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Safety and Quality Strategy 2017–2020

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Our Vision

Executive Summary Gold Coast Hospital and Health Service is an academic tertiary level Hospital and Health Service

providing high levels of health and wellbeing for members of the Gold Coast community that it serves. Operating in a complex and challenging environment, we balance efficient service delivery with high quality health outcomes. Our relentless commitment to providing exceptional patient care, with empathy, compassion and dignity for all is woven into the very fabric of Gold Coast Health (GCH) and can be seen in the spirit and dedication of our Board, leaders, clinicians, staff, researchers, educators, learners and volunteers. Patient and family centred care is at the heart of Gold Coast Health’s model of care. As well as being safe and effective, our care is a mutually beneficial partnership between our patients, their families and those delivering the care service. All health care systems strive to provide safe high quality care, improvement of patient experience, reduction in inefficiencies and variations, and update practice in the light of evidence from research. Gold Coast Health subscribes to various standards to monitor these aspects of delivery. These set out common requirements for services and staff, and promote safety and continuous quality improvement. Building a safe high quality healthcare system requires all of us who work within GCH to take responsibility for our own behaviours and the actions of individuals and teams who work with us. This Gold Coast Health Safety and Quality Strategy consolidates all the activities that demonstrate to our patients, the Gold Coast community, State and Federal governments and our peers, that we are responsible for providing safe high quality healthcare. This in turn demonstrates our accountability for the care that we will provide our patients. This is our strategy for change. This is the time to mobilise our legacy, our uniqueness and our capabilities to advance our leadership through a renewed commitment to working with system partners and our community. This strategy sets the stage for Gold Coast Health to take bold, focused and deliberate action to shape the future of healthcare with our patients. We are excited to share our roadmap for the next 3 years with you and look forward to having you join us as we embark on this transformative journey.

Sincerely

Colette McCool PSM Chair, Board Safety, Quality and Clinician Engagement Committee

Professor Marianne Vonau OAM Executive Director Clinical Governance, Education and Research

Gold Coast Health will be recognised as a centre of excellence for world class healthcare

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Introduction The Gold Coast Hospital and Health Service Safety and Quality Strategy 2017-2020 is a high level road map that sets out:

• Our vision and goals for safety and quality • The framework which will strategically guide our journey towards

excellence and world class healthcare • Our safety and quality excellence targets for 2020 • Organisation-wide initiatives we will implement to achieve our goals • Enablers which will underpin the strategy framework.

This strategy is intended for all Gold Coast Health (GCH) staff. The goals, strategy framework and organisational wide initiatives are relevant to the daily work of every staff member. It is deliberately simple, holistic and adaptable to ensure our staff’s engagement in making a measurable difference to patient outcomes.

Context The Board of Gold Coast Hospital and Health Service is defining a new standard of health service delivery that will result in a healthier population and worldwide recognition as a hub of health service innovation which is set out in our Vision, Purpose and Values. This Safety and Quality Strategy directly aligns with and supports the Board’s strategic direction while fulfilling a range of statutory, State and National obligations.

Our Purpose Providing excellence in sustainable and evidence based healthcare that meets the needs of the community.

Our Values Gold Coast Health has a strong commitment to ‘living our values’. These values are reflected in everything we do and are central to our delivery of this Safety and Quality Strategy.

• Integrity – to be open and accountable to the people we serve. • Community First – to have the patient’s and community’s best interest

at heart • Excellence – to strive for outstanding performance and outcomes • Respect – to listen, value and acknowledge each other • Compassion - to treat others with understanding and sensitivity • Empower – to take ownership and enable each other to achieve more

Strategic Focus Areas This Safety and Quality Strategy sits within the Gold Coast Health Strategic Plan 2017 – 2020. The plan has three interrelated strategic focus areas:

1. Ensure patients have access to health services 2. Deliver safe, effective and efficient quality services 3. Support a healthy Gold Coast community

Defining Quality Gold Coast Health is progressing to being recognised as a centre for excellence in safety and quality. Our aspirational goals are based on the internationally recognised definition of healthcare quality developed by the Institute of Medicine. They are deliberately ambitious and will be used to underpin our journey towards excellence.

Domain Gold Coast Heath Goal

PATIENT CENTRED Patient experience exceeds expectations

SAFE Zero patient harm

TIMELY Health service is provided when it is needed

EFFECTIVE World class patient outcomes

EQUITABLE All patients have equal access to health services

EFFICIENT Reliable processes support coordinated care

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How will we achieve our quality goals? Safety and Quality Strategy Framework 2017-2020 To achieve our vision for safety and quality at Gold Coast Health, it is essential that we strategically apply a framework to enable success.

What is the Framework? The Gold Coast Health Safety and Quality Strategy Framework has been adapted from: A Framework for Safe, Reliable and Effective Care, 2017 by the Institute for Healthcare Improvement. The framework has two overarching domains; culture and learning system and contains nine interrelated and interlinked elements outlined below. Element What does success look like? 1. Engagement of Patients and Families

Patients and their families are at the centre of everything we do. The care and service they receive exceeds their expectations.

2. Safety Culture All staff feel safe and supported to raise concerns and are thanked for doing so. There is a high level of trust throughout the organisation.

3. Accountability All staff are empowered to act in ways which exemplify our values and take responsibility for their actions in fulfilling their role. Behaviours that are detrimental to our safety and organisational culture are held to account.

4. Teamwork, Communication and Collaborative Negotiation

Teams gain a genuine shared understanding and agreement on matters of importance to patients, families and colleagues.

5. Leadership Leaders facilitate and mentor teamwork, improvement, respect and psychological safety. Leadership at all levels is supported and recognised.

6. Reliability Variation in healthcare is minimised by application of best evidence and research. Principles of reliability are embedded within all improvement.

7. Continuous learning We reliably collect information from our near misses and unsafe conditions which results in early problem solving and proactive system improvements. This information is shared throughout GCH.

8. Improvement and Measurement

All staff have the knowledge, skills and are actively engaged in continuous robust improvement processes.

9. Transparency Our actions, information and performance are visible and openly shared with staff, patients, families and the community.

Why is this approach so important?

It is internationally acknowledged that health service systems can find quality improvement difficult to sustain. Program and project fatigue brought about in part from the failure to recognise the interrelated elements of the complex health service environment can be a significant issue.

The Safety and Quality Framework offers a fresh holistic approach. The Framework brings together all the elements and overarching domains that are essential to achieving safe, reliable, effective, patient centred care. It means we can more effectively plan to influence each of the nine elements of culture and learning system more strategically, in a way which recognises the effect one element has on another. It is also adaptable, enabling prioritisation of elements in order to progress in incremental steps towards safety and quality excellence.

Through specifically identifying, targeting, measuring and improving each element within the framework, we will be able to better influence meaningful, sustainable change for staff, patients, families and the community.

Our patients and families Our patients and their families are at the core of everything we do at Gold Coast Health. This is reflected in the Framework with engagement of our patients and their families the central driving force of the Safety and Quality Framework and at the very beginning of our Safety and Quality Road Map.

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Safety and Quality Strategy Framework 2017 – 2020

Adapted from: Framework for Safe,

Reliable and Effective Care Institute for Health Care Improvement 2017

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Safety and Quality Road Map to Excellence 2017 - 2020

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Culture and learning system The Safety and Quality Strategy Framework 2017- 2020 outlines the interrelated importance and influence both culture and learning systems have on our quality goals. It is critical that each domain is strategically considered and deliberate action is taken to strengthen each element within the domain. The importance of culture to facilitate long term sustainable change on our safety and quality outcomes cannot be underestimated. We need to facilitate, enable and support culture change which will result in sustainable measureable improvements in our safety & quality priority areas. There are a number of organisational wide enablers that will influence our culture and learning system to optimise quality outcomes.

Culture Gold Coast Health is committed to building a ‘Culture of Success’. We recognise the key influence that safety culture and accountability have on our safety and quality outcomes, and are implementing key initiatives to strengthen these cultural elements. A holistic accountability framework based on the Vanderbilt principles, will strengthen key strategic work within these areas. A number of major initiatives have been implemented to date, including:

• Clinician Engagement - acknowledges the valuable role that clinicians provide in the delivery of our service. Clinical teams are at the core of service delivery and have a direct influence on the reliable, safe, effective delivery of high quality healthcare.

• Speak Up for SafetyTM – promotes an environment where all staff have the shared belief that it is safe to raise questions and concerns to prevent unintended patient harm. A culture where staff feel safe and supported to speak up, and are actively encouraged and thanked for doing so.

• Core Capability Framework – which articulates the behaviours that all staff need to demonstrate to ‘live our values’. It outlines the practical road map to achieve professional excellence at all levels.

• Magnet Program - provides a framework to build supportive and enabling structures and processes with a focus on outcomes, culminating in an empowering staff culture which ultimately leads to the highest levels of safety, quality, patient and staff satisfaction.

• Relational Coordination (RC) – focuses on using the power of relationships to improve quality and efficiency outcomes. RC initiatives are designed to improve relationships between functional workgroups who work together to deliver coordinated care.

Learning The overarching learning system, within which we operate, is critical to drive the journey towards safety and quality excellence. Innovative, collaborative and globally informative translational research will be used to drive improvements in health at an individual, population and system level. Efficient transfer and application of scientific knowledge is crucial to successfully meeting the challenge of providing contemporary health and medical services. This will be achieved through:

• Embedding research as core business • Building research capacity • Providing effective governance and research support • Strengthening partnerships • Translating research to care • Continuous evaluation of patient care, outcomes and experience.

References and further reading Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service (NSQHS) Standards. https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/resources-to-implement-the-nsqhs-standards/#NSQHS-Standards

Chassin, R. & Loeb, M. High-Reliability Health Care: Getting There from Here. The Joint Commission. Milbank Quarterly, Vol.91, No. 3, 2013 (pp. 459-490)

Frankel A, Haraden C, Frederico F, Lenoci-Edwards J. A Framework for Safe, Reliable, and Effective Care. White Paper. Cambridge, MA: Institute for Healthcare Improvement and Safe & Reliable Healthcare; 2017. Gold Coast Health Clinician Engagement Strategy 2017.

Gold Coast Health Research Strategy 2014-2018.

Gold Coast Health Service Plan 2016-2026.

Gold Coast Health Strategic Plan 2016-2020.

Northern Health Education and Research Plan 2015 – 2020.

The Australian Council on Healthcare Standards (ACHS). EQuIP National Standards. http://www.achs.org.au/publications-resources/equipnational/

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