Healthcare Quality

1
Healthcare Quality SafetyMeeting the Next
ChallengesInternational Society for Quality in
Healthcare Conference Reporthttp//www.isqua.org
/isquaPages/documents/ISQUAprogramme08_000.pdf

• Colin Davies
• Service Development Programme Manager

2
The Presentation

• Report on key points from the ISQua Conference
• The conference
• ISQua
• To Err is Human
• Standards
• Key Points
• International Examples
• High Level Points

• Highlights quality assured service improvement
  tools for the CKO and the NHS library services -
  demonstrating NLH working in alignment with
  international quality.
• TWO NLH developments for driving knowledge
  service improvement
• National Service Framework
• Cost Framework

3
The conference

• Conference was held in Copenhagen on 20th-22nd
  October 2008.
• It attracted 1000 delegates from 68 countries,
  with 54 concurrent sessions and 400 posters

• The NLH conference poster illustrated the
  outcome of patient care as a series of processes
  through research and evidence, to knowledge into
  practice. It links knowledge with business need,
  value for money, skilled library workforce,
  knowledge infrastructure and library service
  delivery.
• See poster at
• http//www.library.nhs.uk/forlibrarians/nsf

4
ISQua

• International Society for Quality in
  Healthcares mission is to drive continuous
  improvement and offers
• quality assurance for governments and NGOs that
  have developed health quality and safety
  standards
• standards accreditation for governments and NGOs
• an international quality kite mark

• NLH has not yet sought ISQua accreditation.
• However, the National Service Framework for
  Quality Improvement (NSF) has been written in
  alignment to ISQua requirements.
• NSF is a quality assurance tool for service
  improvement.
• Cost Framework costs service requirements
  defined by CKO and/or Commissioner.

5
To Err is Human

• Lucian Leape spoke that there are not bad people
  but bad systems
• Changing the culture whereby quality and safety
  is at the centre of the healthcare team
• Creating strong leadership is needed to ensure
  implementation of quality and safety
• Building organisational knowledge is critical to
  improved quality and safety in patient care
  outcomes

• Quality tool for CKOs to plan, commission and
  measure continuous improvement of knowledge
  activity that underpins clinical outcomes.
• NSF aims to embed the library in corporate
  knowledge process and outcomes.
• Cost Framework will drive change through zero
  based costing based on CKO requirements.
• NSF peer review is the process for measurement
  of quality and competency.

6
Standards

• Dr Charles Shaw cofounder of the Kings Fund
  and advisor to DH - dont write new standards
  adopt and apply existing standards
• Need to find the balance
• Central, top-down or local, bottom-up?
• Regulatory, or developmental?
• Minimal, or optimal standards?
• External, or internal quality systems?

• NSF has adopted standard criteria from Helicon,
  ISO 9001 and CHKS standards for healthcare
  organisations.
• NSF is a national quality assurance framework.
• NSF will enable CKOs to drive forward local
  corporate and service knowledge outcomes.
• Cost Framework informs the CKO on reducing fixed
  costs and increasing service outputs.

7
Standards

• Quality Cycle (Shaw 2008)
• Standards
• Targets
• Guidelines
• Expectations
• Measurement
• Survey
• Indicator
• Change Improvement

• NSF is a continuous quality improvement
  programme.
• NSF does not contain targets.
• NSF baseline will establish national key
  performance indicators.
• Cost Framework applies best industry practice.
• CKOs will be able to benchmark, understand
  trends, evidence best practice.

8
Key Conference Points

• Baseline is critical to long term measurement
  point for service and performance improvement
• NSF baseline will be completed by April 2009
• Accreditation is about competence to deliver
• NSF accreditation is on hold. Peer review
  commences May 2009
• Surveyors are essential to quality assessment.
  Surveyor competency must be a priority at all
  times
• NSF Surveyor Training has been commissioned

• Inspection does not necessarily improve quality
  but does increase compliance
• Self-assessment focuses organisations on service
  improvement
• NSF is a self-assessment programme
• Voluntary peer review requires support but is
  effective in supporting service improvement
• NSF peer review is currently being supported

9
Key Conference Points

• Risk assessment is the process to achieve and
  maintain accreditation and sustain quality
  improvement
• Research is required to credibly report quality
  improvement. Anecdotal opinion is not acceptable
• Plans for impact assessment will apply research
  methodologies
• Research in Australia has shown a high level of
  reliability of surveyor teams

• Statistics and data analysis is the key measure
  of quality and safety
• NSF will define local performance outcomes and
  determine data collection. National stats are
  collected.
• Regulatory standards should be based on safety
  and should be seen as minimum to drive standards

10
International Examples

• UK, Australia, US, Canada, India, France, Denmark
  etc are all implementing self-assessment and
  accreditation inspections of healthcare services
  to drive quality improvements
• All of these countries have key drivers to
  improve public health, patient engagement,
  clinical outcomes, partnership working and risk
  management
• The NICE model for clinical improvements is being
  emulated across Europe, particularly for its
  support for patient involvement
• Englands NHS National Service Framework for
  Quality Improvement of Health Library Services to
  improve the evidence base for decision making is
  a leader in the field
• The NLH and NSF were the only library/knowledge
  service at the ISQua conference. Denmark, Ireland
  and Belgium were interested in the NSF as a
  quality tool.

11
High Level Points

• Regulation has little impact on quality
• Standards should be based on best evidence
• Standards should focus on organisation and
  clinical standards and be differentiated from
  targets
• Standards should be consistent with international
  standards
• There should be a balancing of a top down and a
  bottom up approach to implementing standards.