The Role of Australian Commission on Safety and Quality in Health Care and Victorian State Government Department of Health and Human Services

Question:

Discuss concept of quality improvement and reole of ACSQHC.
 

In this report, the author will discuss the concept and significance of the quality improvement in health care. The author will detail the role of “Australian Commission on Safety and Quality in Health Care” and the “Victorian State Government Department of Health and Human Services”.

Quality improvement in health care can be defined as the combined effort of medical professionals, researchers, educators, patients and their families to achieve better patient outcomes through effective changes in the health care (Australian Institute of Health and Welfare (AIHW), (2015). Every change may not lead to the improvement unless it makes full use of “science of disease biology” (Greenfield et al., 2015). Therefore, the change must include generalisable scientific knowledge, and the care is delivered in macrosystem, microsystem, and mesosystem in a modified way (Will & Weinschreider, 2012). The changes refer to enhanced medical care facilities and improved health outcomes. Meeting the needs and expectations of the patients is the key to measuring the quality of services (Winters et al., 2013). Such practices include evidence-based care, patient engagement, provision of care with effective coordination with another part of the health care system, patient-centered care, and care including culture competence and linguistically appropriate (Boswell et al., 2015).

There are ten national standards, which regulate the quality, and safety of the health services, which ultimately improves the patient outcomes (Boy & Sheen, 2014). The primary standards are:

• Prevention of the health infections
• Partnership with the consumers
• Safety related to medical services
• Measurement of safety and quality of health service
• Identification and application of correct health plan for the patient
• prevention of pressure injuries
• Blood product management
• Recognition of clinical deterioration
• Prevention of fall
• Handover of the patient in a clinical emergency (Hannaford et al., 2013)

The “Australian Commission on Safety and Quality in Health Care” (ACSQHC) along with “Victorian State Government Department of Health and Human services” plays a significant role in quality improvement of health services (Hibbard & Greene, 2013). These bodies govern and monitor the ten national standards. Based on these standards these governing bodies have formulated their guidelines for further improvement of health organizations. Evidence-based practice is gaining importance all over the world. It includes the principle of support or rejection of a treatment based on evidence, experienced clinical judgment in identification of “unique health state and diagnosis” and values/preferences of clients (McCalman et al., 2012). Together with patient-centered care it is the best measurement of health quality improvement. Additionally, effective collaboration between heath care professionals and correct leadership style is essential for a right working environment (Cunningham et al., 2012). The author will further discuss the role of ACSQHC in an improvement of hospitals and health services.

There exists the range of benefits with an implementation of quality improvement programs that reflect the importance of these programs in health care settings. These include improved patient health with reduced mortality and morbidity with increased managerial processes (McFadden et al., 2014). By improving clinical processes, excess cost due to system failure or medical errors and redundancy is reduced. Those organizations committed to such quality services reflect a culture of positivity and improvement development (Healy, 2013). It will, in turn, improve the communication, funding and partnership opportunities. It ensures the reliability and predictability of the services. Overall the organization will have a balance of “quality, efficiency, and profitability” in its accomplishments of goals (Hibbard & Greene, 2013). 

Quality Improvement in Health Care

The Council of Australian Governments has established ACSQHC to coordinate and lead national improvements in health care safety and quality (Boyd & Sheen, 2014). This aim includes involvement of Health Ministers to drive desired improvements by providing them “strategic advice on best practices.” “The National Health Reform Act 2011” as an independent and permanent authority under the “Commonwealth Authorities and Companies Act 1997” specifies the roles of ACSQHC and its responsibilities (Huber, 2013). Since 2014, “Public Governance, Performance and Accountability Act 2013” governs it (Boyd & Sheen, 2014).

To achieve its aim, ACSQHC will develop “national safety and clinical standards formulate and implement national accreditation schemes and develop national datasets”. In addition, it will identify and decrease any “unwarranted variation” in services and patient outcomes (Healy, 2013). This unwarranted variation includes misuse or underuse of health services, a discrepancy in productivity and health care safety and quality (Kyrkjebø and Hanestad, (2009). It will work towards “nationally coordinated action” to address infections associated with health care and antimicrobial resistance (Lowthian et al., 2013). It also attempts to develop “clinical care standards” to provide care based on specific clinical conditions of a patient. The clinical standards will focus on the “areas of high volume, high-cost care where there is known variation from well-established models of care” (Boyd & Sheen, 2014).

It supports its role in achieving its goal by obtaining the range of data, interprets the same by its analysis, disseminates the information related to safety and quality of health care, and publishes reports of the same. According to Greenfield et al., (2015) ACSQHC promotes health care safety and quality awareness as well as awareness of clinical and health service standards by engaging with range of stakeholders, State and Territory Governments, private sector health providers, clinicians, public health bodies and consumers (Healy, 2013). The ACSQHC vision for Australia’s health care improvement comprises of three core principles that are “consumer-centered, information supported and safety organization” (Huber, 2013).

In 2012, ACSQHC implemented the “National Safety and Quality Health Service Standards (NSQHS)” (Hannaford et al., 2013). These provide guidelines for increased safety and quality in particular areas of practice. It identified clinical governance as the “core aspect of the health service safety and quality” (Healy, 2013). The nature of these standards is evidence based which requires the initiative of clinical governance found on prior learning and research (Boyd & Sheen, 2014). The ACSQHC works with jurisdictions to coordinate the implementation of those standards and monitor their effectiveness. It will administer the accreditation of health care professionals through “Australian Health Services Safety and Quality Accreditation Scheme (AHSSQA)” (Greenfield et al., 2015).

ACSQHC together with the “National Health Performance Authority” strive for identification and development of “indicators of the safety and quality performance of the health system” (Ibrahim et al., 2014). These indicators help the care providers in improving their performance. It will support and assist the accrediting agencies to implement the standards of NSQHS (Boswell et al., 2015). In Queensland, AHSSQA is “mandatory for hospitals, multipurpose health centers and day procedure units” (Greenfield et al., 2015). It uses ten standards of NSQHS, replacing the clinical standards, which the accreditation agencies used previously. “State and territory” health departments regulate the requirement for accreditation. It monitors the outcomes on a timely basis for rectifying the practice performance. According to Boyd & Sheen, (2014) “ACSQHC will continue to coordinate the establishment of these processes and the related activity of health service accrediting agencies and monitor the effectiveness of the NSQHS Standards”. The mental health service is to maintain accreditation against the “NSQHS Standards” and the “National Standards for Mental Health Services” (Badland et al., 2014).

Ten National Standards to Regulate Quality and Safety of Health Services

In 2006, AIHW and ACSQHC signed a partnership agreement with broad intentions to drive and enhance the safety and quality of health care by working towards more “informative and usable national system of information” (Australian Institute of Health and Welfare (AIHW) (2015). The development of “set of 55 national indicators of the safety and quality of clinical care provided to patients across the Australian health care system” was the primary outcome of this agreement (Cunningham et al., 2012). 

The framework provided by ACSQHC includes 21 actions, which will be adopted by the medical professionals to improve the practice performance and hospital services (Finkelman, 2015). This framework insists on collaborative work to revise the existing plans to design new goals. The guidelines insist the framework to be followed by all the primary, secondary and other acute care facilities (Cunningham et al., 2012). The official website of ACSQHC highlights the “national patient blood management” (Boyd & Sheen, 2014). Blood product is essential life saving tool. Improper blood transfusion is associated with various health hazards such as allergy or Erythroblastosis foetalis. Improvement in blood collection and management will lead to decrease in morbidity and mortality rate (Engelbrecht et al., 2013).  According to (Boswell et al., 2015) Effective communication among clinical staff and other team of hospital is essential for achieving the goal of quality improvement. Several communication programs are developed that include “health literacy, summaries of electronic discharge and open disclosure” (Girard & Parsons, 2012).

Patient fall is the other major health concern increasing since recent times (Ibrahim et al., 2014). The ACSQHC has developed guidelines for fall prevention. It mandates the hospitals to build up residential aged care facilities to arrange special care for aged and disabled patients as they are largely affected by falls (Thomas & Mackintosh, 2015). Australia is conducting field trials for implementing the use of assistive robots in nursing homes for aged patients. These robots communicate much like humans and improve quality of care and emotional well-being of elderly patients (Khosla et al., 2013).

In order to improve the patient safety and medication procedures two main tools were developed. These are “Medication safety self-assessment for Australian hospital and Medication safety self-assessment for antithrombotic therapy in Australian Hospitals” (Boyd & Sheen, 2014). These tools assist the medical professionals to self-assess their safety practice performance and provide an opportunity for improvement (Cunningham et al., 2012). According to Girard & Parsons, (2012), Patient engagement is another important aspect of the person-centered care. Inclusion of patients in decision-making and collaborating with them to disseminate the information is an important approach of person-centered care (Lowthian et al., 2013). The ACSQHC intends to prioritize “clinical practice development” and to reduce the cost due to medical errors and redundancy (McFadden et al., 2014).

The commission has collaborated with “Royal Australian College of General Practitioners” in Australia and developed a framework for general practice accreditation. It aims to address the issues related to general practice and works to drive the goal of safety and quality improvement (Varghese, 2014). In order to improve the mental health safety, the commission has developed an appeal system and standards with “National Health Service” (NHS) for quality improvement of mental health services (McGorry et al., 2013). In Australia, cognitive impairment among aged population is a common issue. Hospitals are burdened with patients of dementia and Alzheimer’s disease (Roberts et al., 2009). The ACSQHC is engaged to “Therapeutic Advisory Group” to direct the quality use of mental health medication (Cunningham et al., 2012). 

Implementation of Quality Improvement Programs in Health Care Settings

The commission also undertakes nationally coordinated action to address health care-related infections and antimicrobial resistance through “infection control guidelines” (Mento et al., 2002). It focuses on the prevention of “airborne, contact and droplet standard infections” (Australian Institute of Health and Welfare (AIHW) (2015). This action is carried by ACSQHC in collaboration with Territory Department of Health (Moumtzoglou, 2012). Additionally, a “Knee Pain Advisory Group” is formed by the commission to address and improve the issues related to care delivered in knee osteoarthritis (Mumford et al., 2015). 

The Victorian State Government Department of Health and Human Services provides ten standards highlighting the “National Safety and Quality Health service” (Boyd & Sheen, 2014). The first standard deals with the staff and caregiver’s responsibilities. The staff responsibilities include right skills, organizational support, and patient engagement in decision-making and proper training (Olds et al., 2013). To accomplish the vision annual review is performed by the management. The second standard involves consumer partnering and emphasize on collaboration with patients for quality improvement of services (Healy, 2013).

Prevention and control of infection is included in third standard. It refers to maintenance of aseptic conditions and hygiene by regular cleaning and sterilization of the equipments and medical instruments. Strict guidelines are set for the staff. It mandates the clinicians to “adopt the antimicrobial stewardship programs” for patient support (Spooner et al., 2016). The fourth standard refers to prevention of medical errors and it adverse health effects. It explains provision of timely medical care to the patients, administration of correct medicines in right dosage and extra care while handling high-risk medicines (Boswell et al., 2015)

The fifth standard includes “Patient identification and procedure matching” (Cunningham et al., 2012). It refers to stringent hospital conditions in correct identification of patient’s name and specific clinical condition and medication for which they are entitled (Staggers & Blaz, 2013). There are several incidences of major health adversities due to maladministration of hospitals. Current practices include identification of patients with specific ID card and bands or other suitable measures (Healy, 2013). Clinical handover is the sixth standard refers to timely update of handover documents. It focuses on patient inclusion in decision making, discharge planning, maintaining the confidentiality of collected information (Hannaford et al., 2013). The seventh standard is the management of blood and blood products to eliminate the immunological complications arising due to error in clinical transfusions. Correct blood transfusion is essential for patient’s survival. The standard refers to responsibilities of staff in maintaining, efficient handling and storage of blood products (Engelbrech et al., 2013). Additional precautions should be taken for intravenous access equipments and a careful monitoring is required while transfusion (Moumtzoglou, 2012).

The eighth standard deals with “preventing, and managing pressure injuries”. It highlights the strategies for preventing injuries. It also involves comprehensive skin assessment (Thomas & Mackintosh, 2015). Pressure injury is highly associated with “immobility” during hospital admissions (Thomas & Mackintosh, 2015). This area demands implementation of appropriate management plans. The other parameter is the “analysis of risk assessment” during the patient transfer (Swayne et al., 2012). The ninth standard is “Recognition and responding to clinical deterioration” in acute care facilities. The care providers need to identify and respond quickly to prevent any sudden death due to cardiac arrests and other related factors (Varghese, 2014). The standard refers to “Regular monitoring of physiological changes” and communicating the information to the family members of the patient and assists them with their concern (Pascoe et al., 2014).

Benefits of Quality Improvement Programs in Health Care Settings

The tenth standard deals with the prevention of falls in hospital and its harm. There must be adequate care facilities for disabled and aged patients. Majority of the falls are preventable if appropriate measures are taken (Lowthian et al., 2013). Therefore, adequate strategies must be developed to prevent falls. Staff must assess each patient and note the risk of falls. Additional care and preventive measures should be taken at the time of discharge, handover and transfer of the patients (Moumtzoglou, 2012).

According to the “Alfred Annual Report”, there is increase in improvement of health safety and quality services due to growing awareness related to healthy lifestyle, sustainability of the environment by recycling and waste management and community involvement (Girard & Parsons, 2012). In addition, to the standards of Victorian State government, there are additional regulations for “the allied health services” (Will & Weinschreider, 2012). It mainly focuses on, CPD rural health; prevention of workplace bullying, allied health graduates, heat waves associated health impacts and CCC framework. This framework directs the workers to develop structures and processes for “effective health workforce based on credentialing, competency, and capability” (Cunningham et al., 2012). 

Conclusion

Quality improvement is implementing safe health care practices that are “efficient, equitable, timely and patient centered”. This level of focus on quality improvement did not exist several years ago. In this assignment, the author has clearly depicted the importance of quality improvement and its role in service improvement within hospitals and health services. It highlighted several benefits of improving clinical and managerial processes. As evident from peer reviewed articles these improvement programs have a potential to make the major contribution in resource poor settings. According to Hibbard & Greene, (2013), “Demonstrable improvements in quality may encourage greater investment in health systems in developing countries by increasing donor, population and governmental confidence that resources are being used well”. The concept of “data-driven” as meaningful quality improvement is well justified. Managed care indicates the “management of care processes” and not the management of doctors and nurses.

The author has given an insight into the role of both “Australian Commission on Safety and Quality in Health Care (ACSQHC)” and “Victorian State Government Department of Health and Human Services” which provides safe and quality services based on the ten national standards. The commission has developed national safety standards, accreditation schemes are formulated and implemented and develops health related databases. The committee has laid a proper framework for managers, leaders, physicians, nurses and other health care professional who will be influenced by the goal to change the quality existing services. It works towards the goal by reducing the unwarranted variations in practice methods. In addition, it also undertakes nationally coordinated action to address health care-related infections and antimicrobial resistance. Taking into consideration, the guidelines, health standards, and accreditation schemes there will be the improvement in evidence-based care, person-centered approach, patient engagement, increased fall prevention, protective blood transfusion and control of health care-related infections. 

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