There were seven priority areas for the new Community Health Organisations (CHOs), Ms. Martina Queally, Chief Officer, Community Healthcare Organisation Dublin South East/Wicklow, told the Conference.
These were the development of governance structures within the CHOs, continuing to engage with service users and developing models for integration, staff engagement, development and resource planning, developing capacity to monitor and measure results, developing and improving the physical clinical environment, learning from reflecting on practice and sharing experience and integration.
The development of governance structure within the CHOs included the development of management structures and defining roles and responsibilities, establishing Primary Care Team and network governance model structures for quality management, developing leadership capacity at all levels and continuing to develop systems for quality improvement and risk management.
High quality healthcare had to be safe, effective, efficient, patient centred, equitable, and integrated and promote health. High quality care would not be achieved by focusing on one or two aspects, but had to encompass all aspects with equal importance being placed on each.
Ms. Queally said the Board of the provider organisation was responsible for the quality of care delivered across all the services. Quality governance referred to the values, behaviours, structures and processes that needed to be in place to enable a board to delegate levels of responsibility in order to discharge its responsibility for quality. “Many of our services are provided through other agencies but there is equal responsibility to assure the governance of agencies which we fund.”
“Many of our services are provided through other agencies but there is equal responsibility to assure the governance of agencies which we fund.”
She said the Board and executives should hear directly of client and patient experiences, quality and safety should be on every agenda and understanding required measurement.
“It can be difficult for clients to give us feedback because they may have become ‘good patients’. It is important that we listen to our clients and patients and let them know we want their views.”
There were a number of health advocacy services in place and a national patient survey was being developed.
The guiding principles of quality and patient safety were putting the patient first, safety, personal responsibility, defined authority, clear accountability, leadership, multidisciplinary working, supporting performance, an open culture and continuing quality improvement.
The accountability framework was important in making explicit the responsibility of managers, setting clear targets, monitoring them and arranging escalation if they were not met.
Turning to integrated corporate and clinical governance, she said The Secretary of State for Health, England, 2010 said ‘The main lesson I take from the problems at Mid-Staffs is that in future we must never separate quality and financial data. They are two sides of the one coin.’
A CHO Risk Register was also in place with a reporting process from each care division regarding their local risk registers.
The National Risk and Incident Management System had planned and systematic approach to identifying, evaluating and responding to risk. It provided assurances that responses were effective, it consisted of proactive and reactive components, Proactive components included activities to prevent adverse impacts and reactive components included actions in response to adverse events.
Ms. Queally said that in 2014 all CHOs implemented the HSE Safety Incident Management Policy and Guidelines and a robust reporting and monitoring process was in place in respect of serious incidents. A CHO Risk Register was also in place with a reporting process from each care division regarding their local risk registers. A Quality and Patient Safety Committee had been established and training provided in the area of serious incident management and system analysis investigations and this continued to be rolled out.
“Enlightened employers know that investing in the wellbeing of their staff is money well spent. The 7.1% response rate to the first HSE employees survey was very disappointing but we are told it is statistically representative, but we should be listening to what our staff tell us whether it is statistically representative or not.
“The HSE employee survey had shown that 89% of staff felt that their role made a difference to patients, 86% felt they were trusted to do their job, 73% felt they had clear, planned goals and objectives for their job, 72% felt satisfied with the quality of care they gave to patients and clients, 63% considered their personal targets for their job to be realistic, 29% claimed to actually be involved in decisions that affected them in their work and 26% claimed to have all the equipment, support and resources required to do their job correctly, a level significantly below benchmarking norms.
“We have a staff that are very motivated – our staff wok really well and really hard and that is probably a unique feature of the health service. I think it is very important that they are well managed because ours is a people service, we are reliant on staff to provide the best service and it is important that we do not abuse that internal motivation that staff have.
“One of the big challenges for any CHO Chief Officer is that there aren’t four walls around us. We are trying to govern and assure quality of many services which are delivered in people’s homes or in other places. Trying to ensure you have visibility with staff and engage with them is a challenge.
“In the last five to six years, to reduce the pay bill in health, the normal yearly departure of experienced staff was accelerated, with incentivised career breaks, early retirements and the moratorium and we are still trying to pick up the pieces from that. It is probably testament to very good management that we focussed on non patient services in reducing expenditure but we do need investment in facilities which was not done over the last number of years.
“In view of the need to tackle delayed discharges and the movement of the care of chronic diseases to the community, it was crucial to address integration systems, an information base in the community and investment in facilities.”