scholarly journals Healthcare professional perspectives on quality and safety in New Zealand public hospitals: findings from a national survey

2014 ◽  
Vol 38 (1) ◽  
pp. 109 ◽  
Author(s):  
Robin Gauld ◽  
Simon Horsburgh
Keyword(s):  
New Zealand ◽  
Patient Care ◽  
Health Professionals ◽  
Pearson Correlation ◽  
Public Hospitals ◽  
Health Board ◽  
Quality And Safety ◽  
District Health ◽  
Policy Makers ◽  
Clinical Leadership

Background Few studies have sought to measure health professional perceptions of quality and safety across an entire system of public hospitals. Therefore, three questions that gauge different aspects of quality and safety were included in a national New Zealand survey of clinical governance. Methods Three previously used questions were adapted. A total of 41040 registered health professionals employed in District Health Boards were invited to participate in an online survey. Analyses were performed using the R statistical environment. Proportional odds mixed models were used to quantify associations between demographic variables and responses on five-point scales. Relationships between other questions in the survey and the three quality and safety questions were quantified with the Pearson correlation coefficient. Results A 25% response rate delivered 10303 surveys. Fifty-seven percent of respondents (95% CI: 56–58%) agreed that health professionals in their District Health Board worked together as a team; 70% respondents (95% CI: 69–70%) agreed that health professionals involved patients and families in efforts to improve patient care; and 69% (95% CI: 68–70%) agreed that it was easy to speak up in their clinical area if they perceived a problem with patient care. Correlations showed links between perceptions of stronger clinical leadership and performances on the three questions, as well as with other survey items. The proportional mixed model also revealed response differences by respondent characteristics. Conclusions The findings suggest positive commitment to quality and safety among New Zealand health professionals and their employers, albeit with variations by district, profession, gender and age, but also scope for improvement. The study also contributes to the literature indicating that clinical leadership is an important contributor to quality improvement. What is known about the topic? Various studies have explored aspects of healthcare quality and safety, generally within a hospital or group of hospitals, using a lengthy tool such as the ‘safety climate survey’. What does this paper add? We used a simple three-question survey approach (derived from existing measures) to measuring healthcare professionals’ perceptions of quality and safety in New Zealand’s public hospitals. In doing so, we also collected the first such information on this. What are the implications for practitioners? New Zealand policy makers and health professionals can take some comfort in our findings, but also note that there is considerable scope for improvement. Our finding that more positive perceptions of quality and safety were related to perceptions of stronger clinical leadership adds to the international literature indicating the importance of this. Policy makers and hospital managers should support strong clinical leadership.

Did healthcare professional perspectives on the quality and safety environment in New Zealand public hospitals change from 2012 to 2017?

2020 ◽  
Vol 34 (7) ◽  
pp. 775-788
Author(s):  
Robin Gauld ◽  
Simon Horsburgh
Keyword(s):  
New Zealand ◽  
Patient Care ◽  
Health Professionals ◽  
Online Survey ◽  
Improve Patient Care ◽  
Public Hospitals ◽  
Quality And Safety ◽  
District Health ◽  
Content Type ◽  
Improve Patient

PurposeThe work environment is known to influence professional attitudes toward quality and safety. This study sought to measure these attitudes amongst health professionals working in New Zealand District Health Boards (DHBs), initially in 2012 and again in 2017.Design/methodology/approachThree questions were included in a national New Zealand health professional workforce survey conducted in 2012 and again in 2017. All registered health professionals employed with DHBs were invited to participate in an online survey. Areas of interest included teamwork amongst professionals; involvement of patients and families in efforts to improve patient care and ease of speaking up when a problem with patient care is perceived.FindingsIn 2012, 57% of respondents (58% in 2017) agreed health professionals worked as a team; 71% respondents (73% in 2017) agreed health professionals involved patients and families in efforts to improve patient care and 69% (65% in 2017) agreed it was easy to speak up in their clinical area, with none of these changes being statistically significant. There were some response differences by respondent characteristics.Practical implicationsWith no change over time, there is a demand for improvement. Also for leadership in policy, management and amongst health professionals if goals of improving quality and safety are to be delivered upon.Originality/valueThis study provides a simple three-question method of probing perceptions of quality and safety and an important set of insights into progress in New Zealand DHBs.

Making sense of place-based clinical leadership: is England catching up?

BMJ Leader ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. 76-79
Author(s):  
Ted Adams ◽  
Danny Ryan ◽  
Richard Taunt
Keyword(s):  
Health Care ◽  
New Zealand ◽  
Clinical Care ◽  
Geographical Area ◽  
Health Board ◽  
District Health ◽  
Clinical Leadership ◽  
Making Sense ◽  
Catching Up ◽  
Regional Plan

IntroductionSuccessful health care organisations have understood the need to engage with clinicians, with a resulting desire for clinical leaders to emerge and be trained.Sustainability and transformation plans (STPs)The development of sustainability and transformation plans has highlighted the need for clinical leaders to be engaged at every level of each regional plan. The plans are based around a geographical area rather than being focussed on pre-existing organisations, so-called place-based plans. Health care place-based plans need place-based clincal leaders.Examples of clincial place-based leadershipClinical leaders have existed across boundaries before STPs were developed, for example in Canterbury District Health Board in New Zealand or closer to home in Wales.ConclusionWe discuss the benefits that removing organisation boundaries could have on clinical care, believing that as patients cross organisational boundaries so should their health care and so should clinical leaders.

scholarly journals A model of multidisciplinary professional development for health professionals in rural Canterbury, New Zealand

2017 ◽  
Vol 9 (4) ◽  
pp. 292 ◽  
Author(s):  
Susan Bidwell ◽  
Andrea Copeland
Keyword(s):  
Professional Development ◽  
New Zealand ◽  
Nurse Practitioners ◽  
Health Professionals ◽  
Rural Areas ◽  
Community Pharmacists ◽  
Continuing Professional Development ◽  
Health Board ◽  
District Health ◽  
Multidisciplinary Model

ABSTRACT INTRODUCTION Pegasus Health Charitable Ltd, a Christchurch Primary Health Organisation, is contracted by the Canterbury District Health Board to provide continuing professional development for primary care practitioners in the region. Rurally located health practitioners have largely been unable to participate because of the travel time and distances involved. AIM The initiative reported in this paper aimed to fill this gap by developing an accessible and high-quality multidisciplinary model of professional development for general practitioners, nurse practitioners, practice nurses and community pharmacists in rural areas of North Canterbury, New Zealand. METHODS A survey was conducted to learn from the experiences of 14 health professionals in an existing multidisciplinary group, which had developed as a local initiative in one rural community. RESULTS The survey had an 86% response rate. All respondents believed the multidisciplinary format worked well, had improved collaborative working and increased the consistency of patient care. Access to professional development had improved and the meetings provided a useful forum for the mostly part-time staff to interact as a group. The main caution noted was the potential to become inward looking without being exposed to fresh ideas from other practices. DISCUSSION The multidisciplinary model was considered workable and valuable by the survey respondents. Based on our findings, the multidisciplinary model has been formalised by the Pegasus team responsible, and three new groups are now operating successfully in rural areas of North Canterbury.

Registered nurse prescribing: A descriptive survey of prescribing practices in a single district health board in Aotearoa New Zealand

2020 ◽  
Vol 36 (3) ◽  
pp. 61-72
Author(s):  
Melinda McGinty ◽  
◽  
Betty Poot ◽  
Jane Clarke ◽  
◽  
...  
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Registered Nurse ◽  
Health Conditions ◽  
Health Board ◽  
Prescribing Practices ◽  
District Health ◽  
Survey Tool ◽  
Aotearoa New Zealand ◽  
Descriptive Survey

The expansion of prescribing rights in Aotearoa New Zealand has enabled registered nurse prescribers (RN prescribers) working in primary care and specialty teams, to enhance nursing care, by prescribing medicines to their patient population. This widening of prescribing rights was to improve the population’s access to medicines and health care; however, little is known about the medications prescribed by RN prescribers. This paper reports on a descriptive survey of self-reported RN prescribers prescribing in a single district health board. The survey tool used was a Microsoft Excel spreadsheet to record nurse’s area of practice, patient demographic details, health conditions seen, and medicines prescribed and deprescribed. Simple data descriptions and tabulations were used to report the data. Eleven RN prescribers consented to take part in the survey and these nurses worked in speciality areas of cardiology, respiratory, diabetes, and primary care. Findings from the survey demonstrated that RN prescribers prescribe medicines within their area of practice and within the limits of the list of medicines for RN prescribers. Those working in primary care saw a wider range of health conditions and therefore prescribed a broader range of medications. This survey revealed that the list of medications available for RN prescribers needs to be updated regularly to align with the release of evidence-based medications on the New Zealand Pharmaceutical Schedule. It is also a useful record for both educational and clinical settings of the types of medications prescribed by RN prescribers.

scholarly journals Modeling the Costs of Hospital-Acquired Infections in New Zealand

2003 ◽  
Vol 24 (3) ◽  
pp. 214-223 ◽  
Author(s):  
Nicholas Graves ◽  
Tanya M. Nicholls ◽  
Arthur J. Morris
Keyword(s):  
New Zealand ◽  
Economic Cost ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Primary Data ◽  
Health Board ◽  
District Health ◽  
Hospital Acquired Infections ◽  
Input Variables ◽  
Hospital Acquired

AbstractObjective:To model the economic costs of hospital-acquired infections (HAIs) in New Zealand, by type of HAI.Design:Monte Carlo simulation model.Setting:Auckland District Health Board Hospitals (DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services. Costs are also estimated for predicted HAIs in admissions to all hospitals in New Zealand.Patients:All adults admitted to general medical and general surgical services.Method:Data on the number of cases of HAI were combined with data on the estimated prolongation of hospital stay due to HAI to produce an estimate of the number of bed days attributable to HAI. A cost per bed day value was applied to provide an estimate of the economic cost. Costs were estimated for predicted infections of the urinary tract, surgical wounds, the lower and upper respiratory tracts, the bloodstream, and other sites, and for cases of multiple sites of infection. Sensitivity analyses were undertaken for input variables.Results:The estimated costs of predicted HAIs in medical and surgical admissions to Auckland DHBH were $10.12 (US $4.56) million and $8.64 (US $3.90) million, respectively. They were $51.35 (US $23.16) million and $85.26 (US $38.47) million, respectively, for medical and surgical admissions to all hospitals in New Zealand.Conclusions:The method used produces results that are less precise than those of a specifically designed study using primary data collection, but has been applied at a lower cost. The estimated cost of HAIs is substantial, but only a proportion of infections can be avoided. Further work is required to identify the most cost-effective strategies for the prevention of HAI.

scholarly journals Staff expectations for the implementation of an electronic health record system: A qualitative study using Normalisation Process Theory

2019 ◽  
Author(s):  
Carolyn Mccrorie ◽  
Jonathan Benn ◽  
Owen Johnson ◽  
Arabella Scantlebury
Keyword(s):  
Collective Action ◽  
Electronic Health Record ◽  
Patient Care ◽  
Health Professionals ◽  
Implementation Strategy ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Successful Implementation ◽  
Health Record ◽  
Quality And Safety

Abstract Background Global evidence suggests a range of benefits for introducing electronic health record (EHR) systems to improve patient care. However, implementing EHR within healthcare organisations is complex and in the United Kingdom (UK), uptake has been slow. More research is needed to explore factors influencing successful implementation. This study explored staff expectations for change and outcome following procurement of a commercial EHR system by a large academic acute NHS hospital in the UK. Methods Qualitative interviews were conducted with 14 members of hospital staff who represented a variety of user groups across different specialities within the hospital. The four components of Normalisation Process Theory (Coherence, Cognitive participation, Collective action and Reflexive monitoring) provided a theoretical framework to interpret and report study findings. Results Health professionals had a common understanding for the rationale for EHR implementation (Coherence). There was variation in willingness to engage with and invest time into EHR (Cognitive participation) at an individual, professional and organisational level. Collective action (whether staff feel able to use the EHR) was influenced by context and perceived user-involvement in EHR design and planning of the implementation strategy. When appraising EHR (Reflexive monitoring), staff anticipated short and long-term benefits. Staff perceived that quality and safety of patient care would be improved with EHR implementation, but that these benefits may not be immediate. Some staff perceived that use of the system may negatively impact patient care. The findings indicate that preparedness for EHR use could mitigate perceived threats to the quality and safety of care. Conclusions Health professionals looked forward to reaping the benefits from EHR use. Variations in level of engagement suggest early components of the implementation strategy were effective, and that more work was needed to involve users in preparing them for use. A clearer understanding as to how staff groups and services differentially interact with the EHR as they go about their daily work was required. The findings may inform other hospitals and healthcare systems on actions that can be taken prior to EHR implementation to reduce concerns for quality and safety of patient care and improve the chance of successful implementation.

scholarly journals Community Governance and Civil Society: An Examination of the Purpose, Intent and Structure of Residents' Groups in New Zealand

2021 ◽  
Author(s):  
◽  
Jarrod Coburn
Keyword(s):  
New Zealand ◽  
News Media ◽  
Local Community ◽  
Political Activity ◽  
Health Board ◽  
District Health ◽  
Community Governance ◽  
Set Up ◽  
Civil Defence ◽  
Charitable Activities

<p>Residents’ groups have been in existence in New Zealand for almost 150 years yet very little is known about them. The collection of residents’, ratepayers’ and progressive associations, community councils, neighbourhood committees and the like make up a part of the community governance sector that numbers over a thousand-strong. These groups are featured prominently in our news media, are active in local government affairs and expend many thousands of volunteer hours every year in their work in communities… but what exactly is that work? From the literature we see these groups can be a source of local community knowledge (Kass et al., 2009), a platform for political activity (Deegan, 2002), critical of government (Fullerton, 2005) or help maintain government transparency and accountability (Mcclymont and O'Hare, 2008). They are sometimes part of the establishment too (Wai, 2008) and are often heard promoting the interests of local people (Slater, 2004). Residents’ groups can be set up to represent the interests of a specific demographic group (Seng, 2007) or focus on protecting or promoting a sense of place (Kushner and Siegel, 2003) or physical environment (Savova, 2009). Some groups undertake charitable activities (Turkstra, 2008) or even act in a negative manner that can impact on the community (Horton, 1996). This research examines 582 New Zealand organisations to derive a set of purposes that residents’ groups perform and ascertains how their purposes differ between geo-social and political locality and over three distinct eras of community development. The thesis also examines the relationship between residents’ groups and councillors, council officers, district health board members and civil defence and seeks to uncover if the level of engagement (if any) has an affect on their overall raison d’etre. The research concludes with a typology of New Zealand residents’ groups along with the key purposes of each type.</p>

scholarly journals Promoting positive interactions between midwives and obstetricians at the primary/secondary interface

2021 ◽  
Vol 57 ◽  
pp. 41-48
Author(s):  
Rachel Cassie ◽  
Christine Griffiths ◽  
George Parker
Keyword(s):  
New Zealand ◽  
Thematic Analysis ◽  
Maternity Care ◽  
Interprofessional Collaboration ◽  
Theoretical Perspective ◽  
Positive Interactions ◽  
Health Board ◽  
District Health ◽  
Interprofessional Communication ◽  
Aotearoa New Zealand

Background: Interprofessional communication is a critical component of safe maternity care. The literature reports circumstances in Aotearoa New Zealand and overseas when interprofessional collaboration works well between midwives and obstetricians, as well as descriptions of unsatisfactory communication between the two professions. Aim: To explore and define effective collaboration between midwives and obstetricians at the primary/secondary interface in maternity care, in order to generate suggestions to foster positive collaboration. Method: Eight primary care midwives, three obstetricians and two obstetric registrars from a single District Health Board in Aotearoa New Zealand were interviewed about their interactions at the primary/secondary interface and their understanding, and use, of the Referral Guidelines. The theoretical perspective was Appreciative Inquiry. Data were analysed using thematic analysis. Findings: Results indicate usually positive interprofessional interactions. Dominant emergent themes are the need to negotiate differing philosophies, to clarify blurred boundaries that sometimes lead to lack of clear lines of responsibility, and the importance of three-way conversations. Of the three themes, this article focuses on three-way communication between midwife, obstetrician/registrar and woman. Participants reported that, when effective three-way communication between woman, midwife and obstetrician occurred, philosophical difference could be negotiated, blurred boundaries clarified and understanding of the respective roles of the LMC midwife and the obstetric team promoted. Participants value the Referral Guidelines but report some limitations to their applicability. Conclusion: Effective three-way communication promotes good maternity care. This study has identified ways to support optimal communication.

scholarly journals Use of aspirin and statins for cardiovascular risk reduction in New Zealand: The residential care story

2009 ◽  
Vol 1 (3) ◽  
pp. 184 ◽  
Author(s):  
Jae Bon Hoem ◽  
Ngaire Kerse ◽  
Shane Scahill ◽  
Simon Moyes ◽  
Charlotte Chen ◽  
...  
Keyword(s):  
New Zealand ◽  
General Practitioners ◽  
Residential Care ◽  
Prescribing Patterns ◽  
Health Board ◽  
District Health ◽  
Cardiovascular Risk Reduction ◽  
Residential Care Facilities ◽  
Care Facilities ◽  
Social Debate

INTRODUCTION : Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality for older New Zealanders. Medication prescribing for secondary prevention of cardiovascular events in residential care is unknown and prescribing patterns for aspirin and statins by general practitioners (GPs) in residential care facilities in Auckland, New Zealand are reported here. METHODS: A representative sample of residential care facilities, all residents over age 65 years and their GPs in one district health board region in Auckland were recruited. Prescribing and medical records were audited by a trained nurse and medications coded into classes according to a standardised process. Diagnoses from summary sheets and hospital letters were recorded. Descriptive statistics were used to show variability in proportion of residents prescribed aspirin and statins. RESULTS: Of a total of 24 facilities approached, 14 consented to participate (58%); 537 residents (88% of eligible) agreed to participate and 533 completed the study. Residents took on average 8.3 (standard deviation 2.4) medications. On average 2.64 (range 1–6) GPs serviced each facility with eight GPs working in more than one facility. On average 54% of residents with documented CVD were prescribed aspirin and 31% of those with CVD and/or dyslipidaemia were prescribed statins. Variability between prescribers and facilities was high. DISCUSSION: Prescribing in residential care does not appear to be guidelines-based. The reasons for this are unknown. Ongoing social debate about the role of prevention for older people and interventions for GPs and residential care facilities may impact prescribing rates. KEYWORDS: Cardiovascular diseases; residential care; aspirin; statins; prescribing patterns; general practitioners

Malnutrition risk of older people across district health board community, hospital and residential care settings in New Zealand

2017 ◽  
Vol 36 (3) ◽  
pp. 205-211 ◽  
Author(s):  
Carol Wham ◽  
Emily Fraser ◽  
Julia Buhs-Catterall ◽  
Rebecca Watkin ◽  
Cheryl Gammon ◽  
...  
Keyword(s):  
New Zealand ◽  
Older People ◽  
Residential Care ◽  
Community Hospital ◽  
Health Board ◽  
District Health
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