New article on making quality systems more useful and effective drivers of high quality care
Health service staff do not see their organisation's quality system as a useful support for providing good care. So what are we going to do about it? Read our research findings in the attached pdf article, published in Health Services Management Research, August 2017.
Creating Great Care in Complex Systems Resource List
Helpful information for creating safety and quality in complex systems
Amalberti, R, Vincent, C, Auroy, Y and de Saint Maurice G (2006) Violations and Migrations in Health Care: A Framework for Understanding and Management. Qual Saf Health Care. December 15 (Suppl 1):i66–i71. (Accessed November 2010)
Balding C (2015) Leading a strategic quality governance system online course.
Balding C (2012) '5 Essential Skills for 21st Century Quality Managers.' InTech Open Access
Balding C (2011) The Strategic Quality Manager: A Handbook for Navigating Quality Roles in Health and Aged Care. Arcade Custom, Melbourne. Available as a handbook or ebook from: www.cathybalding.com
Dekker S (2011) Drift Into Failure – From Hunting Broken Components to Understanding Complex Systems. Ashgate Publishing Company, UK
Flin R, O’Connor P, Crichton M (2008) Safety at the Sharp End – A Guide to Non-Technical Skills. Ashgate Publishing, UK
Lillrank P, Liukko M (2004) Standard, routine and non-routine processes in healthcare. International Journal of Health Care Quality Assurance; 2004; 17, 1; ABI/INFORM Global pg. 39
Meadows DH (2008) Thinking in Systems – A Primer. Sustainability Institute, USA
NHS (2016) Developing people, Improving care. a national framework for action on improvement and leadership development in NHS funded services. NHS, UK.
NZ Health Quality and Safety Commission (2016) From knowledge to action: a framework for building qulaity and safety capability in the NZ health system. (Health Q&S Commission, NZ.
Plsek P, Wilson T (2001) Complexity Leadership and Management in Healthcare Organisations. BMJ, 323, no.7315, pp. 746–49
Weick KE, Sutcliffe KM (2007) Managing the Unexpected. John Wiley and Sons Inc, USA
The six achievements of an effective quality system.
Checklist for a hard working quality system.
Quality systems can and should do so much more for health, aged and community services than they do. Why? Partly this is becuase many boards and executives don't understand the potential of their quality system, and how it must be running like a well oiled machine to drive great consumer care and experiences within complex environments.
Click on the pdf below for the six acheivements - and the corresponding components required to make them a reality in your organisation.
Characteristics of high performing health services 2016
How does yours stack up?
QualityNews: Djerriwarrh Health Service CG Failure
In QualityNews November 2015 I responded to the Djerriwarrh Health Services clnical governance falure, resulting in the deaths of seven babies. Click on the attachment to read my take on why we shouldn't need any more reminding about why leadership and vigilence are critical to patient safety.
A Strategic Quality System
SQS in Action
Western Health, a large multi-campus teaching health service in western Melbourne, implemented the Strategic Quality System two years ago. They were looking for somethng that would bring all their good improvement work together, identify their gaps and focus more completely on their consumers. Here's an overview of their progress a year later.
The Quality System Maturity Scale.
Where is your organisation on The Quality System Maturity Scale? Use my scale to start a conversation about the health and effectiveness of your current quality system - and to plan how you'll evolve it to create even better care and experiences for consumers.
Developing Strategic Quality Governance: Five Actions for Boards
Describes five key actions Boards can - and should - take, to develop strategic quality governance that makes a real difference to consumers.
Available as a pdf document - see below.
(This is the text of an article that appeared in Australian Ageing Agenda, May 2015.)
Change Reality Check - list
Sometimes its easier to hope that change will go well than face the fact that there are boulders along the path to success. But if you don't identify and move the boulders, staff that are subject to the change are likley to look for another path; and before you know it, you're leading a change that noone else is following. Slippage and erosion are part of change in complex systems; but this is accelerated when the change is not a good fit in the first place.
Here's some tough questions that, answered honestly, will help you build a realistic picture of what you're dealing with and the chance of success. Better to know before you embark, when you can work with the staff to do something about it, than hope for the best and spend months rescuing a change that doesn't take, is circumnavigated, or actively thwarted.
Change Reality Check-list - answer 'yes' to two or more of these and you still have some work to do - with those involved - to tailor your change for maximum success and sustainability:
(Adapted from Amalberti, R, Vincent, C, Auroy, Y and de Saint Maurice G (2006) Violations and Migrations in Health Care: A Framework for Understanding and Management. Qual Saf Health Care. December 15 (Suppl 1):i66–i71.)
Five Favourite Change for Improvement Books
My Five Favourite ‘Incredibly Useful Change for Improvement’ Books
These are my current ‘go-to’ books for understanding and making change for improvement in complex organisations. They live in the real world and are full of useful explanation, practical solutions and tools for making process and culture change a reality.
Byham, W (1993) Zapp! Empowerment in Health Care. Fawcett, USA.
Connors R, Smith T (2011) Change the culture, Change the game. Penguin Books, New York, USA.
Heath D & C (2011) Switch: How To Change Things, When Change is Hard. Random House Business Books, USA.
Kotter J (2014) Accelerate: Building Strategic Agility for a Faster-Moving World. Harvard Business Review Press, USA.
Lencioni P (2012) The Advantage: Why Organizational Health Trumps Everything Else in Business. Jossey-Bass, USA.
Generic National Standards presentation for Boards and Executives 2013
This generic presentation for Boards and Executives can be used as a basis for your presentations - don't forget to adapt it to your service and make sure you're confident with the content - do your homework so you'll be able to answer those tricky questions!
Sign up for my monthly newsletter (in the right hand column of this page) to receive ongoing tips and info on effective implementation and staff buy-in.
Presentation from the 'Cathie and Cathy' Workshop at the AAQHC Conference 2012
Handy Books & Articles
These links, books and articles are useful and practical references for quality managers, and cover the essential components of quality systems management – well worth getting hold of to build your professional development library.
Leggat SG, Balding C (2017) A qualitative study on the implementation of quality systems in Australian hospitals. Health Services Management Research, Volume: 30 issue: 3, page(s): 179-186, August 1, 2017. https://doi.org/10.1177/0951484817715594
Provost L and Murray S (2011) The Healthcare Data Guide. Jossey Bass, USA.
The Health Foundation (2011) Quality Improvement Made Simple: What every Board should know about Quality Improvement. The Health Foundation, UK
Swanick and McKimm (eds) (2011) ABC of Clinical Leadership. BMJ Books. www.abcbookseries.com
Bridges W (1997) Managing Transitions. Addison Wesley Publishing Company, USA.
Weeks C (2010) Handy Hints for the Novice Conference Presenter. The Junction, Australia.
Frankel A, Leonard M, Simmonds T, Haraden C, Vega K (eds) (2009) The Essential Guide for Patient Safety Officers. Joint Commission on Accreditation of Healthcare Organisations and Institute for Healthcare Improvement, USA.
Classen et al (2011) ‘Global Trigger Tool’ Shows that Adverse Events in Hospitals may be Ten Times Greater than Previously Thought. Health Affairs, vol 30, no 4
Balding C (2008) From Quality Assurance to Clinical Governance. Australian Health Review, vol 32,no 3. pp.383–91 http://www.publish.csiro.au/?act=view_file&file_id=AH080383.pdf
Handy Links- The Scottish Quality Strategy is a great example of a strategic quality framework in action. - The ACSQHC Guide for Boards is an excellent overview of key board quality governance responsibilities, including examples and checklists. - The Qualityworks' Report for The Australian Safety and Quality Commission on issues for small rural hospitals with implementing the national safety and quality standards. - Catch up with my 2012 book chapter, which lays out the 5 skills that quality managers will need over the next decade: Cathy Balding (2012). Five Essential Skills for 21st Century Quality Professionals in Health and Human Service Organisations, in Savsar M (ed.) Quality Assurance and Management, InTech, ISBN: 978-953-51-0378-3. - Over the last year, the QIPP Safe Care coalition and over 100 NHS provider organisations have tested a pilot programme called ‘Safety Express’ to reduce harm from pressure ulcers, falls, urinary catheters and VTE. - The Health Foundation is an independent charity working to continuously improve the quality of healthcare in the UK. It aims to develop the technical skills, leadership, capacity, knowledge, and the will for change, that are essential for real and lasting improvement. - Change Champions & Associates is an Australian change management organisation that delivers high quality seminars and Master Classes in the health, education and government sectors. The organisation is committed to facilitating networking, information exchange and encouraging innovation.