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Posted 28 Apr 2016 in Falls

Sandy Blake, director of nursing at Whanganui District Health Board (DHB) with significant experience in patient safety, describes the role of clinical leadership in driving quality improvement in reducing harm from falls.

My experience as clinical lead for the Health Quality & Safety Commission’s Reducing Harm from Falls programme has taught me that, as an individual, you cannot do much to truly influence change and make a difference. It takes a team of leaders at all levels of health provider organisations to do what is needed – a team that stretches from patients, families and whānau all the way through to board chairs. Each party has an important contribution to make, playing to their roles and their own set of unique skills.

The success of our efforts depends in particular on leaders knowing their role and playing their part. Taking a systems view and having knowledge of the overall strategy is helpful, but more importantly the key is being guided by evidence and linked by the common goal of reducing harm for our older and more vulnerable people.

The challenge of the falls programme team and expert advisory group is providing the evidence, knowledge and central leadership to allow the sector to understand the seriousness of the falls problem. We need to ensure the sector has the tools, evidence and skills it needs to care safely for older persons at risk of falling or those who have fallen and suffered harm. We often say there is no ‘magic bullet’ to reduce harm from falls, yet many of our activities have influenced behaviour.

Evidence alone, and providing resources, is not enough. Many clinicians I speak to say they have not yet read the falls programme’s series of evidence-based resources, the ‘10 Topics’ (, which identified 10 key priorities to consider when addressing the falls problem, and challenged our existing thinking. We need to encourage clinical leaders to build such resources into mandatory education for those engaged in falls work. The knowledge and evidence base need to be referred to constantly so there is a common language when discussing the problem of falls.

Clinical practice is often driven by personal experience, experience of peers and beliefs. By sharing and showcasing good examples, and providing exposure for local leaders to learn from, we can change people’s beliefs and encourage them to follow and explore a different way.

One platform that brings leaders and emerging leaders with a passion for falls work to the surface is support for the regions to collaborate, lead and drive regional strategies. These are key steps towards a sustainable model of reducing harm from falls, and they work best if the person leading and giving the information is known and respected by their peers.

Two visiting international experts and leaders on falls prevention have conducted workshops nationally and shared their learnings, which has built further capability in local falls leaders. This strategy of acknowledging international leadership has been supported by the Open for better care patient safety campaign platform with the purpose of ‘shining the light’ on falls, data and ideas to help drive improvement.

In the background, senior managers (leaders within their own area of influence) within the Commission partner with ACC and the Ministry of Health so messages to clinicians are clear and consistent. Together we can have conversations with board members and chief executives who have overall accountability for the culture, safety and standard of care delivered.

The ultimate aim is to have a health system that puts the patient and their family/whānau at the centre, and influences how clinicians and carers work every day to listen and plan with the older person to reduce harm from falls.