Safer Better Healthcare

The National Standards for Safer Better Healthcare were launched by HIQA in June last year. The Standards describe a vision for high quality, safe healthcare and provide a framework against which services must deliver them safely. In the next few years, Licensing of Primary Healthcare Centres and all Practices will come into play as HIQA have the legislative responsibility to enforce the standard under their National Standards for Safer Better Healthcare.

Medisec recognise the many challenges that this will pose for our members and, against this background, have been looking at the providers of standards such as the Joint Commission International (JCI), CHKS and International Primary Care Standard (IPCS) to see what and how they can offer our members support.

We recently visited IPCS in its development site Mallow Primary Healthcare Centre (MPHC) and were introduced to the standard by Dr David Molony, GP and Mr Damian Casey,  Facilities Manager.  They were kind enough to share the following article with us, which we reproduce here:

Mallow Primary Healthcare Centre (MPHC) felt the need to demonstrate and measure patient care  and standards in a comprehensive and recognisable manner. Having looked at systems around the world, we had our primary care project in Mallow built to the highest medical building standards that we could find, namely the UK Technical Memorandum Standards.

Since then, the International Primary Care Standard (IPCS) has been developed over the last 6 years  with the co-operation of different individuals  experienced in clinical, management and scientific  standards development as well as patient group input and from a retired  auditor  Billy Nyhan, who spent many hours  sitting in the practices gaining an understanding of their operations.

Why would a primary care standard help in the operation of primary care facilities/general practice? First of all, general practices and primary care facilities are businesses and need to be run as efficiently and effectively as any business. Management standards need to be of the highest quality if the business is to succeed and provide resources for the delivery of patient care. Staff and patient risks have to be assessed regularly and acted upon and every general practice is legally required to have an up-to-date practice safety statement. GPs now need to have audit systems built into their working environment to satisfy  the Irish Medical Council guidelines for registration.

The main emphasis of the IPCS standard has been to develop a documented process of risk assessment, management and continuous improvement as we feel the ethos of identifying problems and putting corrective actions in place better supports a patient focussed service. This also supports the up-skilling and protection of staff, whilst maintaining the highest standards.

It is important to emphasise that this is not a new process because all practices are expected to have the highest standards but, to date, they have only been measured in hindsight, i.e. through the Irish Medical Council or the Courts. It is our experience that practices in Ireland have a very high standard but do not have all the information readily available  as will be required by regulators.

HIQA see their National Standards for Safer Better  Healthcare as the barometer for future healthcare licensing. These standards are aimed  at protecting patients and they provide, for the first time, a strategic approach to improving safety, quality and reliability in our health  services. They will form the basis for future licensing of all healthcare facilities in Ireland”.

To remain in operation, doctors are going to have to demonstrate annually that they run a safe practice, take cognisance of the needs of patients and are complying with the enormous weight of legislation that applies to them.  At first glance, this seems an onerous and impossible task but when we realise how well organised most practices are, then the task, though large initially, is not impossible and,  once documented procedures are in place, it should be easy  to maintain.

There are 3 levels to which primary care facilities/practices are certified to IPCS.

Level 1: The primary care facility/practice fulfils all legislative requirements, i.e. Safety Statement, Risk Assessments, Irish Medical Council and legislative requirements.

Level 2: The primary care facility/practice has a higher management standard and is monitoring their activities  and processes with a continuous improvement programme.

Level 3: The primary care facility/practice has a commitment to the highest standards attainable, consults regularly with patient groups, measures and reviews  clinical, management and financial key practice indicators and shows a high level of community involvement.

IPCS defines the controls required to demonstrate compliance and best practice with the management standard for Primary Healthcare Centres (A Primary Healthcare Centre is any centre providing  pre-hospital medical care  and can comprise single and multi doctor practices). It acknowledges and complies with the fundamental principles of the following international standards and best practice guidelines:

 

• National Hygiene Services Quality Review 2008: HIQA
• National Standards for Safer Better Healthcare 2012: HIQA
• Guidance on Information Governance for Health and Social Care Services in Ireland 2012: HIQA
• National Standards for the Prevention and Control of Healthcare Associated Infections 2008 : HIQA
• Joint Commission International Accreditation Standards for Primary Healthcare Centres 2008
• ISO/OHSAS 18001:2007 Occupational Health and Safety Standard
• Health & Safety Authority Ireland
• Legislation, Regulations, Reports and Codes of Practice

 

IPCS provides the structure, the format and the review systems that are required in this new environment, whereby if you fail to record something, then it did not happen. It provides an increase in positive interaction with patients, visible evidence in the practice of the application of a standard, such as mission statements on walls, assurances of confidentiality, respect, complaints procedures and better patient care. It provides staff with a sense of responsibility, understanding of their roles, sources of legislative and other information as well as structured patient care.

From a management point of view, IPCS provides management review structures to oversee all the processes, review legislative requirements on an ongoing basis and provide the structure to review Key Practice Indicators (KPI) in clinical, management and financial areas.

IPCS covers the following areas:

• Definition and communication of a health and safety policy
• Risk assessment and controls throughout organisation, clinical and operational.
• Safety representative and clear responsibilities of all agreed and documented.
• Documentation of a management manual, document and data system.
• Identification and management of all appropriate legal and other requirements (including, for example, various codes of practice and advisory documents).
• Process guidelines and controls identified, documented and managed (this includes maintenance and calibration of all critical equipment).
• Management of continuous improvement programmes,identification of objectives and targets. Development of Quality Improvement Plans.
• Involvement of all staff and interested parties in all appropriate aspects of the business and improvement process.
• Internal system and regulatory audit compliance process.
• Identification, management and testing of response to all potential emergency situations (fire, accidents, spillages, pandemics, etc.)
• Training (includes identification of training needs, CPD and ongoing training plans for all practice staff) and recording of all training.
• Eventual integration of quality, environmental and safety systems.

There is a cost in initially implementing standards and there is a cost involved in the certification process itself. At IPCS we expect that these costs will be recouped from increased efficiency, identification and eliminate waste, more efficient staff use, identification of responsibilities and organised review of patient care programmes. All processes and activities are reviewed routinely and it is for these reasons that IPCS is an ideal tool for continuous improvement.

The IPCS standard has been introduced to 12 other practices, including most recently a 5 modules course given to practices in the South West Training Scheme in Tralee. There are a number of practices in Cork City and County  and Wexford, exploring  the possibility  of attaining the standard.

For more information  on the IPCS standard, please contact Dr David Molony or Damian Casey at info@ipcs.ie