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  • RMOs in Clinical Governance at Waitemata DHB

    Quality Improvement Workshop

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  • Influencing Organisational Culture to Improve Hospital Performance in Care of Patients with Acute Myocardial Infarction

    BMJ Journals

    Curry, L; Brault, M; Linnander, Erika; McNatt, Z; Brewster, A; Cherlin, E; Peterson Flieger, S; Ting, H; Bradley, E

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    BACKGROUND
    Hospital organisational culture affects patient outcomes including mortality rates for patients with acute myocardial infarction; however, little is known about whether and how culture can be positively influenced.

    METHOD
    This is a 2-year, mixed-methods interventional study in 10 US hospitals to foster improvements in five domains of organisational culture: (1) learning environment, (2) senior management support, (3) psychological safety, (4) commitment to the organisation and (5) time for improvement. Outcomes were change in culture, uptake of five strategies associated with lower risk-standardised mortality rates (RSMR) and RSMR. Measures included a validated survey at baseline and at 12 and 24 months (n=223; average response rate 88%); in-depth interviews (n=393 interviews with 197 staff); and RSMR data from the Centers for Medicare and Medicaid Services.

    RESULTS
    We observed significant changes (p<0.05) in culture between baseline and 24 months in the full sample, particularly in learning environment (p<0.001) and senior management support (p<0.001). Qualitative data indicated substantial shifts in these domains as well as psychological safety. Six of the 10 hospitals achieved substantial improvements in culture, and four made less progress. The use of evidence-based strategies also increased significantly (per hospital average of 2.4 strategies at baseline to 3.9 strategies at 24 months; p<0.05). The six hospitals that demonstrated substantial shifts in culture also experienced significantly greater reductions in RSMR than the four hospitals that did not shift culture (reduced RSMR by 1.07 percentage points vs 0.23 percentage points; p=0.03) between 2011–2014 and 2012–2015.

    CONCLUSIONS
    Investing in strategies to foster an organisational culture that supports high performance may help hospitals in their efforts to improve clinical outcomes.

    - leadership

    - quality improvement

    qualitative research

  • How Guiding Coalitions Promote Positive Culture Change in Hospitals

    BMJ Journals

    Bradley, E; Brewster, A; McNatt, Z; Linnander, E; Cherlin, E; Fosburgh, H; Ting, H; Curry, L

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    BACKGROUND
    Quality collaboratives are widely endorsed as a potentially effective method for translating and spreading best practices for acute myocardial infarction (AMI) care. Nevertheless, hospital success in improving performance through participation in collaboratives varies markedly. We sought to understand what distinguished hospitals that succeeded in shifting culture and reducing 30-day risk-standardised mortality rate (RSMR) after AMI through their participation in the Leadership Saves Lives (LSL) collaborative.

    PROCEDURES
    We conducted a longitudinal, mixed methods intervention study of 10 hospitals over a 2-year period; data included surveys of 223 individuals (response rates 83%–94% depending on wave) and 393 in-depth interviews with clinical and management staff most engaged with the LSL intervention in the 10 hospitals. We measured change in culture and RSMR, and key aspects of working related to team membership, turnover, level of participation and approaches to conflict management.

    MAIN FINDINGS
    The six hospitals that experienced substantial culture change and greater reductions in RSMR demonstrated distinctions in: (1) effective inclusion of staff from different disciplines and levels in the organisational hierarchy in the team guiding improvement efforts (referred to as the ‘guiding coalition’ in each hospital); (2) authentic participation in the work of the guiding coalition; and (3) distinct patterns of managing conflict. Guiding coalition size and turnover were not associated with success (p values>0.05). In the six hospitals that experienced substantial positive culture change, staff indicated that the LSL learnings were already being applied to other improvement efforts.

    PRINCIPAL CONCLUSIONS
    Hospitals that were most successful in a national quality collaborative to shift hospital culture and reduce RSMR showed distinct patterns in membership diversity, authentic participation and capacity for conflict management.

    - Quality improvement

    - Teams

    - Teamwork

  • 3 Ways Hospital Culture Can Save Lives (LSL) [Poster]

    Leadership Saves Lives

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    3 Ways Hospital Culture Can Save Lives [Poster]3 Ways Hospital Culture Can Save Lives

    1. Senior management support
    2. Safety to speak up
    3. Learning and problem solving

     

     

     

  • Culture Change to Save Lives (LSL) [Poster]

    Leadership Saves Lives

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    Culture Change to Save Lives [Poster]Culture Change to Save Lives

    - Create a Coalition

    - Set a Shared Goal

    - Commit to Learning

     

     

     

     

     

  • Leadership and Talent

    State Services Commission NZ

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    The State Services Commission (SSC) is putting in place a programme that is significantly changing how the State sector identifies, develops and utilises leaders and talented people from the start of their careers to their most senior levels.

    Our new talent management system will provide the tools and approaches to help leaders and people reach their full potential.

    By maximising our potential leadership and talent across the public system, we will achieve better results for New Zealanders.

    SSC is building leadership and talent across the State services by:

    • strengthening leadership across the system  
    • encouraging and supporting leaders to step into more challenging and complex roles
    • supporting the move away from a Wellington-centric view, encouraging diversity within the Public Service
    • identifying our most talented people, developing them and placing them where they are most needed. 
  • HealthCentral.nz

    New Zealand Media and Entertainment

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  • Leadership and Leadership Development in Health Care: The Evidence Base

    The King's Fund, Faculty of Medical Leadership and Management (FMLM) and the Center for Creative Leadership (CCL)

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    The key challenge facing all NHS organisations is to nurture cultures that ensure the delivery of continuously improving high quality, safe and compassionate healthcare. Leadership is the most influential factor in shaping organisational culture and so ensuring the necessary leadership behaviours, strategies and qualities are developed is fundamental. What do we really know about leadership of health services?

    The Faculty of Medical Leadership and Management (FMLM), The King’s Fund and the Center for Creative Leadership (CCL) share a commitment to evidence-based approaches to developing leadership and collectively initiated a review of the evidence by a team including clinicians, managers, psychologists, practitioners and project managers. This document summarises the evidence emerging from that review.

    The summary describes key messages from the review in relation to leadership at different levels of analysis: it includes a description of the leadership task and the most effective leadership behaviours at individual, team, board and national levels. 

  • Clinical Service Line Management in Healthcare

    Waitemata DHB and the National Institute for Health Innovation (NIHI)

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    Clinical Service Line Management in Healthcare Systems

    A Clinical Service Line is a management model which organises and markets healthcare services based on care outputs (patient centred services), as opposed to its inputs (traditional structure centred on providers of the same discipline e.g. departments of medicine, nursing, radiotherapists).

    The service line model groups together people of different professions and disciplines, who share a common purpose of producing a comprehensive set of clinical services to achieve a particular clinical output.

     

     

  • Demand Management

    Waitemata DHB and the National Institute for Health Innovation (NIHI)

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    Demand Management

    Managing the provision of hospital services by manipulating demand: reducing the inflow of patients to hospital so that the demand for specialist services reaches a stable relationship with the available supply of specialist care.

    This involves implementing models of care that will shift care along the continuum from hospital specialist care towards primary care and home/self-care.

     

     

  • EMU - A New Model of Emergency Care for the Frail & Elderly

    Waitemata DHB and the National Institute for Health Innovation (NIHI)

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    EMU – A New Model of Emergency Care for the Frail & Elderly

    An integrated, community emergency service specifically designed for elderly and frail patients, offering acute care as close to home as possible, with rapid comprehensive geriatric assessment and treatment, provision for admission of up to 72 hours, and ‘hospital at home’ nursing for patients sent home to recover.

    The EMU presents an innovative patient-centred alternative to acute hospital admission, reducing pressure on ED and inpatient beds.

     

     

  • Frail Elderly - Innovative Models of Care

    Waitemata DHB and the National Institute for Health Innovation (NIHI)

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    Frail Elderly - Innovative Models of Care

    An overview of 12 models of care for the frail elderly which encompass:

    - acute assessment
    - inpatient admission
    - discharge
    - wellness / prevention

     

     

  • Improving Inpatient Doctor-Patient Communication

    Waitemata DHB and the National Institute for Health Innovation (NIHI)

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    Improving Inpatient Doctor - Patient Communication

    Engaging patients by ensuring their concerns are heard and that they are fully informed about their management plan – i.e. what to expect during their admission, the findings from tests/interventions, and the plan for discharge - is empowering.

    Patients feel part of the medical decision-making process, and their satisfaction and trust in their providers is enhanced. People who feel respected and involved in their care have a better hospital experience and are less likely to complain, even when mistakes or unexpected adverse outcomes occur.

     

     

  • Medical Scribes

    Waitemata DHB and the National Institute for Health Innovation (NIHI)

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    Medical Scribes

    A scribe is a medical transcriptionist, hired to accompany a physician into the consultation room to transcribe all details of the patient visit into the electronic medical record in real-time, as dictated by the physician, usually via a laptop computer or tablet.

    The scribe acts as the physician's personal clerical assistant, making calls, bringing up pertinent medical history, lab and radiology results ready for the physician to review, generating referrals and e-prescriptions, acting as a chaperone for physical examinations, and assisting with discharges.

     

     

  • Multidisciplinary Cancer Clinics

    Waitemata DHB and the National Institute for Health Innovation (NIHI)

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    Multidisciplinary Cancer Clinics

    Multidisciplinary Cancer Clinics are a model of coordinated ambulatory care in which cancer patients see providers from all relevant disciplines (e.g. surgical, medical, radiation oncology) at one clinic visit, and leave the clinic with a single, coordinated treatment plan.

     

     

     

     

     

  • Project ECHO - Specialist Telehealth for Chronic Disease

    Waitemata DHB and the National Institute for Health Innovation (NIHI)

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    Project ECHO - Specialist Telehealth for Chronic Disease

    An innovative model of specialist-GP collaborative care, incorporating telehealth technology and best practice, case-based education, known as Project ECHO, expands access to specialist-level care for chronic Hepatitis C infection and a wide range of other complex, chronic disease, to underserved rural and vulnerable populations in New Mexico, USA.

     

     

     

  • Remote Home Monitoring for Chronic Conditions

    Waitemata DHB and the National Institute for Health Innovation (NIHI)

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    Remote Home Monitoring for Chronic Conditions

    Daily remote home monitoring of clinical parameters provides psychological benefit to patients with chronic illness, can improve their ability to self-manage their health, and raises health awareness and literacy levels throughout the family/whanau.

    There has been little compelling evidence however, that current home telehealth programs reduce doctors’ office visits, hospital admissions or mortality rates.

     

     

  • Health LEADS Australia: The Australian Health Leadership Framework

    HealthWorkforce Australia

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    Leadership has similarities in all industries although health is recognised for its complexity and its purposes. Health leaders strive to improve clinical and quality of life indicators, and the wellbeing of the health system. Research shows ‘the quality of health leadership directly and indirectly affects the quality of patient care and is an important factor supporting best practice.’ Leaders affect ‘people, their satisfaction, trust in management, commitment, individual and team effectiveness (and) the culture and climate of organisations. While other factors are important, leadership plays a central role in mobilising people towards a common goal.

  • Healthcare Leadership Model: The Nine Dimensions of Leadership Behaviour

    NHS Leadership Academy

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    The Healthcare Leadership Model is to help those who work in health and care to become better leaders. It is useful for everyone – whether you have formal leadership responsibility or not, if you work in a clinical or other service setting, and if you work with a team of five people or 5,000. It describes the things you can see leaders doing at work and is organised in a way that helps everyone to see how they can develop as a leader. It applies equally to the whole variety of roles and care settings that exist within health and care. 

  • Health Service Co-Design

    Waitemata DHB

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    Purpose of this guide
    This guide will help you work with patients to understand their experiences and make improvements to healthcare services. It provides a range of flexible tools for working effectively with patients in service improvement work. While the focus is on patients themselves, the tools can be equally applied to other groups such as frontline staff, family/whanau, and carers.

    Why use this guide?
    Healthcare staff have the responsibility of providing high quality, effective and safe care for patients. Yet do you really know if you are achieving that? Co-design provides you with the methods and tools not only to know how you are doing but to improve your services in such a way that really meets the needs of patients, because they have contributed to the design.

    Who this guide is for?
    This guide will be useful for any operational, clinical or quality staff who want to involve patients in improving healthcare services.

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