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TDH focusing on quality of care

ASKING mental health service users what they want and acting on those requests has helped make for a better service, says Tairawhiti District Health.

Reducing the seclusion rates of mental health patients is just one of the ambitions TDH recorded in its 2013/14 Quality Account, which was released just before Christmas.

TDH says its Te Whare Awhiora acute mental health unit has achieved that aim by ensuring there is robust cultural support; using strategies other than seclusion; consulting service users about a “sensory modulation room” that offers an alternative; and involving service users in care planning meetings.

Under its new approach complaints, suggestions and lists of improvements supplied by users aren’t framed as “attacks” but are seen as a way to find quality improvements, says TDH consumer leader of mental health and addiction services Chloe Fergusson.

“The service now has a willingness to look at other ways to do things and that is what makes the place special,” she says. “I feel confident that the list will get done — and then get longer — and then get done.”

The new Quality Account also shows that TDH met or exceeded five of the six Ministry of Health targets.

The only target not met was providing stop smoking advice in primary care. The target is 90 percent and in Tairawhiti last year, 86 percent of smokers received advice — an increase of nearly 30 percent on the previous year.

The account also covers what TDH is doing to prevent falls (the most common risk to patient’s safety); to reduce hospital-acquired infections; to make surgery safer; to prevent Sudden Unexpected Death in infants; and “detail of the learnings from the two serious adverse events that occurred last year”.

“The Quality Accounts are snapshots of the areas where services are continually improving, areas where we would like to be doing better, and areas where we are intending to focus in the year ahead,” says chief executive Jim Green.

The report is designed to be published alongside financial accounts to demonstrate that quality and patient safety is of equal value to organisations like TDH, he says.

“We are an organisation that only exists because people need to be supported to gain optimal health and as a funder and provider of services, we are geared to meet this need.

“However, that is not enough. We need to know that the care provided in our district is to a standard that meets the expectations of our communities. Our Quality Account should make it clear to the community just what they can expect from TDH, and what we will not tolerate and take action to correct.”

The TDH board regards quality as the No. 1 priority, says chairman David Scott.

“Close scrutiny and discussion of the indicators is a frequent feature at monthly board meetings and this new Quality Account indicates the time and energy invested by our dedicated staff, with pleasing improvements shown.”

Responsibility for managing patient quality and risk lies with director of nursing and midwifery, Sonia Gamblen, who says it has been a dozen years since she started asking herself why patients had such differing experiences of health care.

“Why does patient A have a good experience and patient B have a completely different experience?” she says.

“I have seen marvellous patient outcomes, but also patients suffering various forms of harm as a result of their hospital experiences.

“While I firmly believe none of the harm was intentional, it was often not seen as preventable. The change in thinking — to consider and put in place measures that prevent adverse patient outcomes and promote safe expert care — makes it an exciting time to be working in health care.”

TDH’s key areas of focus in the year ahead are meeting or exceeding national health targets; improving patient safety; improving connections between primary and secondary care; improving access to clinicians for those living in remote communities; improving TDH’s facilities to treat cancer; and addressing Tairawhiti’s high levels of obesity and diabetes.

“We are making excellent progress but there is still much work to be done,” says Mr Green. “And I am grateful for the efforts of the staff dedicated to doing it.”