Clinicians and Quality Transformation

8/11/2019 Clinicians and Quality Transformation

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The Role of Clinicians in

Quality Transformation

Dato Abd Jamil Abdullah

Head of Surgical ServicesMinistry of Health

Consultant Surgeon, HSNZ, Kuala Terengganu


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Traditional roles


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Traditionally

Doctors

Nurses Allied Health

PATIENT CARE

Administrators

Finance Engineers

ORGANISATIONALCARE


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Clinician participation

CEOs in highest-performing organisations

engage clinicians in dialogue and in jointproblem-solving efforts

Enhancing Engagement in Clinical Leadership, Acdemy of

Royal Medical Colleges and NHS Institute, 2007


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Clinician power

Hospitals with greatest clinician

participation in management scored 50%higher on drivers of performance than

hospitals with low levels of clinical

leadership

Pedro J Castro et al, A Healthier health care systemfor

the United Kingdom Mckinseyquarterly.com, Feb 2008


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Clinicians & Quality

Quality not in Medical School syllabus

Clinicians not formally taught leadership &

transformation skills

Doing better and process management

usually self-taught

Gold standardDouble blind controlled

trials & evidence-based medicine


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My QA journey in

KKM


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QA Workshops - 1991

QA WORKSHOP FOR MEDICAL

SUPERINTENDENTS &

COORDINATORSPort Dickson

25.02.91- 02.03.91 7 days

06.05.91- 08.05.91 5 days

NIA, H.S.A, Problem-Solving Approach


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Achievable

Benefit

Not

Achieved

(ABNA)

Avedis Donabedien


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Problem

Prioritisation

QualityAssurance

Cycle

Problem

Analysis

Quality

Assurance

Study

Identification of

Remedial

Actions

Implementation of

Remedial Actions

Re-evaluation of

the Problem

Problem

identification

Problem solv ing

approach cycle


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QA Study Tour, USA

18.10.93 - 08.12.93 2 months

New York, Baltimore, Kansas City,

Chicago, Salt Lake City, Los Angeles

Different QA approaches

No part time QA clinicians

Good non-clinical support

QA Cycle, Incident reporting, process

control


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1stNational QA Conference

Kuala Lumpur

13.12.94 - 15.12.94

Awareness of Quality Assurance


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Qa Management &

Methodology Course

27.11.95 - 30.11.95, Kuala Lumpur

Exposure to other methodologies Benchmarking, risk management

Report cards


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Other Quality Initiatives

POMR

Credentialling

TQM

ISO

Accreditation


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Quality Related Exposures

QA

Courses/Workshops

QA Conferences QA Conventions

ISQua Conferences

Travelling Fellow

ISO

Safe Surgery

TQM Accreditation

Infection Control

Strategic Planning 5S

TGP

P5VS


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Other Courses

MANAGEMENT FOR CLINICIANS,

18.03.96 - 22.03.96, Genting

MANAGEMENT FOR CLINICIANS ,

16.10.96 - 17.10.96 , Air Keroh

KKM & Manchester University

HEALTH TECHNOLOGY ASSESSMENT,

25.03.96 - 26.03.96


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CLINICAL PRACTICE GUIDELINES WORKSHOP

08.12.96 - 10.12.96

K.Lumpur

STRATEGIC MANAGEMENT by INTAN Kijal

CREDENTIALLING WORKSHOP, Kuala Lumpur

KKM, Academy of Medicine Malaysia


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MSQH Accreditation


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QA Convention

KONVESYEN QA, Kuala Terengganu

28.08.0029.08.00

Every 2 years

2013in Kota Bharu.

A result of many echo workshops

Showcase of QA efforts


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Patient Safety


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THE WHITE BOARD


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Intra-op Communications

Check-In

Intermittent report

`Shout it Out

Pre Closure

disclosure

Can westart

now?


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Intra op. communication

Shout out

One pack in !Stable,

B/P 100/60

Intermittentcommunication

Photo Credit : SSSL, H Ipoh

Hows he doing?

One pack

IN


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Pre-Closure DisclosureClosing now

Preparation of

Final swab

count

Closing sutures

Prepare reversal

Plan for the next

case


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Communication with Relatives

Informing of progress

Showing of specimen


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The operating surgeon should do

pre- & post operative visits.


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[email protected].

my 14March201130

Launching of

MOH Save Surgery Saves Lives Initiative

in Langkawi , 15thNov 2009

Officiated by Director of

Medical Development Division, MOH

Y.Bhg. Dato Dr Azmi Shapie

THE MALAYSIAN THEMESaferSurgery

Through Better Communication


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Safe Surgery Workshops

Involved all category

of OT staff

Clinician driven Can only minimise

errors


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PROBLEMS


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Surgical Error

Prevention

Capt. Stephen W. HardenBetter Teamwork. Better Systems. Better Care.


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Thoughts + Act ions +

Hab its + Charac ter =

Culture


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The Formula for Changing Culture

Thoughts w i th training

Act ions w i th system tools

Habi ts w i th leadersh ip act ions

Character

Culture


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Getting clinicians on

board


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Why Clinicians need to be in

Process owners

Role models

Natural leaders

Knowledgeable


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Advantages

People of Influence

When they know & understand quality

Understand standards

Support quality initiatives

Lead & give input

Innovate and change for the better


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Why few clinicians involved

Not sure if time is well spent

Assumption that a long learning period isrequired

More interested in scientific, clinical-relatedimprovements

No incentivesemployment, promotion,financial

Lack of opportunities for trainingin-house, abroad


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What will interest clinicians?

Work related quality

They give the input

Support to collect and analyse data

Platform to share

Incentives to go on


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SURGICAL OUTCOME AUDIT

REPORT

Standard: 3%16%

Problems with Audit:

Reporting, reliability of data collection

CLINICAL AUDIT

YEAR TOTAL CASES

COMPLICATION

RATEEL EM EL EM

2010 804 1110 3.50% 5.10%

2011 827 913 2.50% 7.30%

2012 597 1013 7.70%) 5.40%


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Reasons for failed surgery

TOTAL FAILED 2010 2011 20129

TOTAL SURGERY 4753 5267 3458


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Dr. C, Normal Vs Abnormal Finding, Apr-Jul 05

0

10

20

30

40

50

60

Apr May Jun Jul

Month

C

ases

TOTAL OGDS OGDS AB-OGDS AB-SIGM


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What role

Leader

Role model

Teacher

Enforcer

Champions

Whistleblower


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Levels of Clinical

Leadership


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Institutional Leader

CEO, DG

Clinician & Leader for organisation

Little patient contact

Able to communicate vision

Skilled in strategic thinking, succession

planning, political-savvy,

Strong negotiation skills and influence


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Service leader

Head of Specialties and services

Advocate of own service

Well connected to centres of excellence

Innovative

People and service development skills

Champion of evidence-based medicine


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Frontline leader

Outstanding clinicians

Passionate about work, respected by

collegues Can see opportunities for improvement

Understands quality improvement

techniques & tools

Team worker


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To transform

Clinicians cannot just do ONLY clinical

work day-in & day-out

Grab any opportunity to learn extra skills

Fit into whatever comfortable level of

leadership role


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Understand and involved with

Management Systems


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Clinicians must be willing to be

part of the organisations tinktank


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Involve in non-clinical training


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Getting to quality

- aware

- educate

- practice

- internalise

- incentives


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Conclusion

Clinicians MUST be involved with Quality

Initiatives

Exposure & training essential Champions will emerge to keep the flag

flying

Incentives sustain the momentum


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Quality is a

journey ,

not a destination


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Thank you

Documents

Clinicians and Quality Transformation