Quality in healthcare

Southern Cross Health Society is pleased to share a selection of quality initiatives which some of our Affiliated Providers are implementing. We encourage other providers to share their own initiatives to help in the development of best practice and continuous improvement in the provision of services to our members.

If you would like more information about any of the articles posted here or have your own quality initiative you would like to share please contact carol.chamley@southerncross.co.nz

MercyAscot quality initiatives

Patient surveys
MercyAscot has a well-established patient satisfaction survey process which drives quality improvement initiatives within the organisation. The current system has been in place for four years and is one of the key mechanisms to ensure patients have a voice in our service development. All patients are surveyed after their discharge from MercyAscot. The response rate has been pleasing, with an average response rate of 49% in 2013. One of the key questions we ask is ‘Would you recommend our hospital to others?’. We have seen a consistent improvement in this measure with 99% of our patients now consistently stating that they would recommend our hospital to other patients.
Noise control
 In 2013, patient feedback highlighted the need to improve noise control and reduce noise in certain circumstances. Patients are asked about the noise in their environment in the post-operative period as there is good evidence to show that recovery is aided by an environment conducive to recuperation and rehabilitation. Ward charge nurses championed the development of an initial programme called ‘Silent September’. Frontline staff identified strategies to help noise control including:
  • Wearing alternative footwear at night.
  • Offering patients ear-plugs.
  • Fast-tracking routine maintenance on door hinges/handles.
  • Conducting handovers in areas more removed from patient rooms.

This programme facilitated a sustained focus on noise control and reduction, and we saw an increased positive response in the surveys.

Patient discharge

Patients also saw room for improvement in our discharge preparation and our support in the post-discharge period. As a result we put in place two simple initiatives. The first was a post-discharge phone call made by a group of senior nurses for a general check-in with our patients, and to reduce the potential for any adverse events. The second initiative was our ‘Preparation for going home’ information which is included in the patient information booklet given to patients before admission. This information is also used as a checklist when our nursing teams discuss discharge with our patients.

Clinical pathways

MercyAscot uses a number of different clinical pathways across a range of specialties to provide a high level of care in the operative and inpatient environments.

Two very well established Orthopaedics pathways are our total hip joint replacement pathway and our total knee joint replacement pathway. These pathways provide standardised protocols and evidence-based guidance to optimise the patient experience and outcome, in the pre-operative, peri-operative and post-operative phases of care. The pathways are based on regional best practice used by the Auckland DHBs and have been developed in conjunction with surgeons working at MercyAscot. While following best practice procedures, the pathways are flexible enough to allow our medical practitioners, nursing staff and allied health staff to practice ‘personalised’ care.

We have seen a significant improvement in clinical outcomes for patients through the adoption of these pathways, largely due to a standardised, yet personalised approach. For example, the use of a progressive physiotherapy approach and early mobilisation has positively impacted length of stay and other adverse outcomes for Orthopaedic patients.

The use of evidenced-based pathways is a core component of service delivery in MercyAscot. We continue to assess the impact of our pathways on clinical outcomes, and we will research, develop (where necessary) and implement best practice pathways in conjunction with our specialists to deliver excellent outcomes for patients.

Audit programme

The MercyAscot Endoscopy clinical outcomes audit programme was established in 2003. This audit focuses on a range of clinical and patient outcomes recognised in the international endoscopy community as key quality markers with specific international benchmarking. Colonoscopy outcomes recorded include:

  • Overall procedure time.
  • Time to caecum.
  • Polyp detection rate, polyp size and polyp numbers.
  • Level of consciousness.
  • Lowest O2 saturation rates.
  • Patient discomfort levels.

A recent publication in the New Zealand Medical Journal1, showed an improvement in all of the outcome measures over the last ten years. The overall trend also showed that practitioners initially identified as ‘outliers’ in terms of their practice, changed or enhanced their practice, such that overall service delivery improved and became more standardised. For example, comparing results across practitioners for their use of analgesia and sedation agents led to a direct change in practice. This change in practice, in turn, led to increased standardisation and increased patient comfort during procedures.

External accreditation

 As well as complying with the New Zealand Ministry of Health certification audit requirements, MercyAscot has participated in an additional, external accreditation programme since its introduction to New Zealand in the late 1980s. The programme is based on the EQuIP 5 framework which is an internationally recognised quality framework in healthcare. It sets high international standards and identifies areas for improvement as we strive to meet the standards.

The programme has provided many specific areas for improvement, but one key example has been an additional focus on medication safety. MercyAscot has a robust medication safety programme in place which includes a number of initiatives such as staff education, medication reconciliation and workflow safety practices. The accreditation process highlighted an opportunity for greater visibility of these initiatives and practices across the organisation. This greater visibility has now been actioned and we will continue to focus on medication safety, always aiming to minimise the number of medication errors and any potential harm to patients from error.

MercyAscot ratings have consistently improved over the years and we currently hold a four-year full accreditation status. The auditors always comment that MercyAscot receives among the highest numbers of ‘extensive achievement’ (EA) ratings in New Zealand. At our recent 2014 interim audit we achieved 9 EA ratings out of 15 criteria.

1Fraser et al, Colonoscopy audit over 10 years – what can be learnt? New Zealand Medical Journal, September 2013. Vol 126, No. 1382.