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Quality & Safety - Sharing Our Learning

A column by Maureen Flynn

The ‘Report of the Quality and Safety Clinical Governance Development Initiative – Sharing our Learning’, was published by the HSE this year on May 6. This report presents an overview of the quality and safety clinical governance development initiatives.

The main purpose of the report is to consolidate and share learning. The clinical governance development initiative involved three phases:

  1. Developing resources for practice: Eight resource documents were developed and tested in use. A wide range of advice was provided to services, associations and interest groups on incorporating the principles for quality and safety within structures, process policies procedures and guidelines
  2. Implementation in practice – focused projects: Five hospital action projects and two primary care teams (primary care projects in progress). Detailed support was provided in these demonstration sites to embed the governance of care quality and patient safety in their management processes
  3. Evaluation and sharing learning: A thematic analysis of the data gathered for the evaluation was used to identify the learning and inform the development of key recommendations.

The report shows the role that clear managerial leadership plays in making quality and safety the number one priority. This leadership should be built on a model where the CEO, general manager, or equivalent person, works in partnership with the clinical director, director of nursing/ midwifery and service or professional leads in matters related to the quality and safety of services provided.

Some of the insights contained in the report are:

  • Active listening with patients and staff – understanding the experience of patients (what matters to them) and what motivates staff – is central in creating a quality culture
  • Real-time measurement prompts wise decisions that lead to the need for good quality data and transparency
  • Terminology matters in avoiding confusion – the term ‘clinical governance’ was seen by some as ‘management speak’, therefore, we are proposing the term ‘quality and safety’ and specifically ‘governance for quality and safety’ instead.

The single most important obligation for any health system is patient safety and improving the quality of care. Informed by the learning from this initiative, a number of recommendations are provided to guide and support health service providers to inform their own specific action plans. These are:

  • Establish a quality and safety committee of the board or community healthcare organisation with responsibility for overseeing and seeking assurance (through clear data analysis), on the quality and safety of services provided
  • Establish a quality and safety executive committee with responsibility for implementing quality and safety arrangements on behalf of the executive management team
  • Make quality and safety a standing item on the agendas of board and community healthcare organisations and all executive management teams, where clinical outcomes data and the profile of quality of care are examined
  • Develop a mechanism for the board or community healthcare organisation to hear directly about patient and staff experiences
  • Value, listen and engage with patients in identifying and acting on suggestions to improve their experience of care as well as overall service improvements
  • Value, listen, and engage with staff in identifying and acting on suggestions for quality improvement including improving their work experience
  • Ensure senior management job descriptions include accountability for quality and safety for staff and patients
  • Invest time to support clinicians and managers as a team in understanding and enacting their leadership role for quality and safety
  • Make local quality and safety data transparent to staff and the public
  • Provide ICT infrastructure, including an integrated quality management system for document control and retrieval (eg. policy, procedures, protocols and guidelines) which are easily accessible by staff.

Opportunity to use the resources
The report has value for nurses, midwives, healthcare providers and policy makers. You might discuss one of the recommendations or resources with your colleagues and look for ways to use it in your own practice setting. The report and resources are available at: www.hse.ie/go/clinicalgovernance

Any feedback on your experience of the resources and how they might be improved is welcomed.

For more information, please email: maureen.flynn@hse.ie or thora.burgess@hse.ie

Maureen Flynn is the director of nursing (national lead for quality and safety governance development) at the Office of the Nursing and Midwifery Services Director, Quality and Patient Safety Division HSE

With special thanks to the working group, steering group, international reference panel and the colleges and associations for preparing and endorsing our approach. Thanks also to the many nurses and midwives that contributed by sharing their experiences.

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