Quality and safety the
national context
RCSI Masterclass
6-11-12
Dr. Philip Crowley, National Director Quality Improvement
The challenge that faces us
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Budget
Medical and nursing recruitment and retention
Limited measurement of quality
Media and morale
New divisions – focus vs integration
Fire fighting (comfortable) Vs process, practice and
care improvement
Nursing and Midwifery Developments

Expanding roles
 Nurse
and Midwifery Prescribing (medicinal products
and X-ray)
 Advanced practice (eg EDs, sexual assault, chronic
disease mangement)
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Driving key safety initiatives
 NEWScores/IMews
 Collaboratives,
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pressure ulcers, falls
Measuring Care (Nursing and midwifery) metrics
Leading Quality Improvements
Mid Staffs and nurse leadership
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Presented to HSE leadership team X 2
Communication to system re acting up
Audit:
 229
CNM2/CMM2 posts acting up
 = 14%
 Ongoing support for developing CNM/CMM2
competency
 Moderate levels of empowerment, time to lead?
 And DoNs, ADoNs, CNM3???
Flipping Healthcare
Move from
“What’s the matter?”
to
“What matters to you?”
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The patient is not the problem (Muir Gray)
“Minimally Disruptive Medicine” (Victor Montori)
Having conversations with the patient, understanding patients (not just
their diseases) and their lives
Patient goal setting
Source: Barry MJ, Edgman-Levitan S. ”Shared Decision Making – The Pinnacle of Patient-Centered
Care.” N Engl J Med. 366;9. pp 780-782. Montori, VM. “Shrinking the health care footprint.” Minnesota
Physician. XXV(1). April, 2011
Quality led by Staff
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Staff experience – seek and value feedback and ideas
for improvement
Quality and safety Walk-rounds
Enable people to do a better job
‘Walk in my shoes’
Do reinvent the wheel
QI Tools
Driver Diagram
Run Chart
Greatest impact at ward level
Leadership
Patient involvement
Clinical Governance
Education & Learning:
- Measurement
- QI Methods
Pathways
Guidelines
EWS
Collaboratives
Conditions
Quality Improvement of Patient care
National
Trust
Ward
Increasing capacity for QI
Now over 200 staff
trained in QI from the
Diploma, Scottish
Patient Safety and
CAWT Programmes.
Pressure Ulcer to Zero Collaborative
73% Reduction in Pressure
Ulcers
Collaborative methodology
February
April
June
Final Celebratory
Event
Overall Collaborative trend over time
25
20
15
10
5
0
February
March
April
May
June
July
August
Overall key learning was
Teamwork – the benefits
of working with a
team/group and
the visual impact of
keeping data’
Key learning was the
importance of
working together,
good collaboration
and communication.
Comments
If managers support
QI initiatives, teams can
achieve great results.
It’s all about teamwork
and communication with
a smile. Great team
building experience
My only advice or request
is if you could organise
the kind of learning sessions
often, that would be a great
help and encouragement.
Academic Hospital Groups
Academic Hospital Groups
Can we move from “teaching hospitals” to “learning
hospitals” and care settings?
Where learning together about how we can improve
quality and safety is at the heart of what we do
Clear roles for Quality and Safety

Board
 Providing direction and leadership
 Overseeing/obtaining
assurance on clinical care
quality and safety (Board Q +S committee)
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Executive
 Operationally managing clinical care quality and
safety (Executive Q+S committee)
Staff
 Delivering quality safe compassionate care
 Contributing
improvement solutions
How can QI division support you?
Quality Improvement
Division
Patients and
Staff
partnership
Quality
Improvement
Capacity
building
Quality data
analysis and
audit
Strategy and
innovation
Quality Improvement
“We have two jobs: our job and the job
of improving our job”
Donald Berwick
Philip Crowley
Philip.crowley@hse.ie
www.hse.ie/go/qps