The International Society for Quality in Health Care (ISQua) was established to promote quality and safety in health care through international cooperation and collaboration. In July 2019, the Commission on Excellence and Innovation in Health (CEIH) formed a formal partnership with ISQua.
Our membership aligns with CEIH’s strategies of partnering with expert organisations, knowledge translation and supporting capability development.
The membership gives CEIH access to international experts in quality improvement and evaluation methodologies including on-site support and advice on CEIH’s key projects. Membership also gives access to other ISQua resources such as webinars, conference talks and presentations, and membership of special interest groups. More information about memberships can be found on the ISQua Memberships webpage.
In August 2019, CEIH offered the opportunity to sponsor clinicians to attend the ISQua conference in Cape Town, including registration and up to $5,000 for travel and accommodation expenses. A total of 37 applications were received through an expression of interest process. The applications were from a range of professions, including allied health, nursing, medical, pharmacy and quality improvement projects, and locations such as CALHN, SALHN, NALHN, WCHN, community health and one regional LHN.
The successful applicants were:
Alana St John – Central Vascular Access Nurse Consultant, SALHN for Implementation of I-DECIDED tool with an aim to reduce hospital acquired infection related to peripheral intravenous catheters through improved documentation, assessment and management.
Angela Cavallaro – Clinical Nurse Neonatal Intensive Care, WCHN for Reducing late onset sepsis in preterm babies with the aim to reduce occurrences by 50% by increasing awareness for families, carers, siblings of the risks of infections for the babies therefore reducing the likelihood to them visiting when they are unwell with common colds and flu.
Shelley Fulton – Senior Occupational Therapist Day Rehabilitation Service, CALHN for Does prehabilitation for patients undergoing major lower limb amputation reduce hospital length of stay? The aim is to pilot a two to three week prehabilitation program to determine if there is a reduction in length of stay.
Victoria Allen – Psychologist Older Persons Mental Health Services, NALHN for Optimising provision of client care and personal wellbeing among staff caring for older adults with complex neuro-behavioural and enduring mental health presentations with the aim to improve staff wellbeing and quality of care through the delivery of a psychoeducational wellbeing program for staff who work with older adults with enduring mental health and or dementia.
The conference was held on 20-23 October 2019.
After returning, our delegates compiled their reflections on the conference, what they learned and how it will impact their future practice.
Victoria Allen, NALHN
NALHN Content of the ISQua information sessions which I attended focused on person-centred care, co-production, risk management, staff wellbeing/resilience, and human factors/ergonomics. Of particular, relevance to my discipline (psychology) and project was information related to person-centred care and staff wellbeing. During a presentation, “Practical Pearls” for staff wellbeing, the following quote resonated with me: “using staff values to guide action”. Other presenters in this conference stream built on this concept by discussing how outcomes can be optimised within the workplace by creating joy, meaning, and purpose within the work environment for staff. To me this represents a positive and strengths-based approach which has the potential to facilitate a meaningful shift in workplace culture which could be of benefit to both staff and consumers. I hope to hold this in the forefront of my mind in approach current and future projects.
There are a number of ways in which attendance of the ISQua 2019 Conference will inform my project aimed to promote staff wellbeing at Northgate House. The theme of collaboration, apparent across co-production sessions, highlighted the importance of gaining further input from staff before finalising the content of information sessions which I intend to deliver. I now intend to complete a staff survey regarding preferences for information sessions to ensure that information sessions are truly reflective of and tailored to staff needs. ISQua information sessions/presentations on staff wellbeing in healthcare settings also highlighted the significant rates of burnout in this field and implications for client care. These presentations provided details of assessment tools I had not encountered previously and would consider including as part of my quality improvement project.
Seeing the passion of presenters at the conference and the reception which research regarding healthcare worker wellbeing received at the ISQua 2019 Conference, I am motivated to present and disseminate results of my own quality improvement project upon its completion. I had not considered this previously and believed that presenting research at international conferences was largely geared towards academics rather than practicing clinicians. As such, this experience has given me confidence that my quality improvement project addresses a significant issue and would be of interest to the broader healthcare community.
I believe that my perspective regarding the potential impact of quality improvement projects in healthcare has markedly expanded following attending the ISQua 2019 Conference. I have been fortunate to have the opportunity to network with international research and gained exposure to other disciplines and realms of research which will inform my ongoing practice as a clinician and shape how I implement quality improvement project/s in the future. Attending the ISQua 2019 Conference also strengthening relationships and built partnerships with other clinicians within SA Health and I believe not only do I now have access to a number of bright minds and leaders within various areas of SA Health but I also am fortunate to have established new friendships.
Angela Cavallaro, WCHN
ISQua’s 36th International Conference was an amazing experience. Cape Town was so vibrant and picturesque but revealed ongoing signs of socioeconomic division, gender division and cultural division. This created the perfect place to host an improvement, safety and quality conference and bring together a fusion of people to learn and teach about an important worldwide issue. For clinicians all over the world, to make a difference in the quality of care we provide, we need to be diverse, have an understanding of cultures and include many fundamental principles in our everyday clinical practice to continuously improve and provide safe, quality healthcare to all our patients. The four days covered many interesting, relevant and current themes within the area of patient safety and quality improvement in healthcare. I was also given an opportunity to showcase a clinical practice improvement project I have been working on in neonatal care. This was an amazing opportunity and a great personal achievement.
Patient centered care – one speaker spoke about the biggest obstacle for her was convincing staff that the patient was at the centre of care. At times we all need reminding of this simple principle, the reason why we work in health. Outcomes aren’t just about numbers or KPIs but are about actual patients and all that comes with them. The support they receive isn’t just about the social worker visiting but how the whole family support fits into the bigger picture. I heard many stories and evidence about how listening to patients and their families alone leads to the simplest form of improvements. We often ‘listen’ to people and their complaints but acting and making simple changes can make such a difference in the patient’s experience. I heard about simple changes such as menu improvements improving patient nutrition, improvements in family support networks, housing and antenatal support care reduced preterm deliveries, all just by listening to what actually helps the patient from the patient. It can be really simple. We just need to listen more and act.
The simplicity of what lower socioeconomic countries do to improve healthcare, like Ghana, Bosnia, Zimbabwe, Namibia and South Africa really emphasised that the basic approach is often the most practicable. There were many discussions about safe and affordable healthcare. It was fascinating to hear about the quality improvement initiatives happening in the poorest nations. Their focus is more about delivering care and saving lives as they work with minimal budgets with no other option. They do this work over and above their everyday practice because they are passionate about saving lives. Their priorities are consistently reducing mortality and morbidity rates and what may seem like such simple interventions or changes can have colossal effects.
Reducing sepsis is an issue worldwide but it was so interesting to hear how third world countries are constantly battling lack of equipment and resources, with many organisations resorting to reusing equipment such as IV cannulas as they have minimal access to sterile stock. This saddened me because the access to equipment is something we take for granted and to think that people are dying from sepsis because they needed a cannula in an emergency was heartbreaking.
During a learning journey, a Doctor from Rwanda spoke about improving the mortality rate amongst women having ectopic pregnancies. These women would attend a clinic and they could not diagnose the ectopic pregnancy early because they did not have scanning facilities. We had an opportunity to brainstorm ideas as a group were able to offer suggestions from our own experiences. He was so excited about the improvements he could make by empowering his staff. This really highlighted the issues many of these countries have with lack of resources, hierarchy and inequality of roles. I reflected on how lucky I am to work and live in such a fortunate country.
In an attention grabbing presentation on patient’s medical records – ‘What are they? What is their main purpose?’ a presenter asked the audience questions. An organisation in the USA has implemented a medical record accessibility program, where patients are encouraged to read their record and charts. A clinician was available to explain or answer any questions. They also had an opportunity to add to their record if there was any information missing or updates that had been missed- after all they know themselves best! This is also starting to develop in one Australian hospital. I thought this was an exciting concept and advancement in patient centered care and shared decision making. I would love to see develop more in our own organisations.
Overall the opportunity to attend this ISQua conference was a brilliant experience. I made new friends, networked and made many professional connections with clinicians from all around the world who all had a passion for patient safety. It gave us an opportunity to beat the drum together and create enthusiasm in such a universally important area of health care. I learnt so much from this conference and have so much to share with my colleagues.
A speaker quoted -Arthur Ashe ‘Start where you are. Use what you have. Do what you can.’ This is true for clinicians from all over the world. We can all make a difference.
Thank you to the Commission of Excellence and Innovation in Health for this incredible opportunity.
Shelley Fulton, CALHN
My experience travelling to Cape Town for 2019 ISQua conference was memorable. The most notable and relevant learning for me was around the term coproduction. It stemmed from a presentation that highlighted the fundamental difference in the delivery of healthcare, in it being a service rather than a product. Furthermore, presentations reflected on the different ways health services have engaged clients in this process. The revolving terminology use, from patient centredness, patient engagement, patient experience etc was discussed. Services, however, are fundamentally different than products. Unlike goods, services always involve the interface of two parties. This is where the term coproduction was coined. Coproduction involves the coming together of: the lived reality of a client, the system, science informed practice and the lived reality of the therapist or clinician (Batalden 2016). This learning has direct implications for SA Health, and more specifically, better embedding co-production in our CALHN project, ‘Does prehabilitation for patients undergoing major lower limb amputation reduce hospital length of stay?’ This involves clients who have participated in the prehabilitation program having an opportunity to be part of the decision making around key decisions including how the program is measured, where it is run and what it includes.
Other memorable conference presentations explored the nature of Universal Healthcare, particularly as the host country South Africa works towards universal healthcare in coming years. A thoroughly thought provoking and big picture plenary address by Rocco Perla looked at the role of government, policy makers and health services working with communities towards health rather than focusing on health care. Regardless of where a person came from, it was acknowledged that communities’ health priorities were for stable housing, employment, food security and access to healthcare.
Away from the Cape Town Conference Centre it was terrific to get to know and exchange ideas with the other SA Health conference attendees, surf a couple of times, explore the magic of Cape Town city and wander the hills around Table Mountain. A big thanks to the Commission on Excellence and Innovation in Health for the opportunity to participate in his memorable experience. With regards to the usefulness of the conference I would argue that SA Health representatives continuing to attend the conference will work to increase the knowledge sharing between ISQua and SA Health. This stronger relationship should help to increase opportunities for participation in ISQua fellowships. An unexpected benefit of attending the conference, with a small SA Health contingent, was the skill sharing and building of relationships amongst this group (a rare occurrence across LHNs and diverse professional backgrounds).
Alana St John, SALHN
In October 2019, I was one of the fortunate clinicians selected by the Commission on Excellence and Innovation in Health to attend the 36th International Conference for the International Society for Quality in Health Care (ISQua). This selection was based on my application which detailed a quality improvement project that I am leading at Flinders Medical Centre (FMC), titled the “I-DECIDED TM Peripheral Intravenous Cannula Improvement Project”.
The I-DECIDED PIVC Improvement Project aims to improve the insertion, documentation, assessment and management of Peripheral Intravenous Cannula’s (PIVC’s) across the Southern Adelaide Health Network to improve patient outcomes.
Approximately 50,000 PIVC’s are inserted at Flinders Medical Centre each year. Literature shows that up to half of PIVCs remain in-situ when not being used, 69% of intravenous (IV) catheters are associated with complications and up to 90% stop working before treatment is finished, requiring the insertion of a new device. The Australian Commission on Safety and Quality in Health Care released a draft Peripheral Venous Access Clinical Care standard in July 2019 which states that 4-28% of PIVC’s inserted are not clinically needed. This rises to 50% of PIVC’s inserted in emergency departments where they are often inserted as ‘just in case’ line at the time of blood sampling.
In 2019 a local PIVC audit demonstrated 9 - 20% of PIVC’s were in-situ without any clear clinical indication and that 40% had no documentation of insertion. 8-13% of cannulas had no documentation regarding dwell time and documentation of site assessment per shift was only completed 43-65% of the time.
Additionally, 22 - 97% (depending on ward/ area) of patients reported that they received consumer information however the FMC does not have consumer information relating to PIVC care and management.
The I-DECIDED PIVC Improvement project aims to improve documentation through the introduction of an evidence-based, clinical decision-making tool for intravenous device assessment and removal (I-DECIDED). The tool was developed by Dr Gillian Ray-Barruel, based on prior work on PIVC assessment and synthesis of evidence including best practice clinical guidelines, phlebitis assessment tools, decision algorithms, checklists and PIVC maintenance bundles.
The I-DECIDED PIVC Improvement project will also focus on PIVC insertion, management, education, competency assessment, consumables and ergonomics.
The ISQua 36th International Conference: “Innovate, Implement, Improve: Beating the Drum for Safety, Quality and Equity” was held at the Cape Town Convention Centre and ran over 4 days. The conference was well supported by approximately 1200 delegates and featured a full program with up to eight concurrent sessions.
The poster hall displayed over 500 posters and there were 250 presentations from speakers across 40 countries. This was the first time that the conference was held in South Africa and so it was widely attended by clinicians from across the continent. Listening to their stories and experiences of working in third world conditions/ health systems certainly provided perspective for many delegates. Below are my highlights from the conference:
1. Learning Journeys
For the first time, the ISQua included daily streamed learning into their program, titled ‘Learning Journeys’. They ran every day with one hour sessions at breakfast, lunch and mid- afternoon. Each session built upon the one prior, with every day focusing on different themes, including Data for Innovation, Improvement and Implementation, Co-Production in Healthcare and Patient Safety.
I particularly enjoyed a Learning Journey session on Co-Production where the presenters discussed ‘The Individual Formally Known as Patient’ and ‘The Individual Formally Known as Professional’. This session looked at how we as clinicians can gain a greater understanding of the lived reality of our patients (e.g. their goals, experiences, support systems, families, community) in order to improve healthcare and patient outcomes. Equally important is an understanding of the lived reality of healthcare professionals e.g. goals, experiences, work pressures, service demands, support systems, families.
2. Methods are Values in Action
The Tuesday morning plenary was thought provoking, as it questioned how we might improve the value of the contribution that the healthcare service makes to better the health of individuals and communities. Presenters discussed the difference between healthcare and health and how large amounts of money, energy and innovation have been invested into improving the quality and reducing the cost of healthcare and yet has overall health improved? When working with consumer focus groups, the presenter jested that consumers never once said “if only the average length of stay could be reduced across the organisation”. Although funny to hear, it does force one to consider the questions we ask (typically from databases), the data we collect to answer them and the choices they lead to that may well prioritise cost at the expense of health.
3. Safety through human factors and ergonomics
Several sessions focused on incorporating human factors and ergonomics into quality and safety improvement which I found particularly useful. Addressing systems and environmental factors minimise risk and chance of error to a larger extent than attempting to change human behaviour alone. Of particular interest was examining work ‘as done’ and not ‘as imagined’. For example, when looking at a change of practice, instead of using a written procedure as the baseline/ guide go and watch how this procedure is performed across an organisation on several occasions. It was suggested to film people in action/ or simulation if required and to then study the films to identify environmental and human factors that could/should be modified to improve practice and safety.
4. Patient narratives to improve care and diagnosis
This session was particularly powerful and emotive as it centred around one of the presenters; Helen Haskell and the deterioration and sudden death of her young son following an incorrect diagnosis in hospital. The session focused on strategies to engage patients in improving diagnosis and care, understanding that patients often have the least amount of power within the healthcare system. They discussed one strategy called “Be prepared, be engaged” which I thought had great promise, as it allows patients and families to be active participants in handovers. The patient is provided with a paper tool each day to collect their thoughts, questions and concerns. The patient then speaks first and last during handover using teach-back to ensure they have understood what has been discussed/ planned. All too often I have patients ask questions after they have seen their treating team. Patients often have questions but may forget them or not ask them as they perceive that they missed their opportunity to ask in the hustle and bustle of handovers. A film (by MedStar - available on the internet) titled “Please see me” was also played in which a patient and a doctor share their lived experiences and anxieties to each other.
Attending the ISQua’s 36th International Conference has inspired some changes/ additions to the I-DECIDED PIVC Improvement project including:
Incorporating patients lived experience into patient assessment, clinical decision making and teaching
Surveying our consumers to gain a greater understanding about what is important to them in relation to PIVC insertion, management and removal
Include patient narratives along with hard data to put a human face to complications
Watch and film PIVC insertion in key areas across the hospital, to identify improvements that could be made to processes or the clinical environment.
My sincere thanks to the Commission for Excellence and Innovation in Health for granting me this once in a lifetime opportunity!
ISQua will be holding their 2020 conference in the beautiful city of Florence and then onto Brisbane in 2021. Having the ISQua in conference in Brisbane presents a great opportunity for South Australian clinicians to attend this valuable conference so close to home!
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