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Quality Improvement and Patient Safety at Interior Health

As one of the province’s five regional health authorities, Interior Health (IH) is responsible for providing publicly-funded health services to more than 722,000 people in B.C.’s vast Southern Interior – an area the size of Great Britain.

Divided into four health service areas, IH has approximately 18,000 health care providers working within a complex “network of care,” including hospitals, community health centres, long-term and extended care facilities, mental health housing, primary health clinics, homes, schools and more.

Historically, patient safety and quality improvement activities have occurred in pockets throughout the region. The coordination of these has been a challenge for two reasons: the Southern Interior is a diverse mix of urban, rural and remote communities; and transportation in the mountainous region is frequently compromised by the weather.

In response to these challenges, Interior Health has developed an innovative approach to support a quality improvement and patient safety (QIPS) network across the region – one based on the idea that accelerating quality improvement depends on supporting and developing the capacity of the people on the ground, removing barriers where possible.

In 2008, the organization hired five regional patient safety coordinators. Four specialize in falls prevention, medication safety/medication reconciliation, surgical best practices and acute care best practices, and one specializes in the new Patient Safety Learning System (PSLS). These “mobile networkers,” armed with cell phones, laptops and videoconferencing tools, travel throughout the region year-round, moving from facility to facility to support clinicians in their local patient safety and quality improvement work.

Integration, alignment and practical support are the key principles of this approach. By moving between facilities the patient safety and PSLS coordinators integrate local improvement activities throughout Interior Health, bringing consistency and coordination to previously disparate activities. They also align activities with Accreditation Canada requirements and other standards with an overarching strategy, but do so with respect to the local context, capacity and creativity of care providers. This engagement strategy blends corporate leadership while encouraging and supporting locally contextualized improvement, supported regionally – a balance mirrored in another unique initiative at Interior Health.

This Fall, IH will launch a new certification program in Patient Safety Investigation (PSI) – the first of its kind in B.C. – to further develop the skills of site-based quality improvement staff. The PSI program includes using near-miss data to prevent and learn from adverse events. Through a mix of human factors /systems safety workshops, ongoing case-based mentorship and a community of practice, quality improvement and PSI staff will improve follow-up skills, creating and auditing the effectiveness of locally actionable improvements following incident investigations.

Front-line workers are also promoting patient safety and quality improvement through use of the Patient Safety & Learning System, a web-based learning and reporting tool that engages front-line workers in identifying safety concerns, making any changes required, and promoting safer patient care. Interior Health is leading the province in the implementation of PSLS, with the system already available across most acute sites and implementation underway in all other sectors by summer 2009.

In recent years, Interior Health has taken a number of other significant steps to promote a culture of patient safety and quality improvement. A new incident management policy engenders continuous improvement in the organization. The policy aims to ensure that patients, families and clinicians feel supported, and that the investigation of incidents is timely, comprehensive, consistent, and focuses on improving structures and processes in order to improve safety and quality overall. By June 1, 2009, all Chiefs of Medical Staff and Health Service Administrators received training in incident management and disclosure of unanticipated outcomes.

For more information about patient safety and quality improvement at Interior Health, please contact Wrae Hill, Corporate Director, Quality & Safety: wrae.hill@interiorhealth.ca

For more information about the BC Patient Safety & Quality Council, please visit www.bcpsqc.ca

 

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