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Gavin Wright, JADE Care Programme, JADE Software Corporation, opened by noting that the executive management of modern health service providers or regional health services is being challenged as never before by increased accountability for the quality of care and services. He reviewed several concepts that are considered to be vital to making constructive progress in this area:
| • | Senior executive sponsorship and support for the initiative. |
| • | Fostering an environment of confidence among clinicians that the focus is on qualitative improvement. |
| • | Establishing a single repository for reporting of a full range of health care "incidents", including sentinel and adverse events, patient complaints, ministerial requests, occupational health and safety incidents, general incidents, etc. |
| • | Integrating the available information, enabling an overview of trends, as opposed to looking at complaints in isolation, and to inform management of risk. |
A number of other factors apply in the context of the whole health services environment. There is increasing community concern about quality of care in health, higher levels of interest from media and a greater focus on accountability of practitioners, and management and information about care is being sought more frequently. The accountability demands and risk management burden on executives and boards are increasing.
Wright introduced an approach that involved managing a generic "incident" event. For each different type of incident to be tracked and reported, system administrators would use a flexible coding structure to define the incident type, then associate this with a user-designed data collection form, business rules for management of the incident and required compliance activities and targets. Thus a common set of standards would exist and incidents could be managed in the same way.
There is a raft of "incidents" that could be included, eg:
| • | Complaints. |
| • | Medication and IV adverse events. |
| • | Operating theatre and emergency department adverse events |
| • | General adverse events. |
| • | Requests for patient information (from patients, legal representatives, government agencies, Health & Disabilities Commission, Medical Management Committee. |
| • | Occupational Health & Safety. |
| • | Abuse of staff. |
| • | Reports from security. |
| The potential benefits of such an approach apply to: | |
| • | Management of the issue: including integration of all events, immediate and informed response to media and government agencies, process and discipline, automatic generation of letters, compliance with legislative time lines. |
| • | Analysis: including determination of why incidents are happening, combined or separate analysis over all events, cross-analysis events over incidents, OSH issues. |
| • | Reporting: including flexible, routine and exceptional reports, compliance reports to the CEO and Board, drill down by patient, ward, etc, trends and benchmarking. |
Further, once information flows in a consistent manner, it is possible to look at quality improvement, eg, by analysing factors indicating corrective action and measuring the effectiveness of action taken.
Wright then presented the JADE Care approach, a structured framework developed in partnership with Canterbury DHB to track incident reports, take a standardised view and create reports.
JADE Care software enables an organisation to manage patient and client related issues in a structured and uniform manner. It involves collecting data and monitoring those data against compliance standards. Functionality includes data collection, monitoring, compliance, reporting, analysis and quality improvement. Wright presented sample screens from the software showing features such as visual representation of completed actions and actions to be completed in relation to individual events, the ability to drill down for details on a particular event, and the ability to undertake activities in relation to an event, based on compliance requirements, using standard templates (refer slides 14-17).
The common event structure includes such details as event description, event code, involved parties, and the standard activities that should result.
Using this approach has resulted in wider involvement in the incident management process, more rapid turnaround in reporting to operational managers, informative reports that promote confidence in and acceptance of the system and an improvement in meeting compliance targets. Complaints are being monitored more effectively and closure is being achieved because of automated processes for required activities, eg, getting information to patients. Internal reporting is less labour intensive and there is improved confidence in the data. As the data collection period expands, the ability to evaluate trends improves and this increases informed decision about what should be done.
Wright concluded that, in the longer term, it is expected that:
| • | Multi-year data will enable much more powerful trend and root cause analysis. |
| • | Extensive and reliable information will provide a constructive foundation for ongoing quality improvement programmes in most areas of incident management. |
| • | Medication errors and problem drugs can be better targeted for management because better information is available and information can be used more effectively. |
| • | Consistently high levels of compliance with required standards will be achieved. |
| • | Corporate management will be well equipped to identify and more effectively manage risk through the implementation of responsive programmes, which can then be monitored for effective outcomes. |
| [View Gavin Wright’s presentation Enhancing Quality and Managing Risk in a Health Context - the JADE Care Approach] | |
