An eight point strategy which, he said, would enable health managers to develop the necessary leadership approach to drive quality improvements in healthcare in Ireland, was spelled out by Dr. Philip Crowley National Director, Quality Improvement Division, HSE, when he addressed the HMI South Forum in Erinville, South/South West Hospital Group, Western Road, Cork. Maureen Browne reports.
Centralisation of decision making power in healthcare has been seen internationally to be a failure and health managers should free the front line and distribute decision-making power to them, he said.
“Leaders should also be adaptive, set strategic goals for improvement, develop a portfolio of projects to support these goals, develop resources to the projects and assign executive sponsors and employ learning systems to raise the chance of producing the intended results.”
Speaking on Quality Improvement In Healthcare 2016, he said the challenges that faced us were demographic and chronic disease trends, access blocks at EDs and OPDs, financial constraints, medical, nursing and AHP recruitment, limited measurement of quality, negative media coverage which affected staff morale and the need to ensure integration of care.
He said quality improvement resulted in better patient outcomes and experiences of care and continued development of and support for staff.
He said at present, there continued to be a major focus in healthcare on finance and controlling staffing levels. While the recent financial settlement that provided budget for projected current service delivery costs was most welcome there can be no tolerance of any budget over-run in this new scenario.
Clinical voices were greatly outnumbered, and in general more time is spent on fire fighting at the expense of the detailed long-term exercise of process, practice and care improvement.
Dr. Crowley said that the HSE’s response was to develop a framework for improving the quality of care.
Centralisation of decision making power in healthcare has been seen internationally to be a failure and heath managers should free the front line and distribute decision-making power to them.
“The purpose of the framework is to influence and guide our thinking, planning and delivery of care in our services and to foster a culture of quality that seeks to provide safe, effective, person centered care.
“The objective of the framework is to achieve a culture of truly person centred quality care that continuously improves.”
He said that the six drivers for improvement were leadership, person and family engagement, staff engagement, use of improvement methods, measurement for improvement, and governance that puts quality at the centre of all decisions that are made.
A whole system approach was needed so that we don’t go about improving one aspect of care at the expense of undermining another. Leaders had to focus their efforts and resources towards listening to frontline staff who are the only people who know how to improve their own work experience and thus in turn patient care
Dr. Crowley said that the role of the Quality Improvement Division was to champion consistent leadership for improving quality, give a greater visibility to quality improvement initiatives, encourage and spur others to quality improvement, build capacity for leadership and quality improvement through training programmes and education events, work with people across the system – patients, clinicians, managers, national bodies to advise and support improvement and share new ideas, test and develop ideas in practice and support the spread of sustainable solutions.
He advised managers: “Assume that front-line staff are as smart as you are, as dedicated to patients as you are, as hard-working as you are, as motivated as you are and that they are the only ones with fundamental knowledge of how the front-line process actually works. However, they usually don’t control the system that sets the context within which they work.”
He said that an Adaptive Leadership Framework should protect voices of leadership without authority, give cover to those who asked the taboo questions, because they provoke new thinking.
“Leaders must stay in touch with operational realities, and break down barriers to implementation of vital safety practices
“Staff engagement is vital and the evidence is that it results in more discretionary effort, more engaged staff, with better patient outcomes and lower rates of harm.”