Guy Peacock - Southern Adelaide Local Health Network - The Basic Physician Trainee Clinical Audit Program: Imbedding Clinical Audit and Quality Improvement within the Physicians Psyche
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Guy Peacock - Southern Adelaide Local Health Network - The Basic Physician Trainee Clinical Audit Program: Imbedding Clinical Audit and Quality Improvement within the Physicians Psyche

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Guy Peacock delivered the presentation at the 2014 Clinical Audit Improvement Conference. ...

Guy Peacock delivered the presentation at the 2014 Clinical Audit Improvement Conference.

The Clinical Audit Improvement Conference explored the role of clinical audit in the new era of National Care Standards.

For more information about the event, please visit: http://bit.ly/clinicalaudit14

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  • 1. The Basic Physician Trainee Clinical Audit Program: Embedding Clinical Audit and Quality Improvement within the Physicians Psyche Guy Peacock Quality & Improvement Manager Division of Medicine & Critical Care Southern Adelaide Local Health Network
  • 2. Southern Adelaide Local Health Network It is not a matter of willpower, but rather the facilitation of a readiness to fully embrace the notion of change.
  • 3. Southern Adelaide Local Health Network
  • 4. Southern Adelaide Local Health Network Southern Adelaide Local Health Network >Population demographics •Primary population:>350,000 •Subsidiary population:>173,000 •Tertiary referral scope:South Australia & Northern Territory >Cultural diversity •Residents born overseas:68,000 (8%) •Indigenous residents: 2,700 people (<1%) >Age profiles •People >65 years:52,500 (15%) •Children and young people:112,000 (32%) •Adults of working age:185,500 (53%)
  • 5. Southern Adelaide Local Health Network Southern Adelaide Local Health Network >Acute Services Structure •Flinders Medical Centre Acute Tertiary Referral Centre •Repatriation General Hospital Acute General Medical Aged Care –GEM Unit Elective Surgical Mental Health Rehabilitation Palliative Care •Noarlunga Community Hospital Emergency Acute General Medical Elective Surgical –fee for service Mental Health
  • 6. Southern Adelaide Local Health Network Division of Medicine and Critical Care >Scope:Acute and Ambulatory Care Services, Southern Adelaide Local Health Network >Staff:2,046 (1,647 FTE) >Capacity: 336 beds >Admissions:37,954 (2013/2014) >Services:Emergency Critical Care General Medical Full Sub-Specialty Medical Services >Budget: $212,000,000
  • 7. Southern Adelaide Local Health Network Basic Physician Trainee Program >Three year competitive entry program >Candidates are selected on the basis of: •Commitment •Academic and clinical history •Evidence of sound communication skills and effective team work. >Offers training and educational experience through rotations across the Network >Ensures specific RACP requirements are met >Maximises training and preparation for the RACP Physician Readiness for Expert Practice (PREP) Program
  • 8. Southern Adelaide Local Health Network Basic Physician Trainee Clinical Audit Program >February –Clinical Audit Project Information Session: •One hour lunch time session •Lunch is provided •30 minute presentation •30 minute Q&A >March –Plan Project: •Establish partnership •Identify & secure Project Supervisor •Set criteria & standards for clinical audit
  • 9. Southern Adelaide Local Health Network Basic Physician Trainee Clinical Audit Program >April –May –Initiate Audit: •Observe practice & data collection >June –Review initial data collection: •Compare actual performance against criteria & standards •Write up initial findings report >July –Initiate Change: •Agree upon changes if indicated and implement
  • 10. Southern Adelaide Local Health Network Basic Physician Trainee Clinical Audit Program >August –September –Re audit: •Re-run the initial audit to establish impact of implemented change >October –Incorporate results of second audit into report >11th October –Submit completed report to Q&I Manager >17th October –Presentations commence at Grand Round
  • 11. Southern Adelaide Local Health Network The imperative in this process is the subsequent implementation of change in order to actively facilitate clinical practice improvement based upon contextually appropriate and accurate health informatics.
  • 12. Southern Adelaide Local Health Network Team Engagement: Winning Hearts & Minds >The Circle of Safety >Engendering Trust & Cooperation •Explaining the why >The three rights •Right People •Right Time •Right Place
  • 13. Southern Adelaide Local Health Network Incentives >Opportunity to influence clinical practice >Valuable addition to personal resume >Publication >Presentation >Prize and Certificate for most outstanding project >Mandatory component of Basic Physician Trainee Program
  • 14. Southern Adelaide Local Health Network The Clinical Practice Improvement Journey Evidence for a problem worth solving Improvement Intervention Managing Change Evidence of Impact Future directions
  • 15. Southern Adelaide Local Health Network Clinical Audit: An Action Orientated Framework >Continuous Process >Quality Improvement Intervention >Managing Change >Determining Evidence of Impact
  • 16. Southern Adelaide Local Health Network Embedding Clinical Audit within the Culture of Health Care >A continuous process –not simply an accreditation stop gap >Must be established as a clear expectation not simply a preference >Focus upon audit that is within your scope of influence >Target audit that holds meaning for you >Build efficiency into your audit process
  • 17. Southern Adelaide Local Health Network Safe, Effective & Appropriate >Relentlessly and continuously pursue the reduction in the risks of injury from care, aiming for zero harm wherever and whenever possible >Ensure that every patient, every time, receives the benefits of care based soundly within the current evidence of best practice >Refrain from providing services to those who are not likely to benefit
  • 18. Southern Adelaide Local Health Network Patient Centeredness >Actively Engaging patients and families in managing their health and making decisions about their care >Honouring each individual patient and family >Offering voice, control, choice, skills in self-care, and total transparency >Readily adapting to individual and family circumstances, and to differing cultures, languages, and social backgrounds
  • 19. Southern Adelaide Local Health Network Measuring Quality >Structures •factors effecting the context of care delivery >Processes •All acts of health care delivery both technical and interpersonal >Outcomes •Outcomes are sometimes seen as the most important indicators of quality because improving patient health status is the primary goal of healthcare. However, accurately measuring outcomes that can be attributed exclusively to healthcare is very difficult Avedis Donabedian MD MPH (1919 –2000)
  • 20. Southern Adelaide Local Health Network Right Design >Is the stated objective of the clinical audit correct? •Explicit about confirming the standard of current practice relevant to the evidence of best practice •Explicit about demonstrating the impact of quality improvement interventions undertaken to address the gap between current and best practice •Clearly establish the intent of the audit in terms of how it relates to confirming or improving Quality of care
  • 21. Southern Adelaide Local Health Network Right Design >What features of Quality are to be measured by the audit? •Translate the objectives of the audit into specific aspects of patient care to be measured •Determine the standards of care that the audit will focus on •Ensure data can be accessed for each aspect of care that will be measured
  • 22. Southern Adelaide Local Health Network Right Design >Has the audit time frame been determined? •Clearly define the period of time for which the audit criteria will apply >Are the correct cases selected for audit? •Explicit inclusion and exclusion criteria must be established >How many cases should be included? •A minimum of 30 cases or 20% of total cohort, working with the larger of these two figures
  • 23. Southern Adelaide Local Health Network Right Design >How will data be collected? •Within the context of the clinical audit determine the most appropriate method of data collection: Who will collect the data Prospective or Retrospective Manual or Electronic Ensure consistency Target efficiency
  • 24. Southern Adelaide Local Health Network Right Design >Ensure data quality by ensuring alignment with the following characteristics: •Accurate •Available & Accessible •Complete •Fit for Purpose •Relevant •Reliable •Timely •Valid
  • 25. Southern Adelaide Local Health Network Quality Improvement Intervention >Make it specific •Who is involved •What do you want to accomplish •Stipulate location •Establish time frame •Identify requirements and constraints •Specify reasons, purpose or benefit of intervention
  • 26. Southern Adelaide Local Health Network Quality Improvement Intervention >Ensure it is attainable •It must be within your scope of influence >Target what is realistic •Can it be achieved within current constraints and permissible time frames? >Is it tangible to the broader team •If it is tangible to the team within daily routine there is greater potential for success •If something is tangible it will be measurable and specific
  • 27. Southern Adelaide Local Health Network “We can map new processes and systems and call it change. But if people’s behaviours have not changed much, all we have is the illusion of change” Dr Leandro Herrero MD MBA FCMI Consultant, Speaker, Author
  • 28. Southern Adelaide Local Health Network Change Management Process >Engage relevant stakeholders from the outset >Ensure transparency around the work that is being undertaken >Take your colleagues on the journey with you >Ensure relevant staff receive appropriate education prior to initiating any change >Establish a process for effective feedback to ensure problems are addressed promptly
  • 29. Southern Adelaide Local Health Network Evidence of Impact >Always re-evaluate after initiating change >Establish how long interventions should be in place before re-auditing >Modify audit criteria to ensure impact of any interventions are captured >Always duplicate the initial audit methodology to ensure comparability
  • 30. Southern Adelaide Local Health Network Secondary Gains >Movement away from a medico-centric model >Promotion of a patient centred model >Evolution of a multidisciplinary approach >Promoting transparency >Evolved sense of teamwork >Enhanced communication skills >Setting achievable goals >Knowledge of change management fundamentals >Appreciating the value of the journey
  • 31. Southern Adelaide Local Health Network Next Steps >Submission of proposed clinical audits by prospective supervisors >Predetermined list of clinical audit supervisors >Predetermined list of audit topics
  • 32. Southern Adelaide Local Health Network “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever does” Margaret Mead (1901-1978 Anthropologist