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)