Developing and implementing an action-oriented staff survey: Queensland Health and the 'Better Workplaces' initiative

QUEENSLAND HEALTH IMPLEMENTED the ?Better Workplaces? staff opinion survey (the survey) in May 2006. The initiative stands as the largest single staff survey ever conducted in Queensland, and one of the largest in Australia. This case study outlines the process of this project, the outcomes to date and some of the pitfalls and successes along the way. Logistically it involved 37 health service districts and 10 corporate areas spread across the state. The survey process incorporated four survey periods over two years. The aim of the survey was: to improve workplace culture at the local level and across the organisation as a whole. Workplace culture is defined by Cole as ?The collection of unwritten rules, codes of behaviour and norms by which people operate, how we do things around here?1 Queensland Health proposed to improve its workplace culture by listening to staff and developing and driving targeted action plans following the survey with each district and division to create a climate of trust, respect, and innovation among staff which will ultimately improve patient outcomes. ?. . . The creation of a culture that is free of blame and encourages an open examination of error and failure is a key feature of services dedicated to quality improvement and to learning.?

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Actions and results from the Queensland Health "Better Workplaces" staff opinion survey

Australian Health Review ◽

10.1071/ah090371 ◽

2009 ◽

Vol 33 (3) ◽

pp. 371 ◽

Cited By ~ 3

Author(s):

Ceri Jury ◽

Hong Eng Goh ◽

Shaney P Olsen ◽

Jan Elston ◽

Jan Phillips

Keyword(s):

Leadership Development ◽

Workplace Culture ◽

Action Plans ◽

Opinion Survey ◽

Improvement Strategy ◽

Comprehensive Program ◽

Queensland Health ◽

Robust Process ◽

Over Time

In April 2006, the Workplace Culture and Leadership Centre (the Centre) from Queensland Health launched the ?Better Workplaces? initiative. The objective was to improve workplace culture and increase the capabilities of its leaders. A comprehensive program of leadership development complemented the workplace culture improvement strategy. As part of the initiative, the Centre launched a series of staff opinion surveys to monitor workplace culture improvement over time. To ensure the survey process was action oriented, the Workplace Culture Team developed a companion process ensuring the results were acted upon and tangible improvements were realised. This resulted in a comprehensive and robust process involving the development and implementation of action plans in every district and division in Queensland Health.

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Industrial strategy and local economic development: The case of the foundry industry in Ekurhuleni Metro

South African Journal of Economic and Management Sciences ◽

10.4102/sajems.v8i4.1175 ◽

2014 ◽

Vol 8 (4) ◽

pp. 448-464 ◽

Cited By ~ 2

Author(s):

T Phele ◽

S Roberts ◽

I Steuart

Keyword(s):

South Africa ◽

Economic Development ◽

Local Economic Development ◽

Local Level ◽

Action Plans ◽

Foundry Industry ◽

The Past ◽

Concrete Action

This article explores the challenges for the development of manufacturing through a case study of the foundry industry in Ekurhuleni Metropolitan Municipality. Ekurhuleni Metro covers the largest concentration in South Africa, but the industry’s performance has been poor over the past decade. The findings reported here highlight the need to understand firm decisions around investment, technology and skills, and the role of local economic linkages in this regard. The differing performance of foundries strongly supports the need to develop concrete action plans and effective institutions at local level to support the development of local agglomerations.

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Triage of Rheumatology Referrals Facilitates Wait Time Benchmarks

The Journal of Rheumatology ◽

10.3899/jrheum.151235 ◽

2016 ◽

Vol 43 (11) ◽

pp. 2064-2067 ◽

Cited By ~ 5

Author(s):

Chandra Farrer ◽

Liza Abraham ◽

Dana Jerome ◽

Jacqueline Hochman ◽

Natasha Gakhal

Keyword(s):

Quality Improvement ◽

Connective Tissue ◽

Patient Outcomes ◽

Inflammatory Arthritis ◽

Wait Time ◽

Wait Times ◽

Referral Letter ◽

Advanced Practice ◽

Priority Ranking ◽

Improve Patient

Objective.In 2014 the Canadian Rheumatology Association published wait time benchmarks for inflammatory arthritis (IA) and connective tissue disease (CTD) to improve patient outcomes. This study’s aim was to determine whether centralized triage and the introduction of quality improvement initiatives would facilitate achievement of wait time benchmarks.Methods.Referrals from September to November 2012 were retrospectively triaged by an advanced practice physiotherapist (APP) and compared to referrals triaged by an APP from January to March 2014. Each referral was assigned a priority ranking and categorized into one of 2 groups: suspected IA/CTD, or suspected non-IA/CTD. Time to initial consult and time to notification from receipt of referral were assessed.Results.A total of 558 (n = 227 and n = 331 from 2012 and 2014, respectively) referrals were evaluated with 35 exclusions. In 2012, there were 96 (42.5%) suspected IA/CTD and 124 (54.9%) suspected non-IA/CTD patients at the time of the initial consult. Mean wait times in 2012 for patients suspected to have IA was 33.8 days, 95% CI 27.8–39.8, compared to 37.3 days, 95% CI 32.9–41.7 in suspected non-IA patients. In 2014, there were 131 patients (43%) with suspected IA based on information in the referral letter. Mean wait times in 2014 for patients suspected to have IA was 15.5 days, 95% CI 13.85–17.15, compared to 52.2 days, 95% CI 46.3–58.1 for suspected non-IA patients. Time to notification of appointment improved from 17 days to 4.37 days.Conclusion.Centralized triage of rheumatology referrals and quality improvement initiatives are effective in improving wait times for priority patients as determined by paper referral.

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Effects of a transsphenoidal surgery quality improvement program on patient outcomes and hospital financial performance

Journal of Neurosurgery ◽

10.3171/2021.7.jns21286 ◽

2021 ◽

pp. 1-10

Author(s):

Christina E. Sarris ◽

Scott T. Brigeman ◽

Estelle Doris ◽

Maggie Bobrowitz ◽

Thomas Rowe ◽

...

Keyword(s):

Quality Improvement ◽

Financial Performance ◽

Patient Care ◽

Patient Outcomes ◽

Transsphenoidal Surgery ◽

Pituitary Surgery ◽

Care Pathways ◽

Improvement Program ◽

Hospital Financial Performance ◽

Improve Patient

OBJECTIVE A comprehensive quality improvement (QI) program aimed at all aspects of patient care after pituitary surgery was initiated at a single center. This initiative was guided by standard quality principles to improve patient outcomes and optimize healthcare value. The programmatic goal was to discharge most elective patients within 1 day after surgery, improve patient safety, and limit unplanned readmissions. The program is described, and its effect on patient outcomes and hospital financial performance over a 5-year period are investigated. METHODS Details of the patient care pathway are presented. Foundational elements of the QI program include evidence-based care pathways (e.g., for hyponatremia and pain), an in-house research program designed to fortify care pathways, patient education, expectation setting, multidisciplinary team care, standard order sets, high-touch postdischarge care, outcomes auditing, and a patient navigator, among other elements. Length of stay (LOS), outcome variability, 30-day unplanned readmissions, and hospital financial performance were identified as surrogate endpoints for healthcare value for the surgical epoch. To assess the effect of these protocols, all patients undergoing elective transsphenoidal surgery for pituitary tumors and Rathke’s cleft cysts between January 2015 and December 2019 were reviewed. RESULTS A total of 609 adult patients who underwent elective surgery by experienced pituitary surgeons were identified. Patient demographics, comorbidities, and payer mix did not change significantly over the study period (p ≥ 0.10). The mean LOS was significantly shorter in 2019 versus 2015 (1.6 ± 1.0 vs 2.9 ± 2.2 midnights, p < 0.001). The percentage of patients discharged after 1 midnight was significantly higher in 2019 versus 2015 (75.4% vs 15.6%, p < 0.001). The 30-day unplanned hospital readmission rate decreased to 2.8% in 2019 from 8.3% in 2015. Per-patient hospital profit increased 71.3% ($10,613 ± $19,321 in 2015; $18,180 ± $21,930 in 2019), and the contribution margin increased 42.3% ($18,925 ± $19,236 in 2015; $26,939 ± $22,057 in 2019), while costs increased by only 3.4% ($18,829 ± $6611 in 2015; $19,469 ± $4291 in 2019). CONCLUSIONS After implementation of a comprehensive pituitary surgery QI program, patient outcomes significantly improved, outcome variability decreased, and hospital financial performance was enhanced. Future studies designed to evaluate disease remission, patient satisfaction, and how the surgeon learning curve may synergize with other quality efforts may provide additional context.

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Barriers to Working With National Health Service England’s Open Data (Preprint)

10.2196/preprints.15603 ◽

2019 ◽

Author(s):

Seb Bacon ◽

Ben Goldacre

Keyword(s):

National Health Service ◽

Health Service ◽

Patient Outcomes ◽

National Health ◽

Open Data ◽

Online Tools ◽

Research Findings ◽

Open Datasets ◽

The Many ◽

Improve Patient

UNSTRUCTURED Open data is information made freely available to third parties in structured formats without restrictive licensing conditions, permitting commercial and noncommercial organizations to innovate. In the context of National Health Service (NHS) data, this is intended to improve patient outcomes and efficiency. EBM DataLab is a research group with a focus on online tools which turn our research findings into actionable monthly outputs. We regularly import and process more than 15 different NHS open datasets to deliver OpenPrescribing.net, one of the most high-impact use cases for NHS England’s open data, with over 15,000 unique users each month. In this paper, we have described the many breaches of best practices around NHS open data that we have encountered. Examples include datasets that repeatedly change location without warning or forwarding; datasets that are needlessly behind a “CAPTCHA” and so cannot be automatically downloaded; longitudinal datasets that change their structure without warning or documentation; near-duplicate datasets with unexplained differences; datasets that are impossible to locate, and thus may or may not exist; poor or absent documentation; and withholding of data for dubious reasons. We propose new open ways of working that will support better analytics for all users of the NHS. These include better curation, better documentation, and systems for better dialogue with technical teams.

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How to Structurally Reform the National Health Service to Improve Patient Outcomes

SSRN Electronic Journal ◽

10.2139/ssrn.3853621 ◽

2018 ◽

Author(s):

Kristian Peter Niemietz

Keyword(s):

National Health Service ◽

Health Service ◽

Patient Outcomes ◽

National Health ◽

Improve Patient

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Getting It Right First Time: the reports

British Journal of Neuroscience Nursing ◽

10.12968/bjnn.2021.17.6.247 ◽

2021 ◽

Vol 17 (6) ◽

pp. 247-252

Author(s):

Sue Thomas

Keyword(s):

Quality Improvement ◽

Service Delivery ◽

Acute Care ◽

Patient Outcomes ◽

Future Directions ◽

Subject Areas ◽

First Time ◽

Improve Patient

Originally launched in 2015, the Getting It Right First Time (GIRFT) programme has become a leading authority for quality improvement in the NHS. In September 2021, the programme published an impressive series of reviews in no fewer than 18 subject areas, neurology being one of these. While earlier GIRFT reports tended to focus on acute care, the new reports have a much wider scope and scan a whole pathway approach for unwarranted variations in practice and what needs to happen to improve patient outcomes. In Part 1, Sue Thomas explores what GIRFT says about the organisation of neurological services and recommendations for service delivery, while Part 2 will explore parallel services, commissioning and future directions.

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Partners Advancing Clinical Excellence: Building Professional Councils for Quality Improvement at Six Community Hospitals

Creative Nursing ◽

10.1891/1078-4535.18.4.177 ◽

2012 ◽

Vol 18 (4) ◽

pp. 177-186 ◽

Cited By ~ 4

Author(s):

Julie Ann Sakowski ◽

Lynda Hooper ◽

Thomas Holton ◽

Abraham A. Brody

Keyword(s):

Quality Improvement ◽

Improve Patient Safety ◽

Bloodstream Infections ◽

Clinical Excellence ◽

Central Line ◽

Community Hospitals ◽

Improvement Programs ◽

Improve Patient

Engaging bedside clinicians, especially nurses, is essential for the success of sustainable process improvement programs and thus for improving the quality of health care. Studies have shown that properly implemented professional councils can be effective in engaging and empowering bedside clinicians to create lasting and meaningful improvements. This case study describes a 5-year program to implement and operate staff-led councils to lead evidence-based practice (EBP) quality improvement initiatives at 6 community hospitals. The outcomes presented in this case study demonstrate that staff-led councils have the potential to improve patient safety and quality of care as evidenced by observed reductions in ventilator-associated pneumonias, central line–associated bloodstream infections, and mortality from acute myocardial infarction and severe sepsis.

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Maximising the value of clinical registry information through integration with a health service clinical governance framework: a case study

Australian Health Review ◽

10.1071/ah19004 ◽

2020 ◽

Vol 44 (3) ◽

pp. 421

Author(s):

Susannah Ahern ◽

Robert Feiler ◽

Susan Sdrinis

Keyword(s):

Quality Improvement ◽

Health Service ◽

Clinical Performance ◽

Clinical Governance ◽

Clinical Registry ◽

Governance Framework ◽

Clinical Registries ◽

Governance Systems ◽

Over Time

This initiative sought to identify unit participation in clinical registries within a large metropolitan health service and to develop approaches to integration of registry reporting within the organisational clinical governance framework to maximise potential quality improvement benefits. The initiative, led by the Medical Services Department at Alfred Health, initially involved identifying health service participation in clinical registries via a range of mechanisms, including one-on-one meetings with clinical registry investigators. In conjunction with the Clinical Governance Unit, tools to summarise and track clinical registry information at Alfred Health over time were developed and piloted. Alfred Health identified 69 clinical registries in which its units participated. These were heterogeneous in terms of clinical area and purpose, as well as the nature and frequency of reporting. Engagement with clinicians led to the establishment of a registry interest group, a calendar of clinical quality registry reports, and a guideline and reporting template and dashboard. Clinician engagement and medical leadership were critical to the development of this initiative. The reporting tool and dashboard have had initial success, with long-term success ultimately being measured by the routine incorporation of registry outcomes into clinical governance reporting over time. What is known about the topic?Health service clinical governance systems require the collection, analysis and ongoing monitoring of clinical performance and quality improvement information. These data may be from internally derived clinical indicators or from external datasets, such as clinical registries. However, although clinical registries have traditionally provided information at the unit level, mechanisms to systematically incorporate these clinical measures into health service clinical governance systems have been lacking. What does this paper add?This paper provides a case study of the steps taken by one large health service to identify, engage clinicians and incorporate disease-specific clinical registry indicators into its organisational clinical governance framework. It highlights the complexity of the task through the time taken to identify, translate and summarise key clinical information into a format suitable for organisational committee reporting. What are the implications for practitioners?This paper highlights to health service managers the importance of initial and ongoing engagement of clinicians in the development of a shared approach to organisational use of clinical registry data. It outlines potential steps that can be taken within a health service to engage clinicians in sharing registry information, and processes that can assist in systematically incorporating registry information into actionable organisational-level reporting as part of clinical governance.

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