Edwina Dunne, Director of Audit and Clinicle Assurance, HSE
Quality and Patient Safety in Irish General PracticeICGP Mallow 14 November 2012 Edwina Dunne Director Quality Patient Safety Audit Quality and Patient Safety Directorate Health Services Executive
Directorate of Quality and PatientSafetyResponsibility for: Quality improvement Risk Management Service user involvement and advocacy Management of serious adverse incidents National audit Patient safety programmes Clinical governance and clinical directors Relationship with HIQA IMC and SCA HCAI
Directorate QPS cont QPS audit to provide level 2. assurance to address the assurance ‘gap’ at corporate governance level for clinical and primary care. Controls Assurance process for CEO to sign CAS now integrated. Collaborative approach includes all services. Including SLA. Focus on Leadership &Governance
Corporate andClinical Governance “The main lesson I take form the problems at Mid- staffs is that in future, we must never separate quality and financial data. They are always two sides of the same coin.” (Secretary of State for Health, England)
The Context Primary care teams/strategy Acute hospital networks New interim HSE directorates Major chronic disease challenge Major financial challenge National standards Government policy on UHI Continuing focus on ED and OPD waits
Quality in Irish General Practice CME network Quality vocational training – big HSE investment Structured diabetes care programme ICGP Quality in Practice initiatives Out of hours cover – integrating practices Same day access, cervical screening and immunisations ICT penetration – disease registers Peer practice visits Leadership – ICGP and academia
Q+PS challenges in general practice Lack of information, benchmarking Variability Isolated GPs Lack of use of guidelines and risk assessment tools Out of Hours cover and patient info Transitions of care Medication reconciliation and prescribing errors Minority group and disability access Lack of critical incident/near-miss review
Future options to improve quality• Involve local community/patients• Real PCT development, involve pharmacy• PCT network to engage with hospital trusts – clinical leadership• Work together to manage standards burden• Audit shared across multiple practices – benchmark and share learning• Measuring performance – prescribing data: preventative inhalers, statin dosage, PPI duration, benzos and antibiotic use – CUT COSTS• Collaborative prescribing – community pharmacy partnership• ICT supported decision prompts, guidelines and risk tools
Irish general practice demonstrates high quality Central role of ICGP and clinical leaders in general practice Lack of information on clinical care process Lack of accountability for state funding Variation and outliers inevitable We need to work together to improve quality through training, evidence use and acceptable performance measurement
Where do we start? Governance and Leadership Who is accountable and responsible To whom for what? Who is the team is it really a MDT? This is not just about Standards but a change of behaviour!
Changes Changes come from small initiatives which work, initiatives when initiated become fashion. We cannot wait for the great visions from great people, we must light our own small fires in the darkness. Charles Handy
Thank you. All suggestions most welcome and if we can assist you contact : email@example.com N.D,QPS Edwina.Dunne@hse.ie QPSA Maureen.Flynn@hse.ie C.G Mary.Brown@hse.ie N.S.