Quality presentation for HANOI

QUALITY How should we think about it for our Mental Health Services? Victor Storm Director of Mental Health, Sydney & South Western Sydney Local Health Districts National Institute of Mental Health, Bach Mai Hospital, Hanoi October 2012 Disclosures  My trip has been funded by my employer, Sydney Local health District  I have not received funds from any other agency or company to give this talk  The ideas that I present are my perspective, developed from reading & discussion with many colleagues, several of whom are here in Hanoi  I have no other conflicts of interest or disclosures Talk Outline  IDEAS have a half life of ideas; meso-facts & examples of change  What were the major impacts on improved health outcomes?  What impacted on mental health services?  Principles that guide quality health care delivery  What has driven quality focus?  Methodologies & Tools for improving quality  The challenges to research and innovation from marketing Ideas have a half life - Arbesman  Many medical schools tell their students that half of what they've been taught may be wrong within five years—the teachers just don't know which half  Facts change in a regular, predictable manner and obey mathematical rules: “Once we recognize this, we'll be ready to live in the rapidly changing world around us.” Samuel Arbesman “THE HALF-LIFE of FACTS” Penguin 2012 This is an idea which has decayed over the past 50 years And Transformed into this: Australian Plain Packaging of Cigarette Packets Most of us need to be guided by basics We should start with basic principles; this way you avoid mistakes This is essential when scientific knowledge and understanding is fluid & dynamic The aspiration of healers over centuries has been to promote health & healing and to minimise harm Quality has been implicit in the delivery of service What have been past major QUALITY Initiatives for health?  Access to clean water  Mass Immunization  Control of sepsis (particularly in child-birth)  Literacy (particularly for women)  Therapeutic advances (antibiotics etc) have had lesser impacts  Major impacts on health now will be achieved by Smoking cessation, minimising alcohol consumption, dietary management and weight control and regular exercise What about Mental Health care?  Major impact was offering care in safe & secure environments; development of asylums  Most people who entered left within 3-6 months  BUT over time an aggregation of people who had illness without recovery led to overcrowded facilities, with poor quality care This often gave rise to public scandal  Impact of ECT and Psycho-tropics medications had a major impact on those who remained in asylums for extended periods What should health care be?  SAFE : avoiding injuries to patients from the care that is intended to help them  EFFECTIVE: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit ( avoid underuse and overuse)  PATIENT CENTRED: Providing care that is respectful and responsive to patient preferences, needs and values and ensuring that patient values guide all clinical decisions Health System Performance Domains from Key Performance Indicators for Australian Mental Health Services  Continuous: Ability to provide uninterrupted, coordinated care or service across programs, practitioners, organisations and levels over time (Sub-domain - Metric: Continuity between providers - TBD; Cross-setting continuity - Preadmission & Post –discharge community care ; Continuity over time -TBD Health System Performance Domains from Key Performance Indicators for Australian Mental Health Services Responsive: Service provides respect for persons and is consumer and carer orientated: respect for dignity, confidential, participate in choices, prompt, quality of amenities, access to social support networks, and choice of provider (Sub-domain-Metric: Consumer & carer experience of care; Consumer & carer participation-Consumer outcomes participation))  Capable: An individual or service’s capacity to provide a health service based on skills and knowledge (Sub-domain - Metric: Provider of skill & knowledge -TBD; Outcomes orientation-Outcomes readiness)  Health System Performance Domains from Key Performance Indicators for Australian Mental Health Services Safe: Potential risks of an intervention or the environment are identified and avoided or minimised (Sub-domain - Metric: Consumer safety-Rates of seclusion; Carer safety - TBD; Provider safety - TBD; Community safety - TBD)  Sustainable: System or organisation’s capacity to provide infrastructure such as workforce, facilities and equipment, and be innovative and respond to emerging needs (research, monitoring) (Sub-domain – Metric: Workforce planning- TBD; Training investment -TBD; Research investment -TBD)  Innovations  Research & its application Often takes much longer than we would wish  Essential we are driven by hard evidence (not just publication)  Scepticism is healthy and we should ask for detail  How transparent is the information?  Are conflicts declared and whose interests are served by the application of innovation?  How we deal with skilled marketers? The lessons learned from the skilled marketing/advertising of two legal drugs And when public health experts get into marketing Direct to Consumer (DTC) Marketing Direct to consumer (DTC) DTC Spending in USA 1996-2012 WHY DTC is done An approach to any quality initiative References  Samuel Arbesman “The HALF-LIFE of FACTS” Penguin 2012  UK National Health Service NHS 2001: Building a Safer NHS for Patients: Implementing an Organisation with a Memory  National Institute of Clinical Excellence (NICE) Clinical Guideline 136 2011:Service User experience in adult mental health: Improving the experience of care for people using NHS adult mental health services References  USA: Institute of Medicine (IOM) 2001: Crossing the Quality Chasm; A New Health System for the 21st Century  Australia NATIONAL MENTAL HEALTH PERFORMANCE SUBCOMMITTEE 2011: Key Performance Indicators for Australian Public Mental Health Services SECOND EDITION References : Websites  Australian Council of Health Care Standards (ACHS) http://www.achs.org.au  The Joint Commission (USA) www.jointcommission.org  The National Institute for Health & Clinical Excellence (UK) http://www.nice.org.uk ... System Performance Domains from Key Performance Indicators for Australian Mental Health Services Responsive: Service provides respect for persons and is consumer and carer orientated: respect for dignity,... satisfaction surveys  Formal External Accreditation of Health Services Specific Tools  Continuous Quality Improvement (CQI), Total Quality Management (TQM) or other variants  Quality assurance... any quality initiative cycle Determine Priorities  Plan Action  Implement Action  Measure Impact  Refine Process & again Health System Performance Domains from Key Performance Indicators for