Variation in the adoption of patient safety practices among New Zealand district health boards
Antony Raymont A E , Patrick Graham B , Philip N. Hider B , Mary P. Finlayson C , John Fraser D and Jacqueline M. Cumming AA Health Services Research Centre, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand.
B University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand.
C Research Centre for Health and Wellbeing, Faculty of Engineering, Health, Science and The Environment, School of Health, Charles Darwin University, Charles Darwin University, Darwin, NT 0909, Australia.
D New Zealand Guidelines Group, PO Box 10665, The Terrace, Wellington 6011, New Zealand.
E Corresponding author. Email: raymonts@vodafone.co.nz.
Submitted: 14 December 2010 Accepted: 12 October 2011 Published: 25 May 2012
Abstract
Objective. To investigate the adoption and impact of quality improvement measures in New Zealand hospitals.
Method. Structured interviews with quality and safety managers of District Health Boards (DHBs). Correlation of use of measures with adjusted 30-day mortality data.
Results. Eighteen of New Zealand’s 21 DHBs participated in the survey. Structural or policy measures to improve patient safety, such as credentialing and event reporting procedures, had been introduced into all DHBs, whereas changes to general clinical processes such as medicine reconciliation, falls prevention interventions and disease-specific management guidelines were less consistently used. There was no meaningful correlation between risk-adjusted mortality rates for three common medical conditions and related quality measures.
Conclusion. Widespread variation exists among New Zealand DHBs in their adoption of quality and safety practices, especially in relation to clinical processes of care.
What is known about the topic? There are a significant number of adverse events which may affect hospital inpatients. Many of these are preventable. In response, quality and safety processes and measures are being adopted across the sector.
What does this paper add? The paper provides a description of the frequency with which a range of processes and measures have been adopted and demonstrates that adoption of these by New Zealand hospitals is patchy and monitoring is uneven. It suggests that the measures implemented do not appear to have impacted common mortality outcomes, though the findings may reflect the limits of feasible measurement of a probabilistic system.
What are the implications for practitioners? Managers should monitor the implementation of quality and safety measures and evaluate them in terms of their direct effects.
References
[1] Wennberg J, Fisher E, Fisher ES, Stukel TA, Skinner JS, Sharp SM, Bronner K. Use of hospitals, physician visits, and hospice care during the last six months of life among cohorts loyal to highly respected hospitals in the United States. BMJ 2004; 328 607–611.| Use of hospitals, physician visits, and hospice care during the last six months of life among cohorts loyal to highly respected hospitals in the United States.Crossref | GoogleScholarGoogle Scholar |
[2] Shaw C, Kutryba B, Crisp H, Vallejo P, Suno R. Do European hospitals have quality and safety governance systems and structures in place? Qual Saf Health Care 2009; 18 i51–i56.
| Do European hospitals have quality and safety governance systems and structures in place?Crossref | GoogleScholarGoogle Scholar |
[3] Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999.
[4] Leape L, Brennan T, Laird N. The nature of adverse events in hospitalised patients: results of the Harvard Medical Practice Study. NEngl J Med 1991; 324 377–84.
| The nature of adverse events in hospitalised patients: results of the Harvard Medical Practice Study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M7gtFKksA%3D%3D&md5=aba99eea3984d3944853981b77e5ef43CAS |
[5] Wilson R, Runciman W, Gibberd R, Harrison B, Newby L, Hamilton J. The quality in Australian health care study. Med J Aust 1995; 163 458–71.
| 1:STN:280:DyaK28%2FosV2qsQ%3D%3D&md5=e676eca63292f5ebf3d048b7d8e42abaCAS |
[6] Davis P, Lay-Yee R, Briant R, Schug S, Scott A. Adverse events in New Zealand public hospitals. Wellington: Ministry of Health; 2001.
[7] Quality Improvement Committee. Scoping the priorities for quality in the health and disability sector . Wellington: Ministry of Health; 2006.
[8] Malcolm L, Wright L. Clinical leadership and quality in District Health Boards in New Zealand: report commissioned by the clinical leaders association of New Zealand for the Ministry of Health. Wellington: Ministry of Health; 2002.
[9] Goldstein H, Speigelhalter D. Statistical aspects of institutional performance: issues and applications. JR Stat Soc 1996; 159 385–444.
| Statistical aspects of institutional performance: issues and applications.Crossref | GoogleScholarGoogle Scholar |
[10] Normand S, Glickman M, Gatsonis C. Statistical methods for profiling providers of medical care: issues and applications. J Am Stat Assoc 1997; 92 803–14.
[11] Anon. Reportable events guidelines. Wellington: Ministry of Health; 2001.
[12] Anon. Credentialling framework for Senior Medical Officers in New Zealand – self-assessment tool. Wellington: Ministry of Health; 2003.
[13] US Agency for Healthcare Research and Quality (USAHRQ) : USAHRQ;. http://www.qualityindicators.ahrq.gov/psi_overview.htm [verified 5 May 2012].
[14] Henderson KE, Recktenwald A, Reichley RM, Bailey TC, Waterman BM, Dekemper RL, et al Clinical validation of the AHRQ postoperative thromboembolism patient safety indicator. J Qual Patient Saf 2009; 35 370–6.
[15] Romano PS, Mull HL, Rivard PE, Zhao S, Henderson WG, Loveland S, et al Validity of selected AHRQ patient safety indicators based on VA National Surgical Quality Improvement programme data. Health Serv Res 2009; 44 182–204.
| Validity of selected AHRQ patient safety indicators based on VA National Surgical Quality Improvement programme data.Crossref | GoogleScholarGoogle Scholar |
[16] Grobman W, Feinglass J, Murthy S. Are the Agency for Healthcare Research and Quality obstetric trauma indicators valid mesures of hospital safety? Am J Obstet Gynecol 2006; 195 868–74.
| Are the Agency for Healthcare Research and Quality obstetric trauma indicators valid mesures of hospital safety?Crossref | GoogleScholarGoogle Scholar |
[17] Elixhauser A, Steiner C, Harris DR, Coffey DR, et al Cormorbidity measures for use with administrative data. Med Care 1998; 36 8–27.
| Cormorbidity measures for use with administrative data.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c%2FptlemtA%3D%3D&md5=893a23c01ce1f1b21b6af46d7636ff33CAS |
[18] Quan H, Sundararajan V, Halfon P, Fong A, Rurnard B, Luthy A, et al Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 11 1130–9.
| Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.Crossref | GoogleScholarGoogle Scholar |
[19] Graham P, Hider P, Cumming J, Raymont A, Finlayson M. Variation in New Zealand hospital outcomes: combining hierarchical Bayesian modeling and propensity score methods for hospital performance comparisons. Health Serv Outcomes Res Method 2012; 12 1–28.
[20] Jha A, Li Z, Orav EJ, Epstein AM. Care in U.S. hospitals – the hospital quality alliance program. N Engl J Med 2005; 353 265–74.
| Care in U.S. hospitals – the hospital quality alliance program.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXmt1KmsL0%3D&md5=1dc6a07a79705b6d5e1555b6d673b411CAS |
[21] Leistikow I, Kalkman C, Brujin HD. Why patient safety is a tough nut to crack. BMJ 2011; 342
| Why patient safety is a tough nut to crack.Crossref | GoogleScholarGoogle Scholar |
