The HSE National Quality and Patient Safety Directorate (NQPSD) has resources, tools and learning programmes, with practical support and clinical expertise ready to help healthcare staff to protect and improve quality and patient safety within their services, the Directorate’s new National Clinical Director, Dr Orla Healy, told a HMI East regional seminar. Maureen Browne reports.
In a wide ranging, participative discussion, she emphasised the importance of patient safety culture, which she said in the first instance, was about psychological safety and creating an environment that fosters freedom and confidence for people to speak up when things go wrong or were not quite right, having a culture whereby incidents are reported, reviewed and the subsequent learning disseminated. “The Directorate takes learning from across service provides and shares that learning and improvement. It is also up to me as a clinical leader and you as operational managers to build resilience for patient safety within our organisations”.
Before her current appointment, Dr Healy occupied a range of senior management roles including that of Chief Operations Officer in the South/South West Hospital Group. She worked as a Specialist in Public Health Medicine for over 15 years, specialising in the area of health improvement and is Adjunct Clinical Professor in the School of Epidemiology and Public Health in UCC.
Chair of the meeting Mellany McLoone, HMI Council Member and Chief Officer of Community Healthcare Organisation Dublin North City and County welcomed everybody to the webinar and thanked Dr Healy for her support.
Dr Valerie Twomey, Brain Injury and Stroke Programmes Manager National Rehabilitation Hospital Dun Laoghaire and a member of the HMI East Regional Committee facilitated a thought provoking conversation putting participants’ questions to Dr Healy. She said she knew first-hand the support, resources and expertise available to healthcare managers from the HSE Quality and Patient Safety Directorate, having worked closely for many years with members of the team and having contributed to the development of the National Quality Improvement Toolkit. To start she asked Dr Healy to talk a little about the education, training, resources and support that the Directorate offered to support staff, patients and the wider healthcare system.
Dr Healy said the Directorate worked in partnership with HSE operations, patient partners and other internal and external partners to improve patient safety and the quality of care by building quality and patient safety capacity and capability in practice, using data to inform improvements, developing and monitoring the incident management framework and open disclosure policy and guidance and providing a platform for sharing and learning, reducing common causes of harm and enabling safe systems of care and sustainable improvements.
In line with the Patient Safety Strategy 2019-2024, the Directorate delivers on its purpose through the following teams:
- Patient Safety Programme: Overseeing and monitoring the implementation of the HSE Patient Safety Strategy.
- QPS Improvement: Using improvement methodologies to address common causes of harm.
- QPS Intelligence: Using data to inform improvements in quality and patient safety.
- QPS Incident Management: Incident Management Framework, Open Disclosure Policy and National Incident Management System. Working with stakeholders to identify, develop and share patient safety learning
- QPS Education: Enabling QPS capacity and capability in practice.
- QPS Connect: Communicating, sharing learning, making connections.
- Establishment and operation of the National Center for Clinical Audit
“My role and that of my team is to support you in both your strategic and operational leadership role, as set out in the patient safety strategy.”
Dr Healy said she was well aware how urgency could trump what was important, so much of the time. Quality and patient safety should be to the forefront at all times, if we were to deliver high quality safe patient care. “That is what operational management is about and you, as operational managers, are also leaders in quality and patient safety.
“It is important to create an environment that fosters the freedom and confidence for people to speak up when things go wrong or are not quite right and having a culture whereby incidents and near-misses are always reported. I would like you to align your strategic and operational planning to the patient safety and quality agenda. I would like you to have the patient and quality agenda in all your plans and embed it in your performance management, it can be knit into every element of your day-to-day activity. It starts with induction. There is a lot of mandatory training, that includes some elements of Quality and Patient Safety such as Open Disclosure and there is also a range of programmes that will provide people with the practical skills to support them to deliver quality and safe care. We have many of the tools needed to help people to deliver on those.
“Each of our Directorate team has a flagship project that they are delivering that will ultimately help you implementing the patient safety strategy commitments. The starting point is education. The vision for quality and patient safety education is that every staff member within the organisation would have the competence and capability, the skills and the tools in quality and patient safety appropriate to the level where they work.
“We have a number of learning programmes available to both staff and patient partners, many of which are already available on HseLand. Our programmes aim to build quality and patient safety competence incrementally, for example we offer a short ‘Introduction to Quality Improvement’module followed by a more comprehensive ‘Foundation in QI programme’ both of which are aimed at all staff.
For those who want to develop their knowledge and skills further we offer an ‘Improvement in Practice programme’ which is blended learning programme aimed at teams and for those who want to achieve an academic qualification, we offer a post-graduate Certificate in Quality and Patient Safety Improvement provided on our behalf by the RCPI. We are also increasingly focusing on human factors and Just Culture and are currently developing a number of e-learning and face to face programmes.
We have established a National Centre for Clinical Audit (NCCA), which provides training in clinical audit. The role of NCCA is to set the strategic direction of audit for this country. There is a scarcity of national clinical audit within community services so we will be working on that. We are also here to support local clinical audits by providing training and methodology necessary and to increasingly link audit to improvements.
Another flagship project we are working on is Electronic point of Occurrence (ePOE) reporting on the National Incident Management System (NIMS) system that has been rolled out in a small number of sites and many more in planning.
“A further project is to bring existing data together (statistics, reports, HIPE, HIQA) in one place to create a dashboard which will be available to you as managers and also to clinicians. It will give access to information and analysis pertinent to your service and it will create signals for quality and patient safety so that you can identify when things may be going wrong as well as when improvements are occurring. Known as Quality and Safety Signals this will enable us all to get a rounded view of a service so that we are not just seeing one incident in isolation.
“We are rolling out a national platform to share learning from incidents and other patient safety sources. The platform will be called Patient Safety Together. The platform will host information of shared learning that will be captured in safety supplements, national safety alerts, patient and staff stories and will provide a host of other resources such as a library digest and information on events and learning opportunities. It will be accessible to all.
“We also want to help people in the context of the Patient Safety Bill and all the legislative changes that are coming to continue to embed an open and transparent culture.”
“We are also working on HSE National Guidelines for post mortem examination services and the chaperone policy.
The major development is to involve patients as partners, so in each group we have at least one, but ideally two, patient partners.”
Dr Healy said the first thing in improvement is for managers to recognise the need to do so, identify major causes of harm, focus on them and tap into all the resources that were available and bring about the necessary improvements. Each major cause of harm now has an improvement programme in development. She advised people to identify areas with problems, which they dealt with on a daily basis, step outside the urgent over the important and apply the improvement methodology available to them.
“If you don’t have resources available yourself there is a network of staff trained and a network within the HSE and a variety of other places available to assist you in that regard. We too are available to help you to audit, apply patient improvement, learn from others and share your own learning. Always call out the need to identify incidents and near incidents, report them, analyse the findings learn from those findings and apply the learning.”
Dr Healy agreed that tension sometimes existed when things went wrong and staff could be traumatised. “Our sole purpose is to do our job to the best of our ability, an incident upsets everybody. I cannot overemphasise the importance of psychological safety, open disclosure, Just Patient Safety Culture and supports for patients and staff involved. The day the incident is reported is not the day this starts for staff. It starts the day the staff member joins the organisation. They need to be equipped with all the tools they need to report, to review, to learn and to deal with consequences.”
The meeting was sponsored by GSK.
National Quality and Safety Directorate Resources and Links.
1. Home page (the front door of the directorate) can be accessed here https://www.hse.ie/eng/about/who/nqpsd/
2. Our anchor for everything we do is the “Patient Safety Strategy 2019-2024” https://www.hse.ie/eng/about/who/nqpsd/patient-safety-strategy-2019-2024.pdf
3. World Patient Safety Day- two week schedule of events and links https://www.hse.ie/eng/about/who/nqpsd/patient-safety-programme/world-patient-safety-day-2022.html
4. To help teams assess their knowledge and skills for QI follow this link https://www.hse.ie/eng/about/who/nqpsd/qps-education/knowledge-and-skills-guide.html
5. Select from our Prospectus of Education and Learning Programmes https://www.hse.ie/eng/about/who/nqpsd/qps-education/prospectus-of-education-and-learning-programmes.html
6. Listen to our new Podcast Series “Walk and Talk Improvement” co-hosted with HSC QI team Northern Ireland – follow this link https://shows.acast.com/walk-and-talk-improvement
7. QI Toolkit – this toolkit contains 20 templates that you can select from and adapt to support you in undertaking a QI project https://www.hse.ie/eng/about/who/nqpsd/qps-education/quality-improvement-toolkit.html