1. health.wa.gov.au
Strategies to engage medical workforce for
quality improvement
Catherine Li1
, Greg Sweetman1
1
Safety, Quality and Risk Department, Fiona Stanley Hospital, Perth, 1
Department of Medical Education, Fiona Stanley Hospital, Perth
Email: Catherine.Li@health.wa.gov.au
FSHM20161018003
3-E Model to develop capacity, capability and culture in improvement
Methodology (guiding principles)
Introduction
Medical engagement is critical to organisational performance. The changing nature of the medical profession and growing desire by medical students and trainee doctors to engage in clinical audit and quality improvement (QI) provides an excellent opportunity for medical officers from all levels to
participate into the improvement process, create opportunities for open and transparent dialogue about patient safety, quality and clinical practice, and leverage available resources for clinical auditing.
» Motivations
» Goals &
objectives
» Values & benefits
» Ownership
» Appreciate
diversity
» Build on existing
knowledge &
skills
» Authentic support
» Education &
training
» Internal & external
opportunities
» Collaborations
» Information &
knowledge sharing
» System
approach for QI
» Understanding
variation
» Knowledge
in specialties,
ability to predict
» Psychology-
strategies to
overcome
common barriers
in QI
» Culture of QI
Engaging
Enhancing
Embedding
(4 QI components by
Mr Deming)
3-E Model by Catherine Li, Performance Review and Audit Coordinator, FSH, WA
by Catherine Li, Performance Review and Audit Coordinator, FSH, WA
Key strategies Outcomes
• Over 180 medical staff received training and support for QI
• 217 QI submissions made by medical staff in 18 months, represent approximate 33%
submissions across the entire organisation. 24% indicated for future publication.
Improvement examples
• Proportion of patients with a hip fracture receiving surgery on or the day after presentation with
hip fracture: improved from 82% to 96%.
• Electronic standardised handover tool implemented to facilitate effective and efficient handover
between medical staff in ICU.
• Screening tool for delirium and cognitive impairment trialled and used to enhance patient safety.
• Baseline data on identifying healthcare providers’ perspective on the barriers to advanced care
planning in WA hospitals.
• Baseline survey on patients’ perception on quality of Anaesthesia.
Conclusion
Clear value streams and identification of clinical audit initiatives together with a
collaborative partnership with the SQR department are the key ingredients for medical
officer engagement in QI.
Nursing & Midwifery
Medical
Allied Health
Pharmacy
Other
Nursing and Midwifery
46%Medical
33%
Allied Health
9%
Other
7%
Pharmacy
5%
0%
20%
40%
60%
80%
100%
120%
Quality of submissions by medical staff (n=40 completed activities)
98%
93%
98%
93% 93% 93%
63%
90%
65%
30%
53% 53%
Collaboration between SQR
and Medical Education
Identifiable quality
management infrastructure
Collaborate with external
agencies
Education and training
Presentation opportunities
• Tailored clinical audit programs available for all junior medical officers (JMO).
• Identified medical champions / superviors for each audit topic.
• Linkage between department needs and JMOs’ interest / career aspiration.
• Accessible, ownership and autonomy
• Open and transparent decision making process
• Mechanisms to identify accountabilities and responsibilities
• Information and knowledge sharing
• Provide clinical audit opportunities for medical students
• Institute of Healthcare Leadership Medical Service Improvement program
• Authentic support: eliminate interdepartment barriers by simplifying related
governance processes.
• Early engagement of key stakeholders.
• Accessible tailored resources for QI
• Departmental opportunities: audit / committee meetings
• Organisation wide opportunities: annual IMPROVE conference
• Open up dialogues for discussions, incentives and raise the profile of quality
activities