Quality Improvement & Patient Safety
- Staff Nurse Cathy’s Journey
Staff Nurse Cathy joined the Institute of Mental Health
(IMH) as a fresh graduate from the local polytechnic
During her orientation week, she was introduced to the hospital’s
Quality & Safety Framework
Wow, this
looks
difficult. I
wonder how I
will play a
part...
Quality & Safety Framework
In her ward, Cathy saw various indicators displayed. She also learned that the hospital benchmark against other
hospitals and there were hospital data in the IMH Indicators intranet and sharepoint folders
Indicators and Benchmarking
Benchmarking Partners
One day, her patient Mr Lee fell in her ward and suffered a fracture...
What can I do to
prevent such
incidents? The
Quality & Safety
Framework has a
Culture of Safety
Programme, let me
look at it…
Culture of Safety
Cathy recalled the Culture of Safety Programme under the Quality & Safety
Framework. She reported the incident
IMH CULTURE
OF SAFETY
Code of Conduct
for Safety
Patient Safety
Training
Incident Reporting
Information System (IRIS)
Monthly Safety
Walkabout by
Leadership
Staff Support & Assistance
Scheme
Patient Safety
Climate Survey
Staff & Patient Engagement &
Communication
Culture of Safety
She read up on the IMH’s Code of Conduct for Safety under the Culture of Safety Programme. The incident
reinforced her commitment to the Code.
Code of Conduct for Safety
Communicate openly, respectfully and directly with team members, referring providers, patients and families in order to optimize health services and to promote mutual trust and understanding.
Encourage support and respect the right and responsibility of all individuals to assert themselves to ensure patient safety and the quality of care.
Promptly report to supervisor, any individual who may be impaired in his or her ability to perform assigned responsibilities due to any cause (e.g., emotional issues, substance abuse).
Promptly report adverse events and potential safety hazards and encourage colleagues to do the same
Willingly participate in, cooperate with and contribute to briefings and investigations of adverse events.
Comply with all applicable laws and hospital policies.
Adapted from Johns Hopkins Hospital & New York Presbyterian Hospital
It also spurred her to do more to improve quality & patient safety. She went through the Quality & Patient Safety resource page in the intranet and NHG quality publications to improve her knowledge in these areas
Quality Resources
Senior Management Townhalls
Senior Management Messages
Quality Day
Safety Carnival
Quality Improvement & Patient Safety Intranet
Safety Huddles and Handovers
Adverse Events Sharing/Talk
Senior Management Walkabout & Rounding
NHG Quality Publications
She also received information on quality & patient safety matters through various
platforms
Communicating Quality Matters
One day, Cathy attended CEO’s Townhall and learned about the hospital’s FY2016 Quality and Patient Safety
priorities
Quality & Patient Safety (QPS) Priorities
She also saw various Statistical Process Control charts on the priorities…
Data Capability
0
1
2
3
4
Res
trai
nt
rate
Restraint rate (number of 4-5 point restraint episode per 1000 patient days)
Restraint rate UCL … LCL … Mean Target = 2.38
0
20
40
60
80
100
Pas
sin
g ra
te (
%)
D6 - Percentage of subsidized inpatients (with ALOS >= 4 days) assessed by Specialist within 24 hours of arrival in the wards, within the next 3 days, and subsequently according to the frequency specified (by specialist) thereafter
Passing Rate UCL … LCL … Mean Target : Year 2013-2015 = 60%; Year 2016 = 80%
…and learnt that IMH had shifted from using run charts to SPC charts. There are mini-workshops for staff to learn
how to interpret and plot charts
In the past…
Run chart
• Simple
• Incapable of showing if the process was stable and in control
• Tends to cause over- or under-reaction to data
Now…
Control chart
• Slightly more complex
• Separates process variation attributed to assignable causes from that caused by background noise
• Tells readers when actions need to be taken
Data Capability
From CEO’s Townhall, Cathy learnt that there were workgroups & committees working to improve the priorities and other clinical indicators. She met with the chairpersons
of the Restraints and Assaults Workgroup to understand their work.
Training •Restraints
• Restraints clinic
• Assault • Care & Response (C&R)
and soft skills / de-escalation (assault)
Education •Restraints
• Roadshows
• Assault • Staff Manual on Assault
Reduction Training
• Assessment tool (assault)
Culture • Multi-disciplinary effort • Assault Workgroup and
Restraints Workgroup
• Safety rounding
• Early risk identification & inter-block sharing of best practices (assault)
Restraints & Assaults Workgroup
Intrigued and inspired by CEO’s Townhall and the Workgroups’ initiatives, Cathy volunteered to take part in various quality projects
and initiatives under the Quality Council
Quality Council
I know how I can
play an active role in
quality & patient
safety now.
Thank you for
listening to my
story!
Today, Cathy has developed a passion for quality and patient safety. She attended various training, such as the IMH patient
safety training, NHG Root Cause Analysis training, etc. and sits on various quality committees & workgroups that report
to the Quality Council.
She is also coaching and inspiring her colleagues on quality & patient safety.
Quality Care Through Partnerships 2016 IMH Quality Day Video on Improvement Projects
Thank You
Clinical Indicators Benchmarking Partners Psychiatric Electronic Clinical Observation (PECO), Japan
•Attempted suicide
•Completed suicide
•Mean GAS (discharge – admission) for schizophrenia patients
•% tertiary patients
•Readmission rate (all acute patients)
•ALOS (all acute patients)
•Restraint hours per 1000 patient hours
UPC KU Leuven, Belgium
•Number of patient days, admissions and beds in service
•Completed suicide
•% Time-out compliance
•Hand rub consumption
•Hand hygiene compliance rate
• Fall with injury rate
•Number of reported aggression incidents
Organisation for Economic Co-operation and Development (OECD)
• Same hospital readmissions within 30 days among schizophrenia patients
• Inpatient suicide rate among patients diagnosed with mental disorder
•ALOS (mental and behavioural disorders)