Advancing Patient Safety
through Leadership and
Accreditation
Philip Hassen
Immediate Past President, ISQua
March 13, 2013
Objectives
1.
Increase understanding of the importance of
leadership as a key factor in advancing safety
and improvement.
2.
Build greater understanding about need for
change.
3.
Understand how the accreditation process can
enable change and improvement.
4.
Provide a Canadian example about how to
advance quality & safety for patients.
2
Why do we need to improve?
“Our current methods of organizing and delivering care are
unable to meet the expectations of patients and their families
because the science and technologies involved in health care
- the knowledge, skills, care interventions,
devices, and drugs –
have advanced far more rapidly than our ability to deliver
them safely, effectively, and efficiently.”
The Robert Wood Johnson Foundation 1996
1. Why do we
need to
improve?
2. What is the
role of
leadership?
3. How
accreditation
enables change
&
improvement?
4. How
Canada has
advanced
safety &
improvement?
Why do we need to improve?
“Medicine used to be
simple, ineffective &relatively safe.”
“Now it is complex, effective, and
potentially dangerous.”
Sir Cyril Chantler
4
Why do we need to improve?
In Canada and most developed countries...
One in ten
One in ten
adults
contract
infection in
hospital
patients
receive
wrong
medication
or wrong
dose
More deaths
after experiencing
adverse events in
hospital than
deaths from
breast cancer,
motor vehicle
accidents and
HIV combined
Why do we need to improve?
World Health Organization – Facts
Adverse Events
 1.4 million Hospital Acquired Infections
 1.3 million die from unsafe injection
 Cost - $6 – 29 billion
Developing Countries
 20 times higher
 Up to 70% of syringes reused
 Cost Lives and Suffering
6
7
8
9
10
Without change
there is no innovation, creativity, or
incentive for improvement. Those
who initiate change will have a better
opportunity to manage and lead the
change that is inevitable.
-William Pollard11
Leadership and Culture
Foundational to every organization which has made
significant advances in quality and safety in health care,
there exists a culture which instills the importance of
patients, residents, clients and families they serve. The key
role of staff is service delivery and safety improvement while
realizing the strategic imperative of
leadership.
1. Why do we
need to
improve?
2. What is the
role of
leadership?
3. How
accreditation
enables change
&
improvement?
4. How Canada
has advanced
safety &
improvement?
Leadership is…
A set of processes that creates organizations in
the first place and defines what the future should
like and inspires people to make it happen
Establishing direction by developing vision & leading
by values
 Aligning people & building commitment
 Inspiring people to overcome obstacles to bring about
change
 Communicating more in actions & in words through
dialogue

Source: J. Kotter. Leading Change. 1996
13
“Research has shown that people consistently select four
characteristics to describe the leaders they would choose
to follow…”
Kouzes, J. & Posner, B. (2007, p. 29). The Leadership Challenge (4th Ed).
Honest
Forward
Looking
Inspiring
Competent
Culture and Leadership
Engage management
and senior decision
makers
 Focus safety not just as
another program but as
a key priority
 Improve
worklife/workforce and
working conditions
 Build partnerships with
patients & families

15
Leadership is…
“A good leader inspires people to have confidence
in the leader; a great leader inspires people to have
confidence in themselves.”
Author Unknown
16
Leadership … Character & Competence
Stephen Covey, 1990, Principle-Centered Leadership
Competence
Leaders
Professional focus |
Knowledge | Skills |
Behaviors |
Methods & Tools
Character
Personal Focus |Values
| Integrity | Courage |
Creativity
17
Leadership is a learnable, teachable and measurable set
of behaviours & practices
Kouzes, J. & Posner, B., 2007, The Leadership Challenge
Model the
way
Encourage
the heart
Inspire
shared vision
Enable
others to act
Challenge
the process
18
“Winning companies know that,
like athletes, no matter how good or
bad a person’s inherent leadership
skills are, they can be improved with
coaching and practice”
(Noel Tichy)
19
Leadership Checklist
Build a safety culture
 Listen and support staff
 Integrate risk management activities
 Promote reporting
 Involve patients/clients, families and the public
 Learn and share safety lessons
 Implement solutions to prevent harm

Source: Charles Vincent, 2006
20
Accreditation : Enabler of Change
“Accreditation is a self-assessment and external
peer review process used by health care
organizations to accurately assess their level of
performance in relation to established standards
and to implement ways to continuously improve
the health care system.”
1. Why do we
need to
improve?
2. What is the
role of
leadership?
3. How
accreditation
enables change
&
improvement?
4. What Canada
has advanced
safety &
improvement?
External Evaluation
Improvement & Change
 Regulatory
 Licensing
 International
Organization for
Standardization (ISO)
 European Foundation of Quality
Management
 Accreditation
23
What is Accreditation?
Strategic change and risk
management tool
 Proactive and continuous
 Transparent and rigorous analysis
of service provision
 Addresses current and future
patient needs facilitated by:




Independent third party
Quality Improvement focus
Objectivity
What is Accreditation?
Accreditation
Is a
process
24
Not an event
Why the demand?
 Accreditation
of healthcare services is in
demand in many countries:
 By government, funders, patients and
communities
 They all want to know that care is SAFE
 That treatment is effective
 That limited resources are used efficiently
Accreditation supports...
Quality improvement
 Patient safety
 Risk management
 Change management

26
Does accreditation make a difference?
 Better
communication and
collaboration
 Stronger
teams
 Increased
credibility and
accountability
27
Value and impact of accreditation:
A literature review by Accreditation Canada
(2011)
25 Benefits (examples)






Provides a Risk Mitigation System
Strengthens interdisciplinary team effectiveness
Improves communication
Promotes measurement and use of indicators improvements
Is not clear whether it increases patient satisfaction
Captures data
Does improving quality save money?

A review of research into productivity and the economics
of continuous quality improvement (CQI)



Unsafe care is expensive
Improving clinical co-ordination saves money
CQI can reduce costs for some processes
Øvretveit 2009. The Health Foundation.
1. Why do we
need to
improve?
2. What is the
role of
leadership?
3. How ISQua
Accreditation
enables change
&
improvement?
4. How Canada
has advanced
safety &
improvement?
Why ISQua Accreditation?
International Accreditation Programmes (IAP)
are varied in approach and content
 ISQua accreditation helps to standardise by
providing



current evidence based standards, self-assessment,
peer review and consistent application
all organisations despite maturity level assessed
against the same standards
Accrediting the Accreditors
International Accreditation
Programmes (IAP)



Standard
Organization
Surveyor Training Programme
IAP Awards to Date
38 organizations
 81 sets of standards
 15 surveyor training programmes

Setting exemplary standards
Accreditation Bodies 1951-2009
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25
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15
10
5
1951
1953
1955
1957
1959
1961
1963
1965
1967
1969
1971
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
0
Government
October 2010
Mixed
International survey results
Shaw et al, 2010 International Survey of Accreditation Organisations 2009
Independent
34
IAP International Reach

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Australia
Brazil
Canada
Columbia
Croatia
Czech Republic
Denmark
Dubai
Egypt
France
Hong Kong
India
Indonesia
Japan
Jordan

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Kazakhstan
Korea
Kyrgyzstan
Malaysia
Netherlands
New Zealand
Norway
Philippines
Saudi Arabia
South Africa
Spain
Taiwan
Thailand
United Kingdom
United States
Other ISQua Healthcare &
Patient Safety Activities
IJQHC
SIG
Special Interest
Group in Quality
of Social Care for
Older Persons
Conference
New
Education
Fellowship
Experts
Strategic Alliances
World Health Organisation (WHO)
 Health Technology Assessment International
(HTAi)
 Canadian Patient Safety Institute (CPSI)
 University Research Consortium (URC)
 International Hospital Federation (IHF)

Accreditation : Canadian Example
1. Why do we
need to
improve?
2. What is the
role of
leadership?
3. How does
accreditation
enable change
&
improvement?
4. How
Canada has
advanced
safety &
improvement?
2012 Canadian Health
Accreditation Report


39
Required Organizational
Practices (ROPs):
Emerging Risks,
Focused Improvements
www.accreditation.ca
40
Patient Safety . . .
Is quality and safety
improving in Canada?
41
Canadian Example
Accreditation Canada working with
Canadian Patient Safety Institute
Some Results:





Ventilator Associated Pneumonia
Acute In-Hospital Myocardial Infarction
Surgical Site Infections
Central Line Infections
Medication Reconciliation
42
Ventilator Associated Pneumonia
(VAP)
• Between Nov/05
and Oct/07,
teams
decreased VAP
rate per 1000
ventilator days
by more than 50
per cent
• VAP rate
dropped from an
average 10.48 to
5.21
Canadian Patient Safety Institute
43
43
44
Acute Myocardial Infarction (AMI)
• Mortality among AMI
inpatients has
decreased from 9%
in 2005, to 4% in
2007
• Of the 7640 AMI
patients for whom
data was submitted
in the first 2 years,
640 died
• In the following year,
the morbidity rate
decreased to, 247 of
4063 patients
The number of patients dying after admission to the hospital
with a heart attack has decreased by almost 50%
Canadian Patient Safety Institute
44
45
Surgical Site Infections
Teams
decreased the
number of
post-operative
infections in
clean surgical
patients from
six to four
percent in the
first 18-months
Surgical infections declined
Canadian Patient Safety Institute
45
46
Central Line Associated Bloodstream
Infections
Teams reported a
reduction in rate
of central-line
associated
bloodstream
infections per
1000 central line
days from an
average of 3.2 for
the first 17
months to 1.78
over the next 19
months - 44%
reduction
Teams have reduced the rate of central-line associated
bloodstream infections
Canadian Patient Safety Institute
46
47
Medication Reconciliation
• Discrepancies occur when
prescriber has unintentionally
changed, added or omitted a
medication a patient was taking
prior to admission
• By completing best possible
medication histories and by
implementing the process of
medication reconciliation, the
Adverse drugs events are being reduced
through medication reconciliation
rate of unintentional
discrepancies has
decreased by 50 per cent
since the initiative was introduced
• The average rate of
discrepancies decreased from
1.02 in 18 months to an average
rate of 0.61 discrepancies
Canadian Patient Safety Institute
47
What is Hospital Standardized Mortality
Ratio (HSMR)?
 HSMR tracks changes in hospital mortality rates in
order to:
 Reduce avoidable deaths in hospitals
 Improve quality of care
 Developed in the UK in mid-1990s by Sir Brian
Jarman of Imperial College
 Used in hospitals in several countries (i.e.
Canada, UK, Sweden, Holland and USA)
48
HSMR - Canada
 The distribution of HSMR for
facilities with at least
2,500 HSMR cases
 The purple bars reflect
fiscal year 2008-2009
 The blue bars reflect fiscal
year 2004-2005
 The chart refers to HSMR,
formerly referred to as
HSMR All Cases
 The chart in the 2007 HSMR
public report is for HSMR
excluding Palliative Care
which has been discontinued
Conclusion: Canadian Hospitals saw a reduction of
approximately 20-25% lower mortality over a 4 year effort.
49
Advancing Patient Safety through
Leadership and Accreditation
1.
Increase understanding of the importance of
leadership as a key factor in advancing safety
and improvement.
2.
Build greater understanding about need for
change.
3.
Understand how the accreditation process can
enable change and improvement
4.
Provide a Canadian example about how to
advance quality & safety for patients.
50
“We are on a journey - a journey that will take enormous
efforts to change. It is clear that improvement in patient
safety and quality will take time, but the time for
change is now. Our patients, residents, families and
communities depend on providers to start now and
commit to the difficult yet achievable work ahead”
51
(Hassen & Dingwall, 2008)
Thank you!
Mission
Inspiring, promoting and supporting
continuous improvement in the quality and
safety of healthcare worldwide