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Towards A Safer Culture in New
South Wales (cont.)
Significant Buy In From Frontline
Clinicians
A pre and post survey of 295
TASC phase one staff showed that attitudes towards
use of Clinical Practice Guidelines compared
more favourably than a recent systematic review,
Farquhar et al, MJA, Vol 177, Nov. 2002.
Changes in staff attitudes are important indicators of efforts to embed a culture
of continuous practice improvement since they have occurred within a context
of continual staffing changes, i.e. they are not so much reflections on individual
learning (as would be the case if the same clinicians had responded to both
surveys), as changes within the culture in which a mobile workforce practices.
Consistent Process Design and
Management
There is significant gains to be made from consistent
process design and management across the health
system. State-wide standardised processes and
systems enables learning be put into the practice
to reduce adverse events and or improve efficiency
across NSW.
More standard processes enable learnings to be shared and reduces issues related
to an increasing mobile workforce. It also assists in benchmarking, design
of fault tolerant processes and process redesign and automation. The amount
of work involved is large and priorities need to be set where there is good
evidence and management that understand the issues.
The TASC project has developed “generic
Area Health Service” ACS and stroke assessment
and management documents that facilitate the “standardized” approach
and streamlines the transfer of patients within
the Area Health Services (AHS). Rotation of particular
medical staff, i.e. medical registrars within
several AHS and the implementation of a “standardized” approach
to the assessment of the patient and subsequent
documentation will enhance the risk management
approach.
There has been considerable work through the
GAP and GMTT initiatives.
Even greater gains are to be had through closer alignment between these processes.
Clinical Governance and Clinical
Leadership
There are many people involved in TASC such
as cardiologists, neurologists, advance trainees,
ED physicians, residents, general physicians,
allied health, IT and other staff.
A strong emphasis of the project has been to
support clinician leadership by providing significant
amounts of training and education in CPI, EBM,
leadership, data analysis, IT systems, and root
cause analysis.
As a result, clinicians are playing a key role
in determining priorities for allocation of resources.
In areas such as creation of liaison nursing
positions, call-in rosters for overnight medical
registrars, availability of weekend exercise
stress tests, and in setting priority levels
for CT scanning of stroke patients, the TASC
clinicians are closely involved in resource allocation
decisions.
Further
information:
Dr Drew Fitzpatrick
Nepean Hospital,
Ph. (02) 4734 2605
fitzpad@wahs.nsw.gov.au
Dr Christopher
Levi
Hunter Health
Ph: (02) 4921 3490
clevi@doh.health.nsw.gov.au
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