Glasgow Obstetrical & Gynaecological Society, 110th session
www.gogs.org.uk
Minutes of the Fourth Meeting of the 110th Session of the Glasgow Obstetrical and
Gynaecological Society held in the Royal College of Physicians & Surgeons, St
Vincent Street, Glasgow on 23rd February 2011
The President, Dr Elaine Melrose, was in the chair.
Apologies were received from:
Drs Lunan, McNay, Mackay, Kearney, Gemmell, Pringle, Perera
Applications for membership were accepted for Dr Pamela Blair, proposed by Dr Jane
Richmond, seconded by Dr Rita Panigrahy
In attendance – 22
PRESENTATION
Dr Melrose welcomed the speaker for the evening, Dr Jason Leitch, National Clinical
Lead for Quality in the Scottish Government, who talked to the society on ‘What does
quality mean in NHS Scotland?’. A dentist by trade, he is in the middle of a 5 year
secondment to the Scottish Government.
In Dr Leitch’s inspirational talk he started by encouraging us to read the Robert Francis
report into Mid Staffordshire, particularly the raw testimony
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGui
dance/DH_113018
He then encouraged us to realise that none of us is as good as we think we are, again
recommending the writings of Atul Gawande, surgeon, author & writer for the New
Yorker.
In general, studies have shown that about 45% of patients get the appropriate care
package, while 55% lack some aspect of care.
About 25% of patients are harmed by coming into hospital eg by infection, drug error,
wrong surgery etc.
Systems for reporting have been archaic, relying on voluntary reporting. A scale of harm
from A to I is used, with A-D being near misses, and I being death.
Jason mentioned the reporting of maternal deaths and SCASSM which we are familiar
with in obstetrics but admitted that this was not his area of expertise.
He then compared ‘efficacy’ with ‘fidelity’ pointing out that much more money is spent on
the former, which is based on research, compared with the latter which is much more
important ie ‘getting information that is already known about out where it is needed’.
About 90% of the harm caused in the health service is system based rather than
because of bad medical practice.
The example of the ‘Surgical Safety Checklist’ was given which has now been published
by WHO. Its wide use has greatly reduced the harm caused to patients at the time of
operation. The use of first names for staff was given as an example which reduced
harm, encouraging a more open atmosphere in theatre. Many of the lessons we are
learning now were learned by the airline industry 30 years ago. Another example was
the use of checklists which again greatly reduced harm. Interestingly when asked if they
would introduce a checklist, only 67% of surgeons said yes, but when asked if they
would like one to be used if they were undergoing surgery, 99% said yes.
One of the major ways to encourage reporting is to ensure a no blame culture. The aim
is to see reporting rates rise significantly while actual events fall.
Jason mentioned the Scottish Patient Safety Programme
(http://www.patientsafetyalliance.scot.nhs.uk/programme) and the Institute for
Healthcare Improvement (www.ihi.org) which he has been very involved with.
The Scottish Safety Programme aims to reduce mortality in Scottish hospitals by 15%
and adverse events by 30% between Jan 08 and Dec 12.
The primary outcome is to develop and build a quality improvement and patient safety
culture in our hospitals, with long term sustainability and capability to drive this approach
at all levels. This will involve a culture change in staff.
The model for improvement considers
o What are we trying to accomplish
o How will we know that a change is an improvement
o What change can we make that will result in an improvement
He described various interventions which have been studied eg ventilator acquired
pneumonia bundle. This has led to a virtual eradication of VAP from ICU in Glasgow
Royal Inf.
The Hospital Standardised Mortality Rates (HSMR) in Scotland were then described
showing various trends for different units. The fall is currently sitting at 5%. As the aim is
a 15% reduction in hospital deaths, a significant amount of work needs to be done to
achieve this.
Jason assured us that it should be easier to achieve in 2011 than 2008 because of
improved workforce (with SPSP fellows, improvement advisors, programme managers,
infection control teams) along with an established ‘walkaround’ system, more non exec
involvement and a higher profile of quality and safety at board level.
The perinatal white paper published by ihi suggests drivers to reduce harm, providing
woman centred care.
http://www.ihi.org/IHI/topics/perinatalcare/perinatalcaregeneral
http://www.ihi.org/IHI/Results/WhitePapers/IdealizedDesignofPerinatalCareWhitePaper.h
tm
Finally Jason mentioned the Healthcare Quality Strategy for NHSScotland which he said
he would not have believed could have been produced when he first started.
http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf
The 3 ambitions are to provide
o Person centred care
o Clinically effective care
o Safe practice with no avoidable injury or harm to patients.
At the end of his talk, Jason pointed out that while he had been speaking 27 patients
would have been harmed while in hospital.
There followed a lively question session at the end of which the vote of thanks was given
by Dr Mathers.
AOCB
Dr Melrose thanked Hazel Newbigging of Hologic for their generous sponsorship.
Members of the society were reminded that the next meeting is on 23rd March when Tim
Overton, Consultant in Fetal Medicine Bristol will give the William Smellie Lecture
“Expecting the Unexpected”.
…………………………………………………President