1 WELCOME
Jan 18, 2016
1
WELCOME
2
Presentation
Vincent Kearns
3
Regulation &
Quality
Vincent Kearns Inspector Manager
Health Information & Quality Authority
4
HIQA mission...• drive high quality & safe care for people
using health & social care services...
5
Role of regulation:• to provide assurance to stakeholders that
services meet certain standards…
• to establish mechanisms for holding organizations/individuals to account…
7
why have regulation?• many organisations have huge, unrealised
opportunities for improvement (Berwick 1996)
• quality of services varies widely from organisation to organisation and even within organisations (Brook et al 2000)
• required changes are often difficult/slow (Ferlie and Shortell 2001)
8
Health Act 2007
S.I. No. 367 of 2013
National Standards 2013
9
Quality improvements
10
National Standards for Residential Services for Children and Adults with Disabilities 2013
• gives a framework/guide• promote/facilitate quality of life• are outcome-based• are based on key principles• are organised into eight key themes
11
12
Responsive Regulation:
targeted
accountable
consistent proportionate
transparent
13
• “Focus on the journey, not the destination. Joy is found not in finishing an activity but in doing it”.
Greg Anderson
14
Project Presentation 1
Deirdre Nally
15
Using the PQASSO system to
simplify compliance to the
HIQA national standards
Deirdre Nally
Project roadmap
16
Define the current
situation
Measure the current
situation
Improve the current
situation
• Value stream map• Voice of the customer
• Quantitative research• Qualitative research
• Map a new process• Visual aid• Policy management
17
Define – Mapping the current PQASSO process
18
Define – Mapping the current HIQA process
19
Measure – HIQA Inspection reports
20
Improving Performance? The adoption and Implementation of Quality systems in U.K Nonprofits.
Cairns et al. 2005
“staff also did not always see the
relationship between the
quality system adopted and their
own work”
“just ticking boxes”
“Time is a particular
problem if people see quality as something separate; this makes them begrudge the time or reluctant to
devote the resources to it”
Where “quality remained an extra, to be worked on as time allowed ... reported only limited benefits”
We are all in the
same boat
21
Measure – Selecting priority issue
3) Management did not see how PQASSO could help with a HIQA inspection
2) Management may not have spent the time to engage and empower all staff at all levels
1) There is a lack of understanding of how PQASSO and HIQA are related.
22
Cross referencing both sets of standards
PQASSO Handbook HIQA National Standards
23
PQASSO Vs HIQA; Outcome 17 - Workforce
24
HIQA standards Vs PQASSO standardsOutcome
titleOutcome description
PQASSO Indicators
Theme 1: Individualised Supports and Care
Outcome 1
Residents
Rights, Dignity and Consultation
Residents are consulted with, and participate in, decisions about their care and
about the organisation of the centre.
Residents have access to advocacy services and information about their rights.
Each resident’s privacy and dignity is
respected, including receiving visitors in private.
Each resident is enabled to exercise choice and control over his/her life in accordance with his/her preferences and to maximise
his/her independence.
The complaints of each resident, his/her family, advocate or representative, and
visitors are listened to and acted upon and there is an effective appeals procedure.
1.1, 11.2
9.7
4
4
4.7, 11.3, 12.3, 4.5
25
PQASSO standards Vs HIQA standards
26
PQASSO is a ‘how to guide’
27
Improve the current situation – New process
28
Referencing system
29
Cover for PQASSO Evidence box
30
Naming system for policiesHIQA Policy
PQASSO Quality Area
The prevention, detection and response to abuse, including reporting of concerns and/or allegations to statutory agencies.
3 / 4
Admissions, including transfers, discharge and the temporary absence of residents.
1 / 10
Incidents where a resident goes missing. 1 / 4 / 8
Provision of personal intimate care 1 / 4
Provision of behavioural support 1 / 4
The use of restrictive procedures and physical, chemical and environmental restraint.
1 / 4
Users_ Provision of behavioural support_XXX
31
Summary• Define
– Both processes were similar• Measure
– Engaging in quality makes a difference– We are all in the same boat– Both sets of standards overlap
• Improve– Amalgamate both processes– Visual aids and policy management
32
Thanks for
Listening!!
33
Project Presentation 2
Alison Ryan
34
Alison Ryan
WOULD YOU LIKE MORE TIME TO SPEND ON WHAT MATTERS?
35
How many times..• can you not find something?• have you done something yourself as it was
easier than asking someone else?• How many minutes of meetings do you have
in your emails that are not filed?• How many meetings have you been at without
a tangible outcome?
36
37
38
39
40
Quality/LeanValue Stream Map - VSM Muda – Elimination of Waste Poke yoke – Mistake ProofingWorkplace organisationStandard work techniquesSupply chainChange Management and leadership
41
42
TQM • Cross Organisation – not just management
notion or an area need buy in across organisation
• Leadership is essential and a number of champions.
• Go with quick wins so results will motivate
43
44
45
Panel Discussion
Lead Panellist – Marian MaloneyGalway Centre for Independent
Living (CIL)
46
Presentation
Martin Naughton
47
Project Presentation 3
Deirdre Nally
48
Improving the processes involved in the
PQASSO Champions Network
Deirdre Nally
49
Aim of Project
Enhance the Champions approach to implementing PQASSO.
Agenda
50
Define the current
situation
Measure the current
situation
Improve the current
situation
• Voice of the customer • Questionnaire feedback • Remote attendance• Training • Formalise the Network• Online Portal
51
Define – What is the current process?
• The ‘Voice of the Customer’ for the Champions and DFI was gathered.
52
Measure – Questionnaire feedback
Feedback from the questionnaires was analysed Positives Challenges
Meeting other Champions Time RequiredExchanging Ideas Distance to travel
Networking Evidence is different for the organisationsAllows you to benchmark
Progress Difficult to attend meetings
Its Motivating/ encouraging Cost of travel Poor attendance Same people every time Repetition of information
Culture Change!!
53
Suggested improvements from the questionnaires:– Share good practices of other organisations– Develop key templates– Remote participation– More training on the inspection process– More training on how to efficiently compile and
store the vast amount of paperwork
Measure – Questionnaire feedback
54
Improve• Four deliverables selected;
1. Remote attendance2. More structured training3. Formalise the network4. Online portal
55
1. Remote attendance
• Equipment to be purchased for remote attendance
• Videos from meetings to be made available online
• Slides from meetings to be made available online
56
2. Structured training• Champions to list desired
training needs• Champions to work with
DFI to meet those needs.
57
3. Formalise the network
“If you want to go fast go alone.
If you want to go far go together.”
(African Proverb)
ChairpersonSecretary
IndependentSelf-
Supporting
58
4. Online Portal
59
PQASSO Champions Network site
https://disfed.sharepoint.com/sites/pqassochampions/_layouts/15/start.aspx#/SitePages/Home.aspx
60
“If you want to go fast go alone.
If you want to go far go together.”
(African Proverb)
61
Project Presentation 4
Declan Denny
62
The Path to Quality for Wexford Disability Services andAddressing inadequacies in the Garda vetting system.
Declan Denny
63
Path to Quality• PQASSO• Charity Evaluation Services (CES) training• Introduction to Total Quality Management• Specialist Diploma in Quality Management
(Lean Healthcare Systems)• Master of Science in Strategic Quality
Management (Lean Sigma Systems)
64
PQASSO / Results• Standardised Care-plans• Service-user surveys• Adoption of HSE complaint procedure• Comprehensive Policy Handbook• Improved Corporate Governance
65
CES Training / Results• Implementing PQASSO• Demonstrate Outcomes• Collect, Analyse, Present and Use Data ---------------------------------
Monitoring and Evaluation of Inputs, Outputs and Outcomes.
66
TQM / Results• Improved HR processes• Streamlined Payroll procedure• Reassessment of service being delivered• Led to organisational change
67
Specialist Diploma / Results• Reduced waiting times for service provision• Increased capacity to deliver services• Progression from FAS Scheme to Section 39
Service Provider• Increased revenue / Need to fundraise
reduced /Reserve fund created
68
Specialist Diploma / Results• Respect for People• Autonomous teams• Improved work-life balance for employees• Employee Assistance Programme• Low turnover of staff• Continuity of Care
69
Masters in Strategic Quality Management /Results
• Business Strategy, Problem Solving, I.T. & I.S., Organisational Culture, Quality Science.
• Thesis, resulting in contribution to public debate and policy development.
70
Addressing inadequacies in the Garda vetting system
• What is Garda vetting?
• What does it do?
• What is it not?
71
• 1749, the creation of the Bow Street runners and the development of a Register of crimes
• 1750, Creation of the Universal Register Office for background checks and character references
• 1869 /1891, Development of the Habitual Criminal Register
Origins and Historyof Garda vetting
72
• 1922 / 1929, Responsibility of Minister for Justice
• 1929, Responsibility devolved to the Gardaí and later renamed the Dublin Criminal Register
• 1999 /Present, Creation of the Garda Central Vetting Unit
Origins and Historyof Garda vetting
73
• System has evolved • Paper based system• Underutilisation of IT• No real-time update facility• Non-portable• Block to free movement of labour
Inadequacies identified
74
Inadequacies identified
• Overproduction due to re-vetting leading to waste
• Means to Identify person seeking Garda vetting unsatisfactory
• Long waiting time for return of vetting forms• No list of prescribed offences
75
Methodology• Comprehensive Literature Review.• Identified Customers of Garda vetting.• Utilised Quality Functional Deployment.
Analysis to identify customer requirements.• Conclusions and Recommendations.• Practitioners review of research and
recommendations.
76
77
Recommendations for new Vetting system
• Creation of an Authorising Authority• Central registration• Robust Identity checks• Issuing of Biometric Photo I.D. Cards• Real-time updating of Central Register• Extranet access to PULSE or Central Register
78
Practitioners Review• Principal Social Worker x 2 - TUSLA• Social Work Team Leader x 3 - TUSLA• CEO of Major service-provider• A qualified Barrister/Solicitor and Lecturer in
Law.
79
Practitioners Comments• “reflects many of the anxieties held by frontline
child protection practitioners”• “a common misconception that Garda vetting is
Garda clearance is clearly outlined by the researcher”
• “ the research addresses an extremely important issue which affects many people and has an impact on society in general”
81
Panel Discussion
Lead Panellist Stuart Lawler NCBI