A Guide to the National Standards for Safer Better Healthcare - hiqa.ie

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityWhat is the Health Informationand Quality Authority?The Health Information and Quality Authority (HIQA) isan independent organisation. It has the legal power andresponsibility for improving the quality, safety and valueof health and social care in Ireland (excluding mentalhealth services)HIQA is also responsible for:n setting standardsn monitoring and inspecting servicesn providing guidance on health informationn carrying out health technology assessments.HIQA is a member of Patient Safety First – an awarenessraising initiative for healthcare organisations to declare theircommitment to patient safety. The members work towardsplaying their part in improving the safety and quality ofhealthcare services.1

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityWhat is the backgroundto this work?The Health Act 2007 gives HIQA its powers over health andsocial care services in Ireland.Under this law, the Authority is responsible (among otherthings) for developing national standards for health andsocial care services.Terms we useThe term “service user” is used throughout the standards document and this includes:n people who use healthcare servicesn their parents, guardians or carersn their nominated advocates n potential users of healthcare services. The word “service provider” refers to any person, organisation or part of an organisation delivering healthcare services. In some instances the term patient is used in the standardsdocument instead of service user where it is more appropriateto talk about a patient.2

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityWhy are these standards important?The aim of these standards is to help drive improvements inthe quality and safety of healthcare services in Ireland. Theirpurpose is to help the public, people who use healthcareservices and the people who provide them understandwhat a high quality, safe healthcare service looks like.In particular, the standards will:n make sure that service providers are accountable to thepublic, service users and those who fund themn help the people in charge of services identify what they aredoing well, and where they need to improven help make sure that the quality and safety of services is thesame no matter where people live in Ireland or what healthservice they use – no matter where the service is, it shouldbe safen descibe what should be in place for day-to-day servicesto be safe and effective..3

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityThe National Standards for Safer BetterHealthcare have been designed so that they canbe used in all healthcare services, settings andlocations and so that a variety of healthcare serviceproviders can use them to improve the quality andsafety of the care they provide.Under current law, all healthcare services provided by or onbehalf of the HSE (excluding mental health) will be monitoredto make sure they are following these standards. Thisincludes, but is not limited to, hospital care, ambulanceservices, community care and primary care.Having been approved by the Minister for Health, theseNational Standards take immediate effect under the HealthAct 2007. In the future, it is intended that service providerswill require a licence in order to provide healthcare servicesand these standards will be used as the basis for licensing.4

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityHIQA reviewed these submissions and used the informationto inform the development of the final standards. A summaryand analysis of the submissions received is available as aStatement of Outcomes on our website www.hiqa.ie.How are the standards structured?The standards are grouped according to 8 themes as follows:n person-centred care and supportn effective care and supportn safe care and supportn better health and wellbeingn leadership, governance and managementn workforcen use of resourcesn use of information.6

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityThe StandardsEach standard describes the outcome required to contribute toquality and safety of healthcare.The standards are set out in the following pages and there arealso examples of what this means for you as a service user.Figure 1: Themes for Quality and Safety7

National Standards for Safer Better Healthcare - Health Information and Quality Authority1Theme 1Person-Centred Care and SupportHealthcare should respect the values and dignity of its serviceusers and be responsive to their rights and needs. The wishesand needs of each individual should also be balanced withthose of other service users. In a person-centred service,providers listen to all their service users and support them toplay a part in their own care and have a say in how the serviceis run. Healthcare service providers should focus their work onthe needs and preferences of service users rather than onwhat is convenient for the service provider.8

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityThe Standards for Person-CentredCare and Support11.1 The planning, design and delivery of services areinformed by services users’ identified needsand preferences.1.2 Service users have equitable access to healthcareservices based on their assessed needs.1.3 Service users experience healthcare which respectstheir diversity and protects their rights.1.4 Service users are enabled to participate in makinginformed decisions about their care.1.5 Service users’ informed consent to care and treatmentis obtained in accordance with legislation and bestavailable evidence.1.6 Service users’ dignity, privacy and autonomy arerespected and promoted.1.7 Service providers promote a culture of kindness,consideration and respect.1.8 Service users’ complaints and concerns are respondedto promptly, openly and effectively with clearcommunication and support provided throughoutthis process.1.9 Service users are supported in maintaining and improvingtheir own health and wellbeing.9

National Standards for Safer Better Healthcare - Health Information and Quality Authority1Examples of what this means foryou as a service user when thisstandard is met:nnnnnnnnyour healthcare professional decides your healthcareneeds in partnership with youyour access to healthcare is not affected by your age,gender, sexual orientation, disability, marital status, familystatus, race, religious belief or membership of theTraveller Communityyou receive information about the risks and benefits ofyour care and treatment as well as other options thatmay be available to you to help you decide if you wouldlike to go ahead with the care and treatmentyou are given time to think about any decisions that youmay need to make about your care and treatment(except in an emergency where this may not alwaysbe possible)your personal information is protected and is onlydiscussed, with your consent, with those involvedwith your treatmentthe care you receive respects your dignity andindependenceyour complaints and concerns are listened to andresponded to in a timely manneryou receive advice and information to help identifyopportunities for you that may lead to a healthierlifestyle.10

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityThe Standards for Effective Careand Support22.1 Healthcare reflects national and international evidenceof what is known to achieve best outcomes forservice users.2.2 Care is planned and delivered to meet the individualservice user’s initial and ongoing assessed healthcareneeds, while taking account of the needs of otherservice users.2.3 Service users receive integrated care which iscoordinated effectively within and between services.2.4 An identified healthcare professional has overallresponsibility and accountability for a service user’s careduring an episode of care.2.5 All information necessary to support the provision ofeffective care, including information provided by theservice user, is available at the point of clinical decisionmaking.2.6 Care is provided through a model of service designed todeliver high quality, safe and reliable healthcare.2.7 Healthcare is provided in a physical environment whichsupports the delivery of high quality, safe, reliable careand protects the health and welfare of service users.2.8 The effectiveness of healthcare is systematicallymonitored, evaluated and continuously improved.12

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityExamples of what this means for you:nnnnnnndecisions about your healthcare are based on yourhealthcare needs using evidence from Ireland and othercountries, while taking into account the needs of otherservice usersyou are involved in making decisions about yourhealthcare and treatmentyou can expect to receive safe and coordinated carewhen you are receiving care from more than onehealthcare professional, or when you move betweendifferent services, such as when your GP refers you to ahospital for further care or treatmentyou will know the name of the person who is in chargeof your care at all timesyou can expect that the healthcare professionals whocare for you can access all the relevant information thatthey need to make decisions with you about your careand treatmentservice users receive healthcare in surroundings that arelaid out in a way that is easy for service users to enterand get around safelythe service you attend regularly checks how well it isdoing in providing safe, high quality care.213

National Standards for Safer Better Healthcare - Health Information and Quality Authority3Theme 3Safe Care and SupportSafe care and support recognises that the safety of serviceusers is of the highest importance and that everyone workingwithin healthcare services has a role and responsibility indelivering a safe high quality service. However, providinghealthcare and support can never be completely risk-free.Service providers must have systems in place to identify,prevent or minimise unnecessary or potential harm associatedwith the provision of care and support to service users. Aservice focused on safe care and support is always looking forways to be more reliable and to improve the quality and safetyof the service it delivers. Such a service learns from situationswhere things have gone wrong and makes changes to theservice it provides as a result.14

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityThe Standards for Safe Careand Support3.1 Service providers protect service users from the risk ofharm associated with the design and delivery ofhealthcare services.3.2 Service providers monitor and learn from informationrelevant to the provision of safe services and activelypromote learning both internally and externally.33.3 Service providers effectively identify, manage, respondto and report on patient-safety incidents.3.4 Service providers ensure all reasonable measures aretaken to protect service users from abuse.3.5 Service providers fully and openly inform and supportservice users as soon as possible after an adverse eventaffecting them has occurred, or becomes known andcontinue to provide information and support as needed.3.6 Service providers actively support and promote thesafety of service users as part of a wider culture ofquality and safety.3.7 Service providers implement, evaluate and publicly reporton a structured patient-safety improvement programme.15

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityExamples of what this means for you:3nnnnnnnthe service is always looking for ways to make yourhealthcare saferif things go wrong while healthcare is being delivered,the service learns from what has happened and makeschanges to reduce the likelihood of the same thinghappening againthe service has plans in place to help it recognise whenthere is a possible risk of harm to service users. Thisallows service providers to respond quickly to thesepossible risksthe service takes necessary steps to protect you fromdifferent types of abuse, such as theft or physical abuse,when you are receiving healthcareif something does go wrong in your care, the service willbe open and honest with you as soon as possible afterthe event has been identifiedif something does go wrong while you are receiving care,– this can be called an adverse event – the service willinvestigate what happened and will involve you in theinvestigation to make sure they understand what issuesyou would like addressed during this investigationthe people working in your healthcare service are allworking together to make sure that the service youreceive is safe and of high quality.16

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityTheme 4Better Health and WellbeingA service focused on better health and wellbeing is one whichconstantly looks for ways and opportunities to promote,maintain and improve the health and wellbeing of its serviceusers. The improvement of the health and wellbeing of serviceusers is not the sole responsibility of service users or serviceproviders, rather they work together to achieve this outcomeand service users are supported to make decisions.417

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityThe Standards for Better Healthand Wellbeing4.1 The health and wellbeing of service users are promoted,protected and improved.Examples of what this means for you:4nnnnadvice, information and support is available to help youmake choices for a healthier lifestyle and to improve yourhealth and wellbeingopportunities are available for you to participate inprogrammes or initiatives to improve your healthand wellbeingservices use information about their service-userpopulation to design appropriate health promotioninitiativesall your health services work with each other and withnational and voluntary agencies to promote better healthand wellbeing for you.18

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityThe Standards for Leadership,Governance and Management5.1 Service providers have clear accountabilityarrangements to achieve the delivery of high quality,safe and reliable healthcare.5.2 Service providers have formalised governancearrangements for assuring the delivery of high quality,safe and reliable healthcare.5.3 Service providers maintain a publicly available statementof purpose that accurately describes the servicesprovided, including how and where they are provided.55.4 Service providers set clear objectives and develop a clearplan for delivering high quality, safe and reliablehealthcare services.5.5 Service providers have effective managementarrangements to support and promote the deliveryof high quality, safe and reliable healthcare services.5.6 Leaders at all levels promote and strengthen a cultureof quality and safety throughout the service.5.7 Members of the workforce at all levels are enabledto exercise their personal and professional responsibilityfor the quality and safety of services provided.5.8 Service providers have systematic monitoringarrangements for identifying and acting on opportunitiesto continually improve the quality, safety and reliabilityof healthcare services.20

National Standards for Safer Better Healthcare - Health Information and Quality Authority5.9 The quality and safety of services provided on behalf ofhealthcare service providers are monitored throughformalised agreements.5.10 The conduct and provision of healthcare servicesare compliant with relevant Irish and Europeanlegislation.5.11 Service providers act on standards and alerts, and takeinto account recommendations and guidance, as formallyissued by relevant regulatory bodies as they apply totheir service.Examples of what this means for you:nnnnnyou can expect that there is an identified person who hasoverall responsibility for the quality and safety of theservice you are attending5when decisions are being made about the way theservice is delivered, the views of service users aresought and consideredservice users can easily find information about healthservices, including the different types of servicesprovided and where they provide themthe people managing your healthcare service make surethat the right staff are in place to make your care saferand betteryour healthcare service is continually looking at how itcan provide a better and safer service to you21

National Standards for Safer Better Healthcare - Health Information and Quality Authority5nnnnnservice users receive safe, high quality care andtreatment because everyone working in the healthservice has a clear understanding of what their jobinvolves and when to seek support and adviceyour service regularly checks to make sure that anyservices provided on its behalf are safe and ofhigh qualityif new laws are made, your healthcare service meets therequirements of these as soon as possibleyour service acts on any standards that are produced byregulatory bodies, such as the Health Information andQuality Authority, that are relevant to its serviceyour service works to improve the quality and safety ofits service by taking into account any recommendationsand guidance that apply to its service, which are issuedby regulatory bodies22

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityTheme 6WorkforceA service’s workforce is one of its most important resources indelivering safe, high quality care and support. It is importantthat the members of the workforce are skilled and competentto deliver quality care and support and that the workforce isplanned, structured and managed to deliver the service’squality and safety outcomes.The people working in healthcare services providing care andsupport need supervision and training to ensure they are doinga good job. As healthcare changes and develops over time,the workforce needs to be supported to continuously updateand maintain their knowledge and skills, whether they aredirectly employed or in a contractual agreement.623

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityThe Standards for Workforce6.1 Service providers plan, organise and manage theirworkforce to achieve the service objectives for highquality, safe and reliable healthcare.6.2 Service providers recruit people with the requiredcompetencies to provide high quality, safe and reliablehealthcare.6.3 Service providers ensure their workforce have thecompetencies required to deliver high quality, safe andreliable healthcare.6.4 Service providers support their workforce in deliveringhigh quality, safe and reliable healthcare.624

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityExamples of what this means for you:nnnnnnnservice providers plan and organise their services toensure there are enough staff with the necessaryqualifications, skills and experience to deliver safe highquality care to service users at all timesthe service makes sure that, where it is necessary,healthcare professionals are registered with theirprofessional body. For example, all doctors are registeredwith the Medical Council and all nurses and midwives areregistered with An Bord Altranaisyou can expect that everybody providing your healthcareregularly receives the necessary training to keep theirskills and knowledge up to dateeverybody working in a service knows how to getsupport and advice when they need it so they can delivera high quality safe servicethe service asks service users how they were treated bystaff in the service and uses this information to improveall service users’ experience6the people who work in the service are supported bythose in charge of the service to provide high quality,safe careif a service provider is concerned about the work of anyof their healthcare professionals, they take thenecessary actions to protect service users.25

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityTheme 7Use of ResourcesThe way resources are planned, managed and delivered are animportant part of delivering safe and high quality care andsupport. Resources include human, physical, financial andnatural resources. Service providers use the resourcesavailable to them to deliver the best possible health outcomesfor service users. The resources available for healthcare arefinite, whether publicly or privately funded. Improving thequality and safety of care requires making the best use of theresources available, not necessarily using more resources.A well-run service knows how it is using its resources, and, asnew evidence and technologies emerge, continuously seeksopportunities to provide better care with the same or fewerresources. Service providers maintain the quality of the carethey provide at all times, even when they are managing fewerresources or when they are looking for ways to make the carethey provide more efficient.726

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityThe Standards for Use of Resources7.1 Service providers plan and manage the use of resourcesto deliver high quality, safe and reliable healthcareefficiently and sustainably.7.2 Service providers have arrangements in place toachieve best possible quality and safety outcomes forservice users for the money and resources used.Examples of what this means for you:nnnnyou can be confident that the healthcare service ismaking the best use of its available resources, includingthe people who work in the service, when caring for youthe decisions on how services use their money areinformed by their service users’ viewsyour healthcare service regularly checks that it is usingthe resources it has available to get the best possibleresults for their service usersthe service gets best value for money when buyingnew goods or services.727

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityTheme 8Use of InformationHigh quality, safe and reliable healthcare is informed by anduses all types of information. Information is an importantresource for service providers in planning, managing,delivering and monitoring high quality, safe services. Highquality information is accurate, valid, reliable, timely, relevant,legible and complete. It is important that service providershave systems in place, including information andcommunications technology, to help them ensure that theinformation that they collect and report is high qualityinformation. When information is shared between services,service providers protect and manage personal information ina sensitive and responsible manner.828

National Standards for Safer Better Healthcare - Health Information and Quality AuthorityThe Standards for Use of Information8.1 Service providers use information as a resource inplanning, delivering, managing and improving the quality,safety and reliability of healthcare.8.2 Service providers have effective arrangements in placefor information governance.8.3 Service providers have effective arrangements for themanagement of healthcare records.Examples of what this means for you:nnnnnnnhealthcare professionals will have access to, and use,good quality information when making decisions withyou about your healthcareyou can expect that necessary information is shared, in atimely manner, while respecting your privacy, betweenhealthcare professionals involved in providing your healthcareyour healthcare information is available to all relevanthealthcare professionals looking after you so that you donot have to repeat your medical historyyou can expect that your rights to privacy and confidentialityare respected when your information is being sharedyour personal information will not be used for otherpurposes, such as research, without your permissionyou can expect that people working in the healthcareservice will record information about you accuratelyyou can expect that your healthcare service will keepyour healthcare records safe and up to date.829

For further information please contact:Health Information and Quality Authority,George’s Court, George’s Lane, Dublin 7Phone: +353 (0)1 814 7400Email: info@hiqa.ieURL: www.hiqa.iePublished by the Health Information and Quality Authority© Health Information and Quality Authority 2012