and Lyn Whitfield

“Health secretary Jeremy Hunt has confirmed that an ‘Ofsted style’ system of summary ratings for hospitals and care homes will be adopted by the NHS.

The decision, which goes against the spirit of advice from the Nuffield Trust that Hunt asked the think-tank to produce, forms part of the government’s response to Robert Francis QC’s final report into the scandal at Mid Staffordshire NHS Foundation Trust.

Hunt asked the Nuffield Trust to investigate whether an ‘Ofsted-style’ report system could and should be introduced to the NHS.

The think-thank concluded in a report last week that this might work for “simpler” services such as care homes and GP practices, but not for complex organisations such as hospitals.

It also warned that any new ratings would need to be carefully aligned with NHS performance and regulatory regimes.

Despite this, the government says it will push ahead with the idea for hospitals and care homes, but not GP practices, for which it argues more choice and quality information is already available.

In a nod towards the Nuffield Trust’s concerns, it says that departmental ratings will also be developed.

However, another part of its response to Francis says that ‘fundamental standards’ will also be developed for the NHS, and that these will be subject to their own inspection and failure regime.

This may create scope for confusion about what is being judged by the different systems, and which regulators get priority.”

… continues on the site

 

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Governing public hospitals – European Observatory on Health Systems and Policies – 22 March 2013

Posted on March 27, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Mgmt Policy Planning | Tags: |

Governing public hospitals – European Observatory on Health Systems and Policies – 22 March 2013

Eurohealth

“While public ownership is a common feature in the European hospital sector, the last few decades have seen a change in the way such institutions are governed, with greater flexibility in terms of the legal form they can take and in the level of autonomy that management and supervisory boards can exercise when making institutional-level decisions. Such features often, but not exclusively, reflect developments in private-sector management practices and associated incentive structures.

At the same time, the over-riding objective of making changes to hospital governance structures is to ensure that service quality remains high or improves, that services meet the needs of the catchment population and that resources are used efficiently. This issue of Eurohealth looks at some recent developments in this area.”

… continues

full text

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Leading the Way to Healthcare Improvement in Quebec: Three CFHI-Funded Healthcare Transformation and Coordination Approaches Realize Results – Canadian Foundation for Healthcare Improvement – 14 March 2013

Posted on March 26, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , |

Leading the Way to Healthcare Improvement in Quebec: Three CFHI-Funded Healthcare Transformation and Coordination Approaches Realize Results – Canadian Foundation for Healthcare Improvement – 14 March 2013

“Three Quebec-led teams are accelerating the transformation of healthcare and seeing positive change, as a result of having applied innovative project and change-management processes to the healthcare challenges in their regions.

The findings are revealed in three reports funded by the Canadian Foundation for Healthcare Improvement (CFHI) released today. They include:

Strategic Community (SC): An Approach for Developing Interorganizational Collaboration by the members of the Work Organization Studies Chair, Université de Sherbrooke, led by Dr. Mario Roy and Madeleine Audet

Innovative Strategy in Organizational Transformation: Creating and Implementing a Transition Support Office within a University Health Centre led by Mélanie Lavoie-Tremblay, Associate Professor, Ingram School of Nursing, McGill University and Marie Claire Richer, Director Transition Support Office (TSO)
In 2008, the McGill University Health Centre (MUHC) set up the Transition Support Office (TSO) to guide the implementation of its large scale redevelopment project which is still underway. Once complete in 2015, the care and services now provided at six hospital sites will be absorbed into three. More than 10,000 staff and thousands of clients will be impacted by the redevelopment. The TSO’s goal is to ensure consistency around the harmonization of clinical practices, team consolidation and process optimization.

Knowledge in Action: Healthcare Management and Governance Innovation Lab, led by Dr. Denis A. Roy, Vice-president of Scientific Affairs, National Institute of Public Health, Quebec”

… continues on the site

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Rating providers for quality: a policy worth pursuing? – Nuffield Trust – 22 March 2013

Posted on March 25, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Rating providers for quality: a policy worth pursuing? – Nuffield Trust – 22 March 2013

“The Nuffield Trust was commissioned by the Secretary of State for Health to review whether ratings of provider performance should be used in health and social care. This report outlines the findings.

Should there be ‘Ofsted-style’ ratings for health and social care providers such as hospitals, GP practices and care homes?”

… continues

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Quality at a glance: using aggregate measures to assess the quality of NHS hospitals – MHP Health Mandate – March 2013

Posted on March 19, 2013. Filed under: Clin Governance / Risk Mgmt / Quality |

Quality at a glance: using aggregate measures to assess the quality of NHS hospitals – MHP Health Mandate – March 2013

Extract from the introduction:

“Efforts to enable the public, patients, policymakers and regulators to make easy comparisons between health service providers are not new. Indeed the first attempts at regional ratings occurred over a decade ago. The Secretary of State for Health’s announcement in late 2012 that he wishes to develop a series of ‘OFSTED-style’ ratings for hospitals can therefore be seen as part of much longer trend of policy thinking.

Yet a method for achieving this which attracts widespread support and sustained confidence has proved to be elusive.”

… continues

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Through the Quality Kaleidoscope: Reflections on the Science and Practice of Improving Health Care Quality – Agency for Healthcare Research and Quality [US] – February 2013

Posted on March 15, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Research | Tags: |

Through the Quality Kaleidoscope: Reflections on the Science and Practice of Improving Health Care Quality – Agency for Healthcare Research and Quality [US] – February 2013

Closing the Quality Gap: Revisiting the State of the Science

Methods Research Reports

Investigators: Kathryn M McDonald, MM, Christine Chang, MD, MPH, and Ellen Schultz, MS.

Rockville (MD): Agency for Healthcare Research and Quality (US); February 2013.
Report No.: 13-EHC041-EF

“Structured Abstract

Background:
The United States devotes significant resources to health care, yet quality is often lacking. In 2004, the Agency for Healthcare Research and Quality launched a collection of evidence reports on quality improvement (QI) opportunities and strategies related to chronic conditions, practice areas, and cross-cutting priorities. This new Closing the Quality Gap series expands the topics examined and marshals the knowledge of eight Evidence-based Practice Centers (EPCs) to synthesize lessons learned and to advance the state of QI science.”

… continues on the site

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Effective governance to support medical revalidation – General Medical Council [UK] – 1 March 2013

Posted on March 5, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Medicine, Patient Safety, Workforce | Tags: , , , , |

Effective governance to support medical revalidation – General Medical Council [UK] – 1 March 2013

A new guide to help Boards check their organisations are placing quality and safety at the heart of their services for patients is published today.

‘Effective governance to support medical revalidation’ is a handbook for Boards and governing bodies to help them assess if their organisations have strong enough systems in place to support quality patient care and revalidation.

The General Medical Council (GMC) developed the handbook in partnership with England’s Care Quality Commission, Monitor, Healthcare Improvement Scotland, Healthcare Inspectorate Wales, Northern Ireland’s Regulation and Quality Improvement Authority as well as the Government Procurement Service.

Revalidation – which this handbook is designed to support – is a new system of checks on doctors and was launched by the GMC in December 2012 to provide patients with greater confidence that UK doctors are keeping up to date and fit to practise.

Doctors need access to a regular appraisal focusing on the GMC’s professional standards and their organisation’s clinical governance systems to complete their revalidation. Organisations need these same systems to be working effectively to deliver safe and high quality care to patients.”

… continues

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Workforce planning implications and learning points from Francis 2013 – Centre for Workforce Intelligence – February 2013

Posted on February 28, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety, Workforce | Tags: |

Workforce planning implications and learning points from Francis 2013 – Centre for Workforce Intelligence – February 2013

“This paper is designed to contribute to this effective response by helping senior leaders in health, social care and public health to identify the key workforce implications of the Francis report.  Its purpose is to inform and stimulate discussion on the changes that the Francis report recommends at a strategic level, as well as providing advice to leaders as they consider how to engage staff to bring about individual change in the workforce.

The CfWI will revisit this thinking after the Government response is published, with a specific focus on how we may further support health and social care leaders in identifying workforce implications.

This CfWI paper is not intended to replace an individual’s own reading and consideration of this landmark report (with its executive summary, three volumes and around 1800 pages); it is intended as a distillation of the 290 recommendations from a workforce perspective. We agree that there is much to learn from the narrative of the report and a great deal to reflect on in terms of people’s own work, attitudes and collective culture (Francis 2013, Executive summary, para 111).”

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Acting on Concerns: Your Professional Responsibility – Royal College of Surgeons of England – 19 February 2013

Posted on February 26, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Surgery, Workforce | Tags: |

Acting on Concerns: Your Professional Responsibility – Royal College of Surgeons of England – 19 February 2013

“The Royal College of Surgeons (RCS) is today publishing a comprehensive manual that advises clinicians on how to act if they consider patients are receiving poor care. Acting on Concerns: Your Professional Responsibility guides surgeons on how best to collaborate with colleagues to monitor performance and quality of care, deal with problems, raise concerns and support others to do the same.

Real excellence in surgery comes from managing past failures and future risks well, with teams supporting each other through difficulties and responding to problems in a timely and constructive way. It is vital that surgeons make every effort to foster a culture where the quality of patient care provided by each individual member of the team is everyone’s concern.

This publication provides practical advice on how to develop an open culture where there is a willingness to address issues. It urges individuals not to wait for things to go wrong before personally attending to the quality of clinical governance in a team or department.”

… continues

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Making it better? Assuring high-quality care in the NHS – NHS Confederation – 11 February 2013

Posted on February 22, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety | Tags: , |

Making it better? Assuring high-quality care in the NHS  – NHS Confederation – 11 February 2013

“The Francis report painted a shocking picture of appalling standards of patient care. This paper aims to start a constructive debate, leading to concrete proposals about how to tackle these issues and find ways of reinforcing both organisational and individual accountability for delivering and improving the quality of NHS patient care.

The Francis report highlighted poor management practices, and an organisational focus on national financial and performance imperatives to the detriment of the quality of patient care.

It also challenged the effectiveness of the regulatory and oversight mechanisms in identifying and tackling poor quality patient care proactively and systematically.

This has focused attention on who is responsible for ensuring patients receive high-quality care, and for acting if appropriate standards are not met. It has particularly highlighted how the decisions and actions of managers at all levels can affect the quality of care patients receive.

This has fuelled calls to make NHS organisations, their boards and individual staff, including managers, more accountable for the quality of care.

We have structured this paper to assess the current position and take account of some of the main recommendations of the Francis report. It presents for consideration some of the options for improvements. We welcome your feedback on this paper and the questions it asks.”

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Patient-led assessments of the care environment (PLACE) – NHS – 19 February 2013

Posted on February 22, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Participation |

Patient-led assessments of the care environment (PLACE) – NHS – 19 February 2013

“Today Jane Cummings, Chief Nursing Officer for England, has written to NHS leaders introducing the new system for assessing the quality of the hospital environment from April 2013.  Patient-led assessments of the care environment (PLACE) is the new system for assessing the quality of the hospital environment, which replaces Patient Environment Action Team (PEAT) inspections from April 2013. PLACE assessments will apply to all hospitals delivering NHS-funded care, including day treatment centres and hospices.

PLACE assessments put patient views at the centre of the assessment process, and use information gleaned directly from patient assessors to report how well a hospital is performing in the areas assessed – privacy and dignity, cleanliness, food and general building maintenance. It focuses entirely on the care environment and does not cover clinical care provision or staff behaviours.

The assessments will be undertaken annually, and results will be reported publicly to help drive improvements in the care environment. The results will show how hospitals are performing nationally.

Most importantly, patients and their representatives will make up at least 50 per cent of the assessment team, which will give them the opportunity to drive developments in the health services they receive locally.”

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Mid Staffordshire NHS Foundation Trust Public Inquiry Chaired by Robert Francis QC – Final report – 6 February 2013

Posted on February 19, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety | Tags: , |

Mid Staffordshire NHS Foundation Trust Public Inquiry Chaired by Robert Francis QC – Final report – 6 February 2013

Extract from the press statment of the Chairman

“This is a story of appalling and unnecessary suffering of hundreds of people. They were failed by a system which ignored the warning signs and put corporate self interest and cost control ahead of patients and their safety. I have today made 290 recommendations designed to change this culture and make sure that patients come first.

We need a patient centred culture, no tolerance of non compliance with fundamental standards, openness and transparency, candour to patients, strong cultural leadership and caring, compassionate nursing, and useful and accurate information about services.”

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Does a hospital’s quality depend on the quality of other hospitals? A spatial econometrics approach to investigating hospital quality competition – University of York, Centre for Health Economics – January 2013

Posted on February 5, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics | Tags: |

Does a hospital’s quality depend on the quality of other hospitals? A spatial econometrics approach to investigating hospital quality competition – University of York, Centre for Health Economics – January 2013

Hugh Gravelle, Rita Santos, Luigi Siciliani

“We examine whether a hospital’s quality is affected by the quality provided by other hospitals in the same market. We first set out a theoretical model with regulated prices which specifies conditions on demand and cost functions which determine whether a hospital will have higher quality when its rivals have higher quality. We then apply spatial econometric methods to a sample of English hospitals in 2009-10 and a set of 16 quality measures including mortality rates, readmission, revision and redo rates and three patient reported indicators to examine to examine the relationship between the quality of hospitals. We find that a hospital’s quality is positively associated with the quality of its rivals for seven out of the sixteen quality measures and that in no case is there a negative association. In those cases where there is a positive association, an increase in rivals’ quality by 10% increases a hospital’s quality by 1.7% to 2.9%.”

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The formula for clear governance: Finding the equilibrium – NHS Governance Review – Grant Thornton – 2013

Posted on February 5, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , |

The formula for clear governance: Finding the equilibrium – NHS Governance Review – Grant Thornton – 2013

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Outpatient Case Management for Adults With Medical Illnesses and Complex Care Needs: Future Research Needs – AHRQ – January 2013

Posted on January 29, 2013. Filed under: Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality | Tags: |

Outpatient Case Management for Adults With Medical Illnesses and Complex Care Needs: Future Research Needs – AHRQ – January 2013

Totten AM, Wagner J, Motu’apuaka M, Hickam DH, Guise JM. Outpatient Case Management for Adults With Medical Illnesses and Complex Care Needs: Future Research Needs. Future Research Needs Paper No. 30. (Prepared by the Oregon Evidence-based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No. 13-EHC035-EF. Rockville, MD: Agency for Healthcare Research and Quality. January 2013.

“Background

In 2010, the Agency for Healthcare Research and Quality (AHRQ) charged the Oregon Evidence-based Practice Center with conducting a Comparative Effectiveness Review (CER)1 to assess the effectiveness of outpatient case management as an intervention strategy for chronic illness management.
The Key Questions the review addressed were:
Key Question 1. In adults with chronic medical illness and complex care needs, is case management effective in improving:
1a. Patient-centered outcomes, including mortality, quality of life, disease-specific health outcomes, avoidance of nursing home placement, and patient satisfaction with care?
1b. Quality of care, as indicated by disease-specific process measures, receipt of recommended health care services, adherence to therapy, missed appointments, patient self-management, and changes in health behavior?
1c. Resource utilization, including overall financial cost, hospitalization rates, days in the hospital, emergency department use, and number of clinic visits (including primary care and other provider visits)?
Key Question 2. Does the effectiveness of case management differ according to patient characteristics, including but not limited to: particular medical conditions, number or type of comorbidities, patient age and socioeconomic status, social support, and/or level of formally assessed health risk?
Key Question 3. Does the effectiveness of case management differ according to intervention characteristics, including but not limited to: practice or health care system setting; case manager experience, training, or skills; case management intensity, duration, and integration with other care providers; and the specific functions performed by case managers?
The analytic framework (Figure A) outlines the targeted population, interventions, and outcomes for the review.”

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Closing the Quality Gap: Revisiting the State of the Science – AHRQ – January 2013

Posted on January 29, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Closing the Quality Gap: Revisiting the State of the Science – AHRQ – January 2013
 
McDonald KM, Chang C, Schultz E. Closing the Quality Gap: Revisiting the State of the Science. Summary Report. (Prepared by Stanford-UCSF Evidence-based Practice Center under Contract No. 290-2007-10062-I.) AHRQ Publication No. 12(13)-E017. Rockville, MD: Agency for Healthcare Research and Quality. January 2013.
 
“Structured Abstract
 
Background. The United States devotes significant resources for the provision of health care, yet quality is often elusive or lacking. In 2004, the Agency for Healthcare Research and Quality launched a collection of evidence reports to bring data to bear on quality improvement (QI) opportunities. This new series, Closing the Quality Gap: Revisiting the State of the Science, consists of eight reports that continue the focus on improving the quality of health care through critical assessment of relevant evidence for selected settings, interventions, and clinical conditions. This report is an introduction to the Executive Summaries of the eight reports in the series and summarizes elements across the series for readers.
 
Overview. The topics are: 
effectiveness of bundled payment programs,
effectiveness of the patient-centered medical home,
QI strategies to address health disparities,
effectiveness of medication adherence interventions,
effectiveness of public reporting, prevention of healthcare associated infections,
QI measurement of outcomes for people with disabilities,
and health care and palliative care for patients with advanced and serious illness.

The overview describes the scope of the eight reports; describes the scope of the series by summarizing the quality levers, populations, interventions, outcomes, and other features across the reports; and discusses key messages by audience (patient/consumer/caregiver, health care professional, health care delivery organization, policymaker, and research community).
 
Conclusions. The series covers many important aspects of quality improvement in health care. This Summary is intended to show how topics relate and complement each other, and how together they provide a picture of the state of the science. It will help readers, as they read the Executive Summaries for the individual topics, to gain a deeper  understanding of the nature and extent of quality gaps across health care, as well as the systemic changes necessary to close them.”

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Quality in the new health system: maintaining and improving quality from April 2013 – Final Report – NHS – 18 January 2013

Posted on January 29, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Quality in the new health system: maintaining and improving quality from April 2013 – Final Report – NHS – 18 January 2013

The National Quality Board (NQB) has published a final report setting out how quality will be maintained and improved in the new health system.

The NQB brings together the national organisations across the health system responsible for quality including the Care Quality Commission, Monitor, the NHS Trust Development Authority, NICE, the General Medial Council, the Nursing and Midwifery Council, the NHS Commissioning Board, Public Health England and the Department of Health.

This report focuses predominantly on how the new system should prevent, identify and respond to serious failures in quality and provides a collective statement from NQB members as to:

•the nature and place of quality in the new health system
•the distinct roles and responsibilities for quality of the different parts of the system
•how the different parts of the system should work together to share information and intelligence on quality and to ensure an aligned and coordinated system wide response in the event of a quality failure
•the values and behaviours that all parts of the system will need to display in order to put the interests of patients and the public first and ahead of organisational interests.”

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Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System – Commonwealth Fund – 10 January 2013

Posted on January 10, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics, Patient Participation | Tags: |

Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System – Commonwealth Fund – 10 January 2013 

Media release. Commission of Leading Health Care Experts Offers New Strategy to Slow Spending Growth by $2 Trillion Over 10 Years While Improving Health System Performance – Commonwealth Fund – 10 January 2013

“Changing How Care Is Paid For, Giving Consumers Better Information and Incentives to Choose Wisely, and Improving How Health Care Markets Function Could Result in Substantial Savings for Federal and Local Governments, Employers, and Families”

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Hospital Pathways programme: lessons learned – King’s Fund – 19 December 2012

Posted on January 8, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Hospital Pathways programme: lessons learned – King’s Fund – 19 December 2012

“This article tells the story of the Hospital Pathways programme, a collaborative programme in which five acute trusts worked with The King’s Fund and the Health Foundation to apply techniques, not widely used in the NHS, to improve both processes of care and interactions between staff and patients.

Here we describe the programme; the method used to evaluate it; what we learned about the approach, and how the lessons have influenced the next programme called Patient and Family-centred Care.”

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Development of Quality Indicators for the Home and Community-Based Services Population: Technical Report – AHRQ Quality Indicators – June 2012

Posted on January 2, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Community Services | Tags: , , |

Development of Quality Indicators for the Home and Community-Based Services Population: Technical Report – AHRQ Quality Indicators – June 2012

Prepared by: Ellen Schultz, Sheryl M. Davies, Kathryn M. McDonald, Center for Primary Care and Outcomes Research, Stanford University.  This project was funded by a contract from the Agency for Healthcare Research and Quality

“Purpose

These quality indicators (QIs) are intended to reflect the health and well-being of beneficiaries receiving home and community-based services (HCBS) through state Medicaid programs. The indicators focus on the well being of HCBS beneficiaries as reflected by potentially preventable hospitalizations. These include hospitalizations for specific conditions associated with chronic disease exacerbation and progression as well as poor access to care and support services.”

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Measuring What Matters: The Cost vs Values of Health Care – Ivey – International Centre for Health Innvovation – November 2012

Posted on December 3, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics | Tags: , |

Measuring What Matters: The Cost vs Values of Health Care – Ivey – International Centre for Health Innvovation – November 2012

Extract from the Executive Summary:

“There is a clear misalignment between what Canadians value, and how Canadian health system performance is measured and funded. Canadian values have shifted substantially in recent years, towards a preference for greater autonomy and empowerment in managing their health care and management. Canadians’ values reflect the desire for a more “personalized” health care system, one that engages every individual patient in a collaborative partnership with health providers, to make decisions that support health, wellness, and quality of life. Yet, health systems are focused on performance management in terms of costs, operational inputs, such as services delivered, or quality measures such
as medication errors, readmissions to hospital, and mortality rates. Health system effectiveness is not evaluated in terms of delivering value to Canadians.

Canadians perceive health care as one of the most fundamentally important features of our society. There have been numerous studies of Canada’s health care system, and in every work to date, the perspectives and views of Canadians have been an important frame of reference for health system renewal and reform.
This white paper builds upon the discussion of past work and considers five main questions:
1. What are Canadians’ core health values?
2. How do values differ among key stakeholders within the sector, and what do they value from their unique health perspectives?
3. Are those publicly articulated values aligned with what is funded or reimbursed?
4. Are those publicly articulated values measured and incented from a health system perspective?
5. How do Canada’s health care values and performance outcomes compare over time to comparator Organization for Economic Cooperation and Development (OECD) nations?”

… continues

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Improving GP services in England – The King’s Fund – 7 November 2012

Posted on November 8, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, General Practice, Patient Participation | Tags: |

Improving GP services in England – The King’s Fund – 7 November 2012

“Exploring the association between quality of care and the experience of patients

Two key elements of the quality of health care provided by GPs are the Quality and Outcomes Framework (QOF), which rewards GP practices for achievement against a range of indicators of clinical quality, and the GP Patient Survey, which asks patients about their experience of using GP services.

Using data for more than 8,000 general practices in England, this paper examines the association between patients’ perceptions about the non-clinical aspects of care and practice performance on measures of clinical quality.”

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2014 [EHR] Clinical Quality Measures – Centers for Medicare and Medicaid Services [US]- October 2012

Posted on October 30, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics, Medical Records | Tags: |

2014 [EHR] Clinical Quality Measures – Centers for Medicare and Medicaid Services [US]- October 2012

“Beginning in 2014, the reporting of clinical quality measures (CQMs) will change for all providers. EHR technology that has been certified to the 2014 Edition standards and certification criteria will have been tested for enhanced CQM-related capabilities, Eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) will be required to report using the new 2014 criteria regardless of whether they are participating in Stage 1 or Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Although clinical quality measure (CQM) reporting has been removed as a core objective for both Eligible Professionals (EPs) and eligible hospitals and CAHs, all providers are required to report on CQMs in order to demonstrate meaningful use.”

… continues on the site

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From vision to action. Making patient-centred care a reality – Richmond Group of Charities [UK] – 2012

Posted on October 23, 2012. Filed under: Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality, Patient Participation | Tags: , , , |

From vision to action. Making patient-centred care a reality – Richmond Group of Charities [UK] – 2012

Extract from the foreword:

“When our ten leading health and social care charities published our joint view on how high-quality, patient-centred, cost-effective care could be delivered, we were surprised how aligned our thinking was. We agreed five themes on which the post-reform NHS should be based
and within which productivity gains are possible:
• co-ordinated care
• patients engaged in decisions about their care
• supported self-management
• prevention, early diagnosis and intervention
• emotional, psychological and practical support.

Our shared vision has yet to be delivered. The Health Select Committee recently warned the government that if standards of quality and access are to be maintained, system redesign is needed, rather than salami-slicing existing services or incremental improvement (House of Commons Health Committee 2012). We agree.

As leading charities that both advocate for and support the care of people with health and social care needs, we renew our commitment to working with colleagues locally and nationally, in policy and in service delivery, to build a sustainable model for the NHS and its partners.”

… continues

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How to deliver high-quality, patient-centred, cost-effective care. Consensus solutions from the voluntary sector – Richmond Group of Charities [UK] – 2010

Posted on October 23, 2012. Filed under: Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality, Patient Participation | Tags: , , , |

How to deliver high-quality, patient-centred, cost-effective care. Consensus solutions from the voluntary sector – Richmond Group of Charities [UK] – 2010

Extract from the introduction:

“This publication is the collective effort of ten of the leading health and social care organisations in the voluntary sector. Each organisation submitted evidence to The King’s Fund, which independently analysed and assessed each submission and worked with the organisations to establish a common position. Together we have identified the five key themes that the health and social care system must embrace to be sustainable and to ensure quality. The themes are:
•co-ordinated care
•patients engaged in decisions about their care
•supported self-management
•prevention, early diagnosis and intervention
•emotional, psychological and practical support”

…  continues

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Measuring Success: A Framework for Benchmarking Health Care System Performance – The Conference Board of Canada – September 2012

Posted on October 2, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Health Mgmt Policy Planning | Tags: , |

Measuring Success: A Framework for Benchmarking Health Care System Performance – The Conference Board of Canada – September 2012

“This current report, Measuring Success: A Framework for Benchmarking Health Care System Performance, provides a foundation for the upcoming provincial and international benchmarking reports. In this report, we discuss the benefits of benchmarking; the benchmarking process and methods; benchmarking frameworks used by other organizations, both within Canada and internationally; and the benchmarking framework that we propose to guide the provincial benchmarking study to be conducted in the fall of 2012. This framework includes a full description of the performance indicators, the rationale for their inclusion, and the ranking methodology.”

… continues

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Australasian Clinical Indicator Report 2004-2011- ACHS – 26 September 2012

Posted on September 27, 2012. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , |

Australasian Clinical Indicator Report 2004-2011- ACHS – 26 September 2012

The report

ISBN: 978-1-921806-13-1 (paperback)
ISBN: 978-1-921806-14-8 (web)

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Quality improvement training for healthcare professionals – The Health Foundation – August 2012

Posted on September 21, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Educ for Hlth Professions | Tags: |

Quality improvement training for healthcare professionals – The Health Foundation – August 2012

“There is an increasing focus on improving healthcare in order to ensure higher quality. Training programmes have been developed to teach health professionals and students formal quality improvement methods.

This evidence scan explores the following questions:

What types of training about formal quality improvement techniques are available for health professionals?

What evidence is there about the most effective methods for training clinicians in quality improvement?

The scan looks at the content of training and the impact it is shown to have, as well as the effectiveness of different methods.

This is an essential area for further exploration and the scan shows that a great deal remains uncertain about training in quality improvement. This includes: the most appropriate content; how training can best be delivered to improve processes and patient outcomes; how to measure and ensure quality within training.”

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Best Care at Lower Cost: The Path to Continuously Learning Health Care in America – Institute of Medicine – 6 September 2012

Posted on September 7, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Educ for Hlth Professions, Health Informatics, Patient Participation | Tags: |

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America – Institute of Medicine – 6 September 2012

Full text

“… IOM convened the Committee on the Learning Health Care System in America to explore these central challenges to health care today. The product of the committee’s deliberations, Best Care at Lower Cost, identifies three major imperatives for change: the rising complexity of modern health care, unsustainable cost increases, and outcomes below the system’s potential. But it also points out that emerging tools like computing power, connectivity, team-based care, and systems engineering techniques—tools that were previously unavailable—make the envisioned transition possible, and are already being put to successful use in pioneering health care organizations. Applying these new strategies can support the transition to a continuously learning health system, one that aligns science and informatics, patient-clinician partnerships, incentives, and a culture of continuous improvement to produce the best care at lower cost. The report’s recommendations speak to the many stakeholders in the health care system and outline the concerted actions necessary across all sectors to achieve the needed transformation.”

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Provider-Level Risk-Adjusted Quality Measurement for Inpatient Rehabilitation Facilities – RAND – 2012

Posted on August 2, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Rehabilitation | Tags: |

Provider-Level Risk-Adjusted Quality Measurement for Inpatient Rehabilitation Facilities – RAND – 2012

by  Andrew W. Dick,  Peter J. Huckfeldt,  Hangsheng Liu,  Hao Yu,  Ateev Mehrotra,  Susan L. Lovejoy,  J. Scott Ashwood

“Quality metrics play an increasingly important role in the evaluation and reimbursement of post-acute providers. Currently, it is difficult to ascertain whether changes in inpatient rehabilitation facility (IRF) patient outcomes are due to changes in treatment or the case mix of patients seen in IRFs. Risk adjustment, however, has the potential to improve the comparability of quality metrics both across providers and over time. This report (1) develops risk-adjusted quality metrics at the provider level for IRFs, (2) develops methods to address low case volume, and (3) uses these metrics to estimate national trends in IRF quality from 2004 to 2009. It presents the results for five IRF outcomes: (1) functional gain, (2) discharge to the community, (3) 30-day readmission to acute care given discharge to the community, (4) 30-day readmission to skilled nursing facility (SNF), given discharge to the community, and (5) discharge directly to acute care.”

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Aligning forces for quality: improving health and health care in communities across America – Robert Wood Johnson Foundation

Posted on August 2, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Health Systems Improvement | Tags: , |

Aligning forces for quality: improving health and health care in communities across America – Robert Wood Johnson Foundation

” Health care is a national problem, but it is solved locally

Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s (RWJF) signature effort to lift the overall quality of health care in targeted communities, reduce racial and ethnic disparities and provide models for national reform.

AF4Q asks the people who get care, give care and pay for care to work together toward common, fundamental objectives to lead to better care. The Foundation has made an unprecedented commitment to improve health care in 16 geographically, demographically, and economically diverse communities that together cover 12.5 percent of the U.S. population.”

Impact
Ambulatory Care
Care Across Settings
Consumer Engagement
Cost & Efficiency
Equity
Hospital Care
Measurement & Reporting
Patient-Centered Care
Payment Reform

Collaboratives
Improving Language Services
Increasing Throughput
Reducing Readmissions
Transforming Care at the Bedside (TCAB)
Past Collaboratives

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NQF Endorses Pulmonary and Critical Care Measures – National Quality Forum [US] – 31 July 2012

Posted on August 2, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Intensive Care, Respiratory Medicine | Tags: , , , , , |

NQF Endorses Pulmonary and Critical Care Measures – National Quality Forum [US] – 31 July 2012

“Washington, DC – the National Quality Forum (NQF) Board of Directors has endorsed 19 measures related to pulmonary conditions and the critical care setting. The measures focus on treatment processes and outcomes for asthma, chronic obstructive pulmonary disease (COPD), and pneumonia.”

“The measures include those that have been endorsed for at least three years and are now undergoing NQF endorsement maintenance. The ongoing evaluation and updating of endorsed measures ensures they are current and relevant to NQF’s pulmonary/critical care portfolio. In all, 35 measures were evaluated against NQF’s endorsement criteria; 19 received endorsement status. Three were new measures and 16 were maintenance measures. Further harmonization efforts are underway for a sub-set of measures. Three measures are still under review.”

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Professional Standards for Hospital Pharmacy Services – Royal Pharmaceutical Society – 31 July 2012

Posted on August 1, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Health Professions, Pharmacy, Workforce | Tags: |

Professional Standards for Hospital Pharmacy Services – Royal Pharmaceutical Society – 31 July 2012

Supporting resources for Professional Standards for Hospital Pharmacy

Media release

“We are pleased to announce the launch of the RPS Professional Standards for Hospital Pharmacy Services: Optimising patient outcomes from medicines. The standards have been developed by a wide range of stakeholders across GB and covers pharmacy services delivered by acute, mental health, private and community service providers.

The 10 overarching standards underpin patient experience and the safe, effective management of medicines within and across organisations.  They will enable patients to experience a consistent quality of service within and across healthcare providers, that helps protect them from incidents of avoidable harm and enables them to get the best outcomes from their medicines.”

… continues

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Preparing for the Francis report: How to assure quality in the NHS – The King’s Fund – 26 July 2012

Posted on July 31, 2012. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Preparing for the Francis report: How to assure quality in the NHS – The King’s Fund – 26 July 2012

by       Anna Dixon, Catherine Foot, Tony Harrison

“The national structures and systems designed to assure the quality of care delivered by the NHS are currently under intense scrutiny.

It is widely expected that regulators will come in for further criticism in the autumn when the Public Inquiry into the serious failures of care at Mid Staffordshire NHS Foundation Trust reports. The Francis Inquiry’s Chair, Robert Francis QC, is likely to propose far-reaching changes at all levels of the system, including to the external organisations that regulate quality. But will further changes to national structures and systems make such gross failings in quality less likely in future?

In this paper we set out our views on how the system of quality assurance, including regulation, needs to evolve, the principles on which it should be built and how it should operate.”

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Quality Measurement Enabled by Health IT: Overview, Challenges, and Possibilities: an environmental snapshot – Agency for Healthcare Research and Quality [US] – July 2012

Posted on July 24, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Health Informatics | Tags: |

Quality Measurement Enabled by Health IT: Overview, Challenges, and Possibilities: an environmental snapshot – Agency for Healthcare Research and Quality [US] – July 2012

Prepared by: Booz Allen Hamilton

“Pathways to Quality Measurement Through Health IT is a 2-year, AHRQ-sponsored initiative that enables advancements in health IT-enabled quality measurement and reporting by identifying strategies, a health services infrastructure, and research issues related to health IT-enabled quality measures. Reports and other materials emanating from this initiative will culminate in the development of a strategic plan to improve health care quality enabled by health IT.

Provides an overview of health IT-enabled quality measurement;
Discusses possibilities for the next generation of health IT-enabled quality measurement;
Illustrates challenges to achieving the next generation of health IT-enabled quality measurement; and
Describes over 80 Federal, State, regional, and private activities seeking to improve health-IT enabled quality measurement.”

Anderson KM, Marsh CA, Flemming AC, Isenstein H, Reynolds J. Quality Measurement Enabled by Health IT: Overview, Possibilities, and Challenges (Prepared by Booz Allen Hamilton, under Contract No. HHSA290200900024I.) AHRQ Publication No. 12-0061-EF. Rockville, MD: Agency for Healthcare Research and Quality. July 2012.

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National Health Performance Authority – Draft Strategic Plan 2012-15: Public Consultation – 11 July 2012

Posted on July 16, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Health Mgmt Policy Planning | Tags: , , |

National Health Performance Authority – Draft Strategic Plan 2012-15:  Public Consultation – 11 July 2012

“The National Health Performance Authority is a recently established agency under the National Health Reform Act 2011. We are now releasing our draft Strategic Plan for consultation, so that Australians can have their say on the proposed mission, values and objectives of the Performance Authority.

The Performance Authority’s draft Strategic Plan 2012-15 outlines the proposed strategic direction the organisation will take in performing its duties of providing independent monitoring and performance reporting of health care organisations.

The role of the Performance Authority is to develop high quality, locally relevant and nationally consistent reports on the performance of local hospital networks, public hospitals, private hospitals and primary health care organisations. This transparent public reporting across a range of performance indicators will stimulate and inform improvements in the Australian health system, increase transparency and accountability and inform consumers.

By making a submission, you will have the opportunity for your views to be considered in the development of the Strategic Plan. “

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All-Cause Readmission to Acute Care and Return to the Emergency Department – Canadian Institute for Health Information – 14 June 2012

Posted on June 18, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine | Tags: , , , |

All-Cause Readmission to Acute Care and Return to the Emergency Department – Canadian Institute for Health Information – 14 June 2012

“One in 12 patients readmitted to Canadian hospitals within 30 days
Study examines who is returning and why

June 14, 2012—Soon after their discharge from hospital, more than 180,000 Canadians were readmitted to acute care in 2010, reveals a study from the Canadian Institute for Health Information (CIHI). In those jurisdictions where detailed emergency department (ED) data was available—Alberta, Ontario and Yukon—nearly 1 in 10 acute care patients returned to the ED within seven days of hospital discharge. The study, All-Cause Readmission to Acute Care and Return to the Emergency Department, included more than 2.1 million hospitalizations across the country. It looked at surgical, medical, pediatric and obstetric patients to better understand who returned to acute care after discharge and for what clinical reason.

“Better understanding of the factors influencing readmission rates is an important step for improving the quality of care for Canadians,” says Jeremy Veillard, Vice President of Research and Analysis at CIHI. “Although readmissions cannot always be avoided, research suggests that in many cases they may be prevented.”

Reasons for readmission varied by patient group”

… continues

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Guide to Patient and Family Engagement: Environmental Scan Report – Agency for Healthcare Research and Quality [US] – June 2012

Posted on June 18, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Participation, Patient Safety | Tags: |

Guide to Patient and Family Engagement: Environmental Scan Report – Agency for Healthcare Research and Quality [US] – June 2012

“This report was prepared for the Agency for Healthcare Research and Quality (AHRQ) by the American Institutes for Research (AIR) under contract HHSA 290-200-600019. It presents the results of an environmental scan conducted by AIR to serve as an evidence-based foundation for the development of the Guide to Patient and Family Engagement: Enhancing the Quality and Safety of Hospital Care.”

Extract from the executive summary:

“This goal of this project is to promote patient and family engagement in hospital settings by developing, implementing, and evaluating the Guide to Patient and Family Engagement: Enhancing the Quality and Safety of Hospital Care (hereafter referred to as the Guide). The Guide will comprise tools, materials, and/or training for patients, family members, health professionals (e.g., hospital clinicians, staff), hospital leaders, and those who will implement the materials in the Guide. Our preliminary vision of the Guide included four components, each with a series of “tools” (e.g., materials, resources, items for training): (1) Patient and Family Active Involvement Materials; (2) Patient and Family Organizational Partnership Materials; (3) Health Professional Materials; and (4) Leadership and Implementation Materials. The tools in the Guide are intended to:

Support the involvement of patients and family members in the safety and quality of their care.
Encourage the involvement of patients and family members in improving quality and safety within the hospital setting.
Facilitate the creation of partnerships between health professionals and patients/family members.
Outline the steps needed to implement changes.”

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Is achieving Ontario’s Emergency Department length of stay performance targets associated with improved patient outcomes following discharge? – February 2012

Posted on June 12, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Emergency Medicine | Tags: |

Is achieving Ontario’s Emergency Department length of stay performance targets associated with improved patient outcomes following discharge? – February 2012

Michael Schull, Astrid Guttmann, Marian Vermeulan, Therese Stukel, & Dorina Simeonov. (2012).  Institute for Clinical Evaluative Sciences.

Extract:

“Background:
Wait time targets are controversial since some claim that the push for improved efficiency could compromise patient safety. On the other hand, spending long hours waiting for care in an ED has itself been shown to have safety risks. We tested the question of whether ED patients, who arrived during a shift when a greater percentage of all ED patients seen on that shift met their respective MOHLTC ED LOS targets, had a lower risk of mortality or hospital admission in the 7 days following ED discharge. We looked only at outcomes among patients discharged from the ED, since subsequent outcomes among admitted patients could be due to in-patient, as opposed to ED, care.  …

Policy recommendations:
Achieving MOHLTC ED wait time targets was associated with a reduced risk of death or hospitalization after ED discharge among both high and low acuity patients. This study provides empirical support for ED LOS targets as a means to improve patient outcomes. ED wait times performance should continue to be monitored. Consideration should be given to providing incentives for EDs to achieve 95% compliance with ED wait time targets, since this was generally associated with the best outcomes.”

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Using Care Bundles to Improve Health Care Quality – Institute for Healthcare Improvement – 2012

Posted on June 1, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Intensive Care | Tags: |

Using Care Bundles to Improve Health Care Quality – Institute for Healthcare Improvement – 2012

IHI Innovation Series white paper by Resar R, Griffin FA, Haraden C, Nolan TW.

“In 2001, the Institute for Healthcare Improvement (IHI) developed the “bundle” concept in the context of an IHI and Voluntary Hospital Association (VHA) joint initiative — Idealized Design of the Intensive Care Unit (IDICU) — involving 13 hospitals focused on improving critical care. The goal of the initiative was to improve critical care processes to the highest levels of reliability, which would result in vastly improved outcomes. The theory was that enhancing teamwork and communication in multidisciplinary teams would create the necessary conditions for safe and reliable care in the ICU. We focused on areas with potential for great harm and high cost, and where the evidence base was strong.

While there were many changes the teams in the initiative worked toward implementing, care of patients on ventilators and those who had central lines became a strong focus, as it satisfied all of our criteria: the evidence for the clinical changes was robust, and there was little or no controversy concerning their efficacy. Further, teams would need to find new and better ways to work together to produce reliable change and superior patient outcomes. We found that by using a “bundle” — a small set of evidence-based interventions for a defined patient population and care setting — the improvements in patient outcomes exceeded expectations of both teams and faculty.

Thus began an innovative approach to improving care: the use of bundles. This white paper describes the history, theory of change, design concepts, and outcomes associated with the development and use of bundles over the past decade. We reflect on what we have learned and make suggestions for further research and implementation of the bundle approach to improving care.”

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