Resources

Based on a review of the literature, and interviews with experts and hospital leaders (board members, administrators, and clinical leaders), this white paper identifies strategies and practices that differentiate ineffective board quality committees from those that truly make a difference.

Care and service improvement requires the ability to make successful local change, then to transfer this for implementation in other departments and services, or across a whole organisation or sector. However, research shows that highly institutionalised and complex healthcare systems find the spread of transformation difficult, being naturally slow to adapt, innovate, and improve. Change therefore usually happens incrementally and inconsistently, with successful innovation resembling a journey rather than a single event. This is characterised by processes of adoption, implementation, sustaining, spreading, and scaling up.

Improving care and services is an ongoing challenge, but what barriers to success do the most damage? The results of this systematic review of 33 qualitative studies identify key organisational characteristics of healthcare organisations that were struggling to improve care. These organisations were characterised by below-average patient outcomes (eg. mortality) or other quality of care metrics (eg. Patient Safety Indicators).

Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumer and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis of 33 studies, the authors focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services, looking at the pros and cons and what supports success.

James Reason once characterised the goal of error investigations as ‘draining the swamp, not swatting mosquitoes’. Critical incidents arise from the interplay between active failures (eg. not double-checking for allergies before administering a medication) and latent conditions (eg. workload).

In this webinar, Prof Steve Nicholls discussed the challenges and opportunities faced in opening Australia’s first dedicated Heart Hospital, integrating clinical cardiology services, research and education to create a centre of excellence.

Start with your clinical governance framework. Dr Sue Sinni, RN, RM shared her insights and useful tools in preparing for and assessing short-notice accreditation. 

QI implementation is complex as it often spans over multiple organisational levels requiring active participation of employees and managers, and involves improvements and modifications of underlying care processes.

Many hospitals continue to use incident reporting systems (IRSs) as their primary patient safety data source. The information IRSs collect on the frequency of harm to patients [adverse events (AEs)] is generally of poor quality, and some incident types (e.g. diagnostic errors) are under-reported. Other methods of collecting patient safety information using medical record review, such as the Global Trigger Tool (GTT), have been developed. The aim of this study was to undertake a systematic review to empirically quantify the gap between the percentage of AEs detected using the GTT to those that are also detected via IRSs.

Too often, seemingly simple improvement interventions are implemented without fully considering how the intervention might achieve the desired results, whether it can cause harm, or whether a different intervention should be considered. The tendency to favour rapid solutions and implementation over longer-term analysis and measurement represents a common pitfall in quality and safety studies.