Entries in the 15th Annual ACHS Quality Improvements Awards 2012

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Category: Non-Clinical Service DeliveryQI Award WinnerISBAR in our communication – building capacity and skill forhealthcare communicationCLINICAL GOVERNANCEHUNTER NEW ENGLAND LOCAL HEALTH DISTRICTNSWRosemary AldrichKim HillJuliana FordAnne DugganAimBy developing and implementing an innovative program implementation model for skilldevelopment we aimed to train 100% Hunter New England Health staff by 2012 to use theISBAR tool to optimise healthcare communication and prevent communication-related incidents and severe adverse eventsAbstractHunter New England Health (HNE Health) is aNSW public health organisation where morethan 15,000 staff provide primary, secondaryand tertiary services to approximately 850,000people resident in metropolitan, regional, ruraland remote centres across an area the size ofEngland. With 45 inpatient facilities, 40emergency departments (with 1,000-65,000presentations annually), networked care foralmost 3,000 inpatients effected through interhospitaltransfers where necessary, andmillions of emails, clinical and non-clinicalconversations and items of correspondenceannually, opportunities for healthcarecommunication-related incidents are limitless.In 2006 the HNE Health Director of ClinicalGovernance initiated a long-term strategy toenhance professional communication acrossall staff. Consistent with the literature, anevaluation of our incident data showed that76% of the 127 HNE Health root causeanalyses (RCAs) undertaken in 2006 citedcommunication failure as a causative factor,with devastating impacts on patients and theircarers, and on staff, risking loss of productivityand ultimately, loss of staff. Funded by theAustralian Commission on Safety and Qualityin Health Care in 2008-2009, we identified,adapted (in consultation with local clinicians),trained staff to use, and piloted the use of theISBAR (introduction, situation, background,assessment, recommendation) tool, aiming toimprove the quality of clinical handover ininter-hospital transfer. Training staff in ISBARenhanced their confidence to communicate,enhanced patient and carer perceptions of thequality of healthcare communication, andshowed potential to reduce adverse incidents.Based on this evidence in 2010 and 2011 theISBAR in our Communication program team(comprising the Director of ClinicalGovernance, the Program Leader, andProgram Implementation Manager) used aseven-element approach to promote use ofISBAR across our organisation, to optimisehealthcare communication (including for highriskprocesses such as clinical handover, theneed to escalate deteriorating patients,communication of results and communicationwith patients and carers), and preventcommunication-related adverse events. Theprogram team did not act alone:implementation was effected through strongExecutive Team leadership, support fromchampions who formed our CommunicationCoalition, and many managers and clinicianleaders who shaped the uptake of ISBARacross the organisation.15 th Annual ACHS Quality Improvement Awards 2012 Page 1 of 42
Category: Non-Clinical Service DeliveryQI Award WinnerSimultaneous attention to Leadership andgovernance, Engaging with people andprocesses, Training and education, Tools andresources, Evaluation and audit, Reportingand communication, and Sustainability (ourLETTERS model) resulted in more than 9,200staff documented as having trained to useISBAR in the year to end November 2011, atwhich time the Clinical Governance ISBARImplementation Manager concluded their role.The number of staff documented as trained inthe previous year had increased to nearly10,000 by April 2012.Our challenge was to educate an entireworkforce to address a critical skill gap,and promote a workplace culture valuingquality communication. A deliberate and broadstrategy for sustaining staff training andembedding use of ISBAR (including makingannual training mandatory, having an e-learning module, training 400 managers andsupervisors as trainers, and having an ISBARemail icon on every desktop) has turnedISBAR into a noun and a verb in ourorganisation. The format is used widely inmany settings and forms of communication,and for recording information, which in turnhas informed other quality activities. And therehave been outcomes for patient safety: usingour original methods for incident evaluation,and compared with 2006 data, in 2011 weobserved a 75% reduction in the number ofreported healthcare incidents concerningcommunication failure, a 50% reduction in theproportion of severe adverse events whichimplicated communication-failure as a rootcause (from 76% to 38%), and a 75%reduction in the absolute number (from 96 to23). Reductions in the number and severity ofadverse events have resulted from a range ofinitiatives in our organisation, of which theISBAR in our Communication program is one.Application of EQuIP PrinciplesEQuIP principle 1.A Consumer / Patient FocusCommunication failure can have catastrophicconsequences for patients and their carers(and staff), and it was to address adverseevents as a result of communication failurethat the communication strategy was initiatedin 2006 by the Director of Clinical Governance.Informed by a pilot evaluation of causes andtypes of communication-related adverseevents and complaints, in 2008-2009 weidentified, adapted and trained staff to use thestandard ISBAR format, and evaluated thecommunication experiences of patients andtheir carers before and after staff were trained(after which patients and carers rated thequality of their communication more highly,and documentation for care showedimprovement). By building on this evidence -derived from interviewing patients and carersabout their experience of healthcarecommunication - the ISBAR in ourCommunication strategy 2010-2011 was ableto deliver improved safety outcomes forconsumers and patients.Using our original methods for incidentevaluation, and compared with 2006 data, in2011 there was a 50% reduction in theproportion of severe adverse events for whichcommunication failure was a root cause (from76% to 38%). Given the reduction in thenumber of severe adverse events over thattime this meant a reduction by 75% in theabsolute number of severe adverse eventsrelated to communication-failure. That therewas no reduction in number of complaintsbetween 2006 (308) and 2011 (389) aboutaspects of communication, however,demonstrates we still have work to do toimprove the quality of healthcarecommunication with our patients and carers.We recognise that the potential exists toempower our consumers to be heard anddemand the information they seek bydeveloping consumer knowledge of the ISBARformat.EQuIP principle 2.Effective LeadershipIn response to evidence of effectiveness oftraining staff in ISBAR, in late 2009 the thenArea Executive Team supported theorganisation-wide roll-out of the program bydedicating resources for a 1FTEimplementation manager position. ClinicalGovernance had devoted the time andexpertise of the Director of ClinicalGovernance, as Executive Sponsor, and of theProgram Leader (an Associate Director ofClinical Governance) to the program and itspredecessor program (approximately 8 hoursper week) since 2008.Page 2 of 42 15 th Annual ACHS Quality Improvement Awards 2012
Page 1 and 2: I N I T I A T I V E SEntries in the
Page 3 and 4: CONTENTSIntroduction2012 QI Award W
Page 5: QI Award Winners 2012NON-CLINICAL S
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Page 33 and 34: Category: Healthcare MeasurementQI
Page 45 and 46: Category: Student AwardResultsThere
Page 47 and 48: Category: Student AwardSubmissionsT

Entries in the 15th Annual ACHS Quality Improvements Awards 2012

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