An advance in clinical excellence in NSW

I neglected to reference this excellent paper in the BMJ from a few months ago by Karen Luxford and Stephanie Newell.  Thanks to Marie Bismark for the reminder. Here's the introduction and an excerpt:

The principles of patient centred care and the mantra of “nothing about me without me”1 have gained broad support, but its proving hard to adopt and embed them in routine practice. New ways of thinking and tackling resistance to change are needed, and a range of initiatives are being pursued. We describe the approach being taken in New South Wales, Australia’s most populous state, with 7.4 million residents and 1.66 million public hospital admissions a year. This has focused on the development of a “patient based care challenge” aimed at spurring system-wide integrated change to promote patient centred care. The term patient based care was introduced with the aim of making patient centred care more broadly recognised as everyone’s responsibility—from the executive through to frontline clinicians and staff—with care systems included as well as bedside care. We discuss how the health districts have responded to this challenge.

The Clinical Excellence Commission was set up in 2004 to promote and support improved clinical care, safety, and quality across New South Wales. The commission monitors state-wide incident reporting and implements quality improvement initiatives to address key safety and quality problems identified. In 2010, a consumer adviser panel was established to actively involve patients, carers, and community members in all aspects of the commission’s work. In 2011 the commission developed a “patient based care challenge” for district healthcare services in collaboration with a partnering with patients advisory committee, which comprised patients, clinicians, managers, and policy makers. Patients and families highlighted the importance of engaging with patients in care at the bedside but also in health service governance and strategic decision making. 

The 26 strategies included were grouped under nine domains drawn from evidence of effective strategies used by leading patient based health services. Although some strategies are specific to hospital settings, most can be used across a range of healthcare settings. We framed the overall strategy as a challenge to health services to reflect the difficulties of making system-wide change and to infuse a competitive aspect into the process.

Thirteen of 15 local health districts committed to the challenge in the first year. The two remaining districts wanted to complete new district-wide strategic plans before committing. Most districts focused on two or three strategies, although six adopted more than three. The most common initial strategies selected were: start each board meeting with a story of patient care from your service (six districts), arrange for board and executive members to visit wards regularly (five), involve patients, families, and carers in governance through participation in committees (five); encourage staff to view patients, family, and carers as core members of the healthcare team (four); and implement processes to support patient or family activated escalation of care for deteriorating patients (two). By October 2014, the 13 districts had adopted an average of 19 (range 13-25) strategies.