• Why do we need a national patient safety campaign?
• Who is coordinating the campaign?
• What does the campaign brand Open for better care mean?
• What is the focus of the campaign?
• What are the campaign aims and goals?
• Who is the campaign for?
• How will we know the campaign is effective?
• How will the campaign achieve change?

Why did we need a national patient safety campaign? 

New Zealand’s health and disability system already provides high standards of care very cost effectively. Health professionals have extensive knowledge, skills and commitment, and are already delivering excellent patient care.

Throughout the country, district health boards (DHBs) have in place interventions that have made a real difference to patient safety – such as programmes to reduce harm from falls, improve hand hygiene, reduce harm to surgical patients, and reduce central line associated bacteraemia (CLAB)[1].

Two other initiatives are Releasing Time to Care, which frees up nurses’ time for direct patient care, and The Productive Operating Theatre, a quality improvement programme for operating theatres.

However, we know patients are still being harmed, sometimes with serious and long-term consequences. Furthermore, some patients are not receiving the care they need, while others are receiving treatments – including medications – that are of no value to them.

The need to make changes to reduce patient harm is compelling.

• In the two years from 2010 to 2012, 170 people fell while in public hospital care and broke their hip. Among this group, 22 more people died than we would otherwise expect.
• Up to 10 percent of people admitted to hospital acquire an infection, and many of these are likely to remain in hospital longer and have a longer recovery time.
• Medication errors made up nearly 7 percent of serious harm reported by DHBs in 2013–14.
• Between 2005 and 2011, ACC accepted a total of 205 claims for retained instruments or wrong site surgery.

The campaign raised the profile of the work being done to reduce harm and improve the quality and safety of health care services. It was an exciting opportunity to make a real difference to the lives of New Zealanders. 

Who is coordinating the campaign? 

The campaign was launched on 17 May 2013 by Hon Jo Goodhew and concluded on 30 June 2016.

The campaign was coordinated nationally by the Health Quality & Safety Commission and implemented regionally by the health sector. DHBs and other providers adopted the national approach and associated resources in a way that best suited their local environment and situation. A key purpose of the campaign was to promote interventions/actions that are evidence based and proven to reduce harm and improve the quality and safety of patient care. The campaign also reduced duplication of effort and encouraged frameworks that promote a level of standardisation in regional approaches.

Each of the four regions (Northern [with First, Do No Harm], Midland, Central and South Island) established a campaign steering group for their region and worked with the Commission on campaign implementation. This approach was chosen to ensure appropriate design, sustainable change, increased capability and ongoing ownership by the sector.

A campaign advisory group made up of external experts advises on the campaign’s design and implementation.

What does the campaign brand Open for better care mean? 

The Open brand was chosen following interviews with a range of people who work in and use health services, including patients, clinicians, board members and management. Consistent feedback was that the brand must represent transparency, participation, teamwork and shared learning, as these are key to improving patient safety.

It’s about being open to:

• working in partnership with patients, consumers, families and whānau
• doing the right thing – knowing the evidence and working with patients and their families and whānau to ensure we know what matters to them
• change, improvement and innovation
• supporting an honest, transparent and respectful culture
• listening carefully and communicating clearly
• acknowledging mistakes and learning from them
• working as a team and across teams
• working across the primary and secondary sector
• using evidence-based practice
• sharing and learning from successes.

What is the focus of the campaign? 

The campaign focused on:

• falls
• healthcare associated infections (surgical site infections)
• perioperative harm
• medication safety
• clinical leadership.

It aimed to change behaviours or processes, leading to improved outcomes for patients.

International evidence shows that when the sector works together and with patients, it can reduce harm and improve patients’ safety and experiences of the health sector.

What are the campaign aims and goals? 

The campaign's overarching goal was:

To inform and mobilise the New Zealand population to ensure safety and quality improvement in health care by preventing harm, avoiding waste and getting better value from resources.

The campaign also promoted a number of generic principles, ie, the need to:

• increase patient involvement in care and quality improvement approaches
• increase capability within the health and disability workforce (and consumers) to ensure quality improvement becomes business as usual
• support and encourage respect and teamwork
• inform and mobilise the population to assist in preventing harm
• promote sharing of good practice
• support and encourage good communication.

This was broken down into quantifiable aims for each of the priority areas (see page 10 in the campaign charter).

The campaign worked to achieve its aim and generic principles via promoting and increasing awareness of the work of the four work programmes: falls, healthcare associated infections, perioperative harm and medication safety, plus clinical leadership.

For each topic the campaign promoted and supported the implementation of key, evidence-based interventions that are known to make a difference (as chosen by the programme area’s experts and advisory groups).

Who is the campaign for? 

The focus of the campaign was broad, with the call to action to everyone who works in New Zealand’s health and disability system, together with patients and their families/whānau. There are different target audiences for each focus areas.

The first topic of focus was reducing harm from falls. This topic had a wide audience – most falls occur in the community, but significant harm is caused by falls in hospitals. The focus was initially on falls in hospital, but it quickly broadened out to include aged care and community settings.

The second topic was surgical site infection. The campaign highlighted and promoted the recommended actions of the Surgical Site Infection Improvement (SSII) programme, which include:

• streamlining the SSI surveillance process
• giving patients the right antibiotic at the right time
• using appropriate skin preparations before surgery
• clipping rather than shaving the surgical site.

The third topic was reducing perioperative harm (surgical harm). The campaign promoted to the health sector evidence-based interventions that can reduce harm from operations, centring on improving teamwork and communication within surgical teams and effective use of the surgical safety checklist.

The fourth topic was medication safety, specifically reducing harm from high-risk medicines and raising awareness of the topic and challenges/opportunities across the sector. The campaign provided an opportunity for all clinicians to engage in reducing harm and error, join in webinars and share ideas and innovations. A suite of ‘one step’ interventions/activities was provided.

In April 2015 reducing harm from falls became the fifth topic. The campaign focused on the theme 'Stand up to Falls', specifically having an integrated approach to falls in older people across health and social services in all care settings. 

How will we know the campaign is effective? 

It is essential to evaluate the success of the campaign, and evaluation is integral to its design. The Commission was interested in the answers to four questions:

1. Did the desired change in safety practice occur?
2. Did a reduction in harm and cost occur?
3. How successful was the process of effecting change through the campaign?
4. Has the campaign resulted in sustainable improvement?

Measurements to answer the first two questions were provided by the quality and safety markers. These are made up of process and outcome measures. The process measures show whether the required changes in practice have been made at a local level (for example, giving older patients a falls risk assessment and developing a care plan for them). The outcome measures focus on harm and cost that can be avoided and provide information about progress against the core campaign goals of reduced harm and cost. 

The second two questions are an evaluation of the specific value added by the campaign approach. This evaluation was a separate activity, drawing on a broader range of evaluative methods including qualitative and economic evaluations. 

How did the campaign achieve change? 

The Open campaign was a call to action for all health professionals, asking them to make a commitment to a patient-centred safety campaign. It identified simple changes in practice that could make a big difference to patient safety. Tools, interventions, networks, collaborations, promotions, resources and workforce development opportunities were given to make it easier to do the right thing, and do it right first time.

 

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References:

[1]  Blood stream infections caused by the insertion of central line catheters into blood vessels near the heart.
[2]  Health Quality & Safety Commission. 2014. Making health and disability services safer: Serious adverse events reported to the Health Quality & Safety Commission 1 July 2013 to 30 June 2014. Wellington: Health Quality & Safety Commission.
[3]  De Raad, JP  (2012) Towards a value proposition… scoping the cost of falls. New Zealand Institute of Economic Research: Wellington.
[4]  Hamblin, R (2013) Working paper. Health Quality & Safety Commission: Wellington.
[5] New Zealand Health Information Service. 2002. Fractured Neck of Femur Services in New Zealand Hospitals 1999–2000. Wellington: Ministry of Health.
[6] Autier P, Haentjens P, Bentin J et al. 2000. Costs induced by hip fractures: a prospective  controlled study in Belgium. Belgian Hip Fracture Study Group. Osteoporosis International 11(5): 373–80.
[7] Osteoporosis New Zealand. (2012). Bone Care 2020. Osteoporosis New Zealand: Wellington.
[8] De Raad, JP  (2012) Towards a value proposition…scoping the cost of falls. New Zealand Institute of Economic Research: Wellington.
[9] Hefford M, Blick G. (2012). Cost benefit analysis of the surgical safety checklist. Sapere Research Group: Wellington.
[10] Graves N, Nicholls T, Morris A. Modelling the costs of hospital-acquired infections in New Zealand. Infect Control Hosp Epidemiol. 2003; 24:56-61.
[11] Graves N, Halton KA, Paterson D et al. The economic rationale for infection control in Australian hospitals. Healthcare Infection, 2009;14(3). pp. 81-88.
[12] Burns A, Bowers L, Pak N et al. The excess cost associated with healthcare-associated bloodstream infections at Auckland City hospital. NZMJ, 2010, 123;1324:17-24.
[13]  Upton A, Smith P, Roberts SA. Excess cost associated with Staphylococcus aureus poststernotomy mediastinitis. NZMJ 2005;118:1210.
[14] Health Quality & Safety Commission. 2014. Making health and disability services safer: Serious adverse events reported to the Health Quality & Safety Commission 1 July 2013 to 30 June 2014. Wellington: Health Quality & Safety Commission.
[15]  Seddon ME, Jackson A, Cameron C et al. The Adverse Drug Event Collaborative: a joint venture to measure medication-related patient harm. NZMJ 25 January 2013, Vol 126: 9 – 20.