The First, Do No Harm patient safety campaign is one of the primary goals of the Northern Region Health Plan – outlining a set of shared objectives for the major public healthcare providers in the top half of New Zealand’s North Island [view the Northern Region Health Plan] .
Approved by the Minister of Health, the plan is an agreed strategy for addressing the significant pressures on healthcare in the Northern Region.These include rapid population growth, ageing population and the rising burden of chronic disease.
Under the plan, the four Northern Region district health boards (Northland, Waitemata, Auckland and Counties Manukau) collaborated with three health organisations – the National Maori PHO Coalition, Alliance Health+ and Greater Auckland Integrated Health Network.
Implementation of the health plan is supported by the Northern Regional Alliance (NRA), a shared services agency owned by the Auckland metropolitan DHBs. A Memorandum of Understanding was been formalised between First, Do No Harm and the Health Quality & Safety Commission and resources and expertise are shared between First, Do No Harm and the National Patient Safety Campaign, Open for better care, which is being coordinated and led by the Health Quality & Safety Commission.
The aim of the campaign is to systematically improve the safety and reliability of care throughout the Northern Region targeting five key areas:
- Falls and Pressure Injuries
- Health Care Associated Infections
- Medication Safety
- Global Trigger Tools (a system for identifying adverse events causing harm to patients)
- Transfers of Care
Since its launch at the beginning of 2012, the Northern Region’s First, Do No Harm campaign, which has worked in partnership with the Health Quality and Safety Commission’s (HQSC) national Open for better care campaign launched in May 2013, has been instrumental in raising awareness of patient safety issues and supporting a regional focus on reducing healthcare associated harm. The First, Do No Harm campaign has focused on supporting the use of improvement science as well as campaign methodology as an effective approach to improving the patient’s experience of care by improving quality and reducing healthcare associated harm.
Key outcomes achieved by the First, Do No Harm Campaign
- The establishment of regional outcome measures that have supported improvement efforts.
- Data collection and information use as a key driver to learn and improve care processes.
- Trust established enabling sharing of data and information across the DHBs and the age-related residential care (ARRC) sector.
- The development of closer working relationships, raised awareness of issues and shared change ideas and learning across the region.
- The development and sharing of regional resources to support improvement efforts, such as change packages and other tools.
- 850 clinical staff have been supported with training and access to resources.
- The development of a partnership approach with the national Open for better care campaign to support shared regional and national outcome goals. Regional approach to national patient safety awareness activities such as April Falls, International Stop Pressure Injury Day and Patient Safety Week.
- Reduction in duplication of effort by sharing resources and collaborating on the development of regional projects and resources, such as the regional transfer of care envelope, St John falls project, and patient information resources.
- Growth in the engagement and capability of the ARRC sector to participate in quality improvement to reduce harms in care settings with approximately 100 facilities in the region engaging in training sessions. This work has led to a number of ARRC teams undertaking further improvement projects.
- The establishment of baseline rates for falls and pressure injuries from the ARRC facilities submitting data is providing key information on current levels of harm and identifying where there may be valuable learning and opportunity for improvement.
- Increasing care providers developing skills and knowledge in undertaking improvement projects. The First, Do No Harm team has provided learning sessions, customised mini learning sessions and coaching for teams in DHBs and ARRC.
- Reduction in healthcare associated infections (HAI) – support of the national programmes such as preventing central line associated bacteraemia (CLAB) infection and surgical site infection that have resulted in the decrease in HAI across the region.
- The falls project has had some success in reducing some of the lower levels of harm in two DHBs. Major harm has been a more challenging area to achieve the targeted outcomes. The region has established and agreed measurement processes with accompanying definitions that support a more robust process to analysing the effectiveness of the changes being made.
- Regional reduction in harm from pressure injuries by 36%. The Northern Region rate for grade 2 pressure injuries and above is approaching the best found in the literature.
In 2015/2016 a regional forum agreed the First, Do No Harm programme should transition from a the current campaign to a to a sustainable regional structure. The structure would be a regional patient safety network focused on quality and safety, based on identified regional and national focus areas. This was reflected in the Northern Region Health Plan: “we will work collaboratively with our DHB and HQSC partners to transition from a campaign to a sustainable structure for continuing a regional systems approach.”
On 30 June 2016 the First, Do No Harm patient safety campaign concluded. This involves returning all of the regional and national activities to individual DHB teams to co-ordinate with the transition components/work streams of the campaign areas to other networks, eg falls and pressure injuries to the regional Health of Older People (HOP) Clinical Network.
A Regional Patient Safety Network is now in place in the Northern Region. Effective transition from the First, Do No Harm campaign to regional collaboration will build on the investment and learning the region has achieved.
Waitemata DHB FDNH dashboard
[View PDF of our FDNH dashboard]
Interpretation of quality time series data - Control Charts
The control charts represent variation in the data analysed. The control limits are derived from this variation and do not, therefore, indicate the desired performance limits. The processes or outcomes analysed may thus indicate stability (within control limits), trends and shifts only. The goal of quality of improvement is to reduce such process variation and improve process performance (eg a shift in the mean).
Types of control chart used:
- X-bar chart: In this chart the sample means are plotted in order to control the mean value of a variable (eg mean value of blood glucose standard)
- U-chart: A type of control chart used to monitor ‘count-type’ data where the sample size is greater than one, typically the average number of nonconformities per unit. In this chart the rate of defectives is plotted, that is, the number of defectives divided by the number of units inspected where this varies with samples, for example occupied bed days each month
- P-chart: The p-chart is a type of control chart used to monitor the proportion of nonconforming units in a sample, where the sample proportion nonconforming is defined as the ratio of the number of nonconforming units to the sample size. In this chart, we plot the per cent of defectives (per batch, per day, per machine, etc.) as in the u chart, where this varies with samples, for example patient volumes each month
The Institute of Healthcare Improvement (IHI) recommends that 15 to 20 data points are needed for a control chart before any results can be derived. Data presented in this report is the current view at the time of reporting. Data can be changed retrospectively to reflect incident reporting.