Variation in the Adoption of Patient Safety Practices among New Zealand District Health Boards

Article excerpt

Abstract

Objective. To investigate the adoption and impact of quality improvement measures in New Zealand hospitals.

Method. Structured interviews with quality and safety managers of District Health Boards (DHBs). Correlation of use of measures with adjusted 30-day mortality data.

Results. Eighteen of New Zealand's 21 DHBs participated in the survey. Structural or policy measures to improve patient safety, such as credentialing and event reporting procedures, had been introduced into all DHBs, whereas changes to general clinical processes such as medicine reconciliation, falls prevention interventions and disease-specific management guidelines were less consistently used. There was no meaningful correlation between risk-adjusted mortality rates for three common medical conditions and related quality measures.

Conclusion. Widespread variation exists among New Zealand DHBs in their adoption of quality and safety practices, especially in relation to clinical processes of care.

What is known about the topic? There are a significant number of adverse events which may affect hospital inpatients. Many of these are preventable. In response, quality and safety processes and measures are being adopted across the sector.

What does this paper add? The paper provides a description of the frequency with which a range of processes and measures have been adopted and demonstrates that adoption of these by New Zealand hospitals is patchy and monitoring is uneven. It suggests that the measures implemented do not appear to have impacted common mortality outcomes, though the findings may reflect the limits of feasible measurement of a probabilistic system.

What are the implications for practitioners? Managers should monitor the implementation of quality and safety measures and evaluate them in terms of their direct effects.

Received 14 December 2010, accepted 12 October 2011, published online 25 May 2012

Introduction

Hospitals work to improve the quality of their services and the safety of their patients in the interests of achieving the best possible outcomes. Variation in hospital processes1 and quality2 remain. Further, results from studies conducted in several western countries, including New Zealand, consistently suggest that there are significant rates of adverse events in hospitals, many of which are preventable.3-6 Although a wide range of effective and practical measures, including structural changes and process improvements, have been found to improve hospital quality and safety (Q&S), there is uncertainty about the extent to which they have been adopted in New Zealand.7,8

This paper presents the results of a survey exploring the adoption of Q&S measures by the District Health Boards (DHBs) that are responsible for planning and funding health services in New Zealand. It is the first publication from a project exploring the application of modern statistical methods to the assessment of hospital performance in New Zealand.9,10 The paper also relates the adoption ofQ&Smeasures to preliminary data on hospital 30-day mortality rates (adjusted for risk factors and comorbidities) for three common acute conditions.

Methods

The Chief Executive Officer (CEO) of each DHB was contacted by mail in 2008 and asked to authorise the research. The person responsible for Q&S in the DHB was then contacted, provided with an information sheet describing the research and asked to provide data by telephone interview. If willing, he or she submitted a consent form.

Interviews were conducted with informants in 18 of the 21 DHBs. The report from Otago included Southland; Tairawhiti and Nelson-Marlborough were unable to participate. In some cases, follow-up interviews were conducted with informants suggested by the Q&S manager. Interviews were completed in 2009. The DHB Q&S managers indicated that the information they supplied applied to all hospitals in the district and independent data were not collected from satellite hospitals. …