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ISBN 0 7337 3352 2 Copyright Standards Australia International All rights are reserved. No part of this work may be reproduced, copied, stored, distributed or transmitted in any form, or by any means, including photocopying, scanning or other mechanical or electronic methods without the prior written permission of the publisher. Published by Standards Australia International, PO Box 1055, Strathfield NSW 2135 Design and typesetting by Write Result, 22 Firwood Trail, Woodvale WA 6026 email: write@iinet.net.au
Contents
1 Introduction
Dr Maree Bellamy
This is a free 7 page sample. Access the full version at http://infostore.saiglobal.com.
27 The introduction of clinical risk pooling and clinical risk management standards within the National Health Service
Steve Walker
35 Controls assurance
Involving the Board
Tim Crowley
43 Risk management
Kevin Knight
iii
109 Role of clinical pathways and variance analysis in risk management and quality improvement
Dr Elizabeth Mullins
iv
141 Using radar logic to develop standards-based management systems that work
Michael Paskavitz
Introduction
Dr Maree Bellamy1
Healthcare is undergoing enormous change. On one hand, greater medical knowledge and expertise accompanied by technical improvements are delivering more sophisticated therapies to significant populations. On the other, we see increased media and public attention to quality issues, with an unfortunate focus on adverse events and unsatisfactory outcomes. This juxtaposition highlights the potential problems and pitfalls for all stakeholders. In many countries, a move toward integrated healthcare systems has resulted in a change in emphasis for healthcare managers and providers. There is a greater awareness of the need to provide care, which is acceptable and beneficial to the broader community. Accompanying this is the task of coordinating care across multiple entities and the challenge of developing a culture of system thinking. Integrating medical practitioners within the totality of the scheme requires a change in the approach of clinicians, with new roles for doctors charged with governance responsibilities. As an overarching principle, accountability has taken on a greater significance accountability for multiple dimensions of performancefinancial, clinical, management integration, quality, risk management, community satisfaction and health outcomes. The public demands improved patient safety. There is a concern that the financial pressures and organizational change in healthcare will decrease doctors' expertise, increase workload and reduce safety. The nature of training and certification of practitioners and institutions have also become key issues. According to James Reason2 the more safety researchers have looked at the sharp end, the more they have realized that the real story behind accidents depends on the way that resources, constraints, incentives, and demands produced by the blunt end shape the environment and influence the behaviour of the people at the sharp end. Changes in technology, procedures, and organizations, combine with economic pressures to create new vulnerabilities and forms of failure at the same time that they create new forms of economic and therapeutic success. Managers and clinicians need tools and techniques to improve the quality of services and to reduce risks to patients, staff and organizations. The wisdom of adopting an integrated management approach, at both corporate and clinical levels, to achieve continuous improvement and clinical effectiveness is receiving increasing recognition. In Britain, greater levels of accountability and a push for improved standards of quality are being driven by a change in governance requirements. There is a similar emphasis in the quality management framework released by NSW Health. That document
1. Director of Health, Standards Australia International. 2. James Reason 1997, Managing the risks of organizational accidents.
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