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Falls management and prevention is often described as a wicked problem. There are so many variables at play; consumer risk appetite and independence, staffing issues, technology and frailty, just to name a few. Endless breakthrough collaboratives, studies and improvement projects have addressed the issue. Whilst individual organisations may have experienced some success, falls remain a key cause of consumer harm across health and aged care.
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In this Lightbulb Moment webinar, Dr Cathy Balding spoke with experienced safety and quality practitioner Cathy Jones about her first safety and quality "ah-ha!" moment about quality plans. They explored the ‘when, what and why’ of Cathy Jones’ lightbulb moment.
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).
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.
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.
Three short videos from Dr Cathy Balding about how to be a more effective quality improvement professional.
As part of their work to reduce healthcare variation, the Australian Commission on Safety and Quality in Healthcare provides a range of case studies that demonstrate how unwarranted clinical variation can be successfully addressed.
The public expects to receive care of the same quality whenever and wherever they receive it. Yet, research shows that care organisations do not function in the same way on each day of the week, or during the night compared with daytime hours. This ‘patterned organisation of time’, known as ‘temporal structuring’, has been explored in studies relating to seven-day-a-week services, with the ‘weekend effect’ impact on outcomes of those admitted on weekends, as one example.
This tool provides a ‘ready reckoner’ for boards wanting to test if they’re focused on the right things to support quality care.
The tools provide audits and information for assessing the quality of end-of-life care to support care process improvement.
