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Good morning everyone, welcome to an AIHI seminar series presentation by Carrie Marr, the CE of the CEC, I’ve used jargon and acronyms already, haven’t I? The Chief Executive of the Clinical Excellence Commission I’m Jeffrey Braithwaite, welcome to this particular seminar series, addition on creating learning systems for quality improvements Carrie’s going to speak shortly Carrie, welcome and thank you for accepting our invitation Thank you Just a short anecdote, Carrie, you have seen her CV which is extremely impressive, and especially her work in Scotland in Tayside So we were chatting over some coffee the other day and I said to Carrie, you’ve got this big job and running the CC, I knew a couple of your predecessors, one of whom’s in the audience It’s a huge job, you must need time out sometimes and have some holidays, and as some of you know I’m not sort of prone to inviting people to go on holidays, I’m more prone to saying to people, work harder But anyway, so we got talking and Carrie said, Yes, yes, I’ll have a couple of weeks break soon And she said, What about you? And I said Yes, I’ll be on leave from the 28th of December until the 26th of January And she said Where are you going? And I said Oh, the UK I’ll be spending time in Scotland And she said, aghast, coming from Scotland, You’re going to be in Scotland in January? And I’m going to be in Sydney in January, are you crazy? So thank you for that tour information about not being in Scotland in January, but I’m still going Carrie as you know from her CV has done some amazing things already in the time she’s been with the CEC But she’s got a long background in health systems improvement, in quality and safety in Scotland We’re going to hear from her now Could you welcome her to the AIHI seminar, thank you Thank you for that warm welcome The conversation I wanted to have with you this morning, when I first got Jeffrey’s brief was to talk to you about what our line of sight is around safety and quality over the next two to five years And thinking about what’s ahead of us We’re in a privileged position because until I went for my coffee this morning I didn’t realise that the founding member of the Clinical Excellence Commission is in the audience with us So you get the privilege of being able to think about resilience and sustainability and healthcare from both of our perspectives today And so I hope that means you might want to think about where we’ve come from as well as where we’re going because for me, organisations and countries go through cycles And each time we go into our next phase of maturity, we build on where we came from Because that’s what gives you the incremental lift to go to the next phase Isn’t it? And I don’t want to speak for Cliff but when I came to the CEC last year, and I had my one year anniversary last week, when I came to the CEC a year ago, what was evident to me was that the 12 years, at that point when I came, of work that had gone in to setting the foundations for that safety improvement effort And we followed a pattern that internationally other countries have also followed We’ve grown our safety and improvement effort in the beginning from adverse events From learning about things that we could have done better And thinking about how we create a focus in healthcare systems to look at things like sepsis and falls and deterioration and thinking about how people feel confident to deal with them And because the clinical excellence commission spent their early days and years building those great foundations what it means is now in this next phase of 10 years that we want to then think about how we grow that and think about systems And we couldn’t do that without having the first phase Then if you look at Scotland and England particularly a lot of the Scandinavian countries, that’s exactly the same pattern that we’ve all followed That we get that transactional competence in our systems We understand what that knowledge of improvement needs to be

And with that change always comes some disruption A different sense of vision and focus and you’ll get that when anybody new comes into an organisation or a ministry But what that also gives us is an opportunity to rethink and refresh what’s our next stretch Where do we want to go? And of course the question that people like Cliff and I and Jeffrey have keep asking people is and how courageous are you prepared to be? Because we can all of us stretch challenge but we might not be as courageous as we really could be And so that’s part of the question that I believe is our responsibility to ask Some of this is about being safe But there’s also a need to think a bit more radically about what we’ll need to do in the future And I’m going to talk to you today a lot about hospitals and healthcare within that hospital model But the other thing that’s becoming really apparent in the reform conversation is we start to move more and more into integrated care, into thinking about how we deliver mental health in the community setting We’re going to have think about how we adopt this model across whole systems You’ve seen that work in New Zealand, and certainly that’s the approach we took in Scotland, quite different from England So there are really interesting time, I think, in New South Wales, journey And one of our intents in this next phase of work is actually to get people thinking about quality as a habit And when I talk about the word habit, what I mean is, instinctively people believe it’s the job It’s not something extra, it’s not an addition to the PD, it is the job And if you go to Cultorum in Sweden, they say everybody’s actually got two jobs You’ve got your job which is quality and improvement and you’ve got a second job which is every day to come in and improve your job Very strong philosophy that that responsibility we all bring to bear that when we come to work we come to work to think about what we can do better and different every single day So there’s something about quality being something that we know we should do every day And something we should practice in everything we do And it becomes instinctive We’re doing it because we know it’s the right thing to do And some of us had the pleasure last week of meeting with Peter Pronovost from John Hopkins and listened to the story of where they’ve got in Baltimore and it’s quite clear that one of the things that’s made John Hopkins successful is that they have instilled in their organisation from the bedside to the boardroom really consistent reliable work practices that actually create that sense of reliability in their system So we want to think about what those work practices are And what was really interesting is for the first 20 minutes all Peter talked about was culture Didn’t talk about anything else, he just talked about how for organisations to thrive, to become resilient, the conversation about their values and their culture is fundamental to that happening And so my invitation and my reflections currently are whether we need to do more of that in New South Wales So these are some of the issues that we’re dealing with We’ve been looking at the work that we’ve been supporting in New South Wales, there some fantastic innovation has happened in New South Wales And so we’ve always and we remain continuing to have a commitment to quality But our senses that if we could just take the great innovation and go to scale we would actually be helping to create more reliability in the system So there’s great pockets but when I go into hospital is it in every ward? Is it in every department? Is it in every facility? We’re not there yet And that is the biggest challenge that all of the international community have always had How when you start to embed this work do you actually move it so it’s something that becomes a systems property? Not just the property of one ward, with one great leader How do you create that system leadership?

We’ve also recognised there’s a bit of a gap nationally in how the kind of agencies, the pillars across New South Wales work together And how we work with the ministry and how we work with the local health districts And that there could be a tighter way of us aligning our work So that we come together with a more cohesive offering of how we can support health and how improvement can support safety And how safety can support flow and operational performance And we see some opportunity for us to join the dots on that The other thing that we’ve reflected on, I’m going to talk about this in a minute, is when we’ve asked the system where the balance is the sense is that we are erring a lot more to compliance than improvement I’ll talk about what that means in a minute when I lay that out for you And the priority thickets is just that sense of reality in healthcare Everybody has got a plan, and everybody’s got a plan with a lot of actions in it, and a lot of objectives The system is feeling as if we’re overwhelming them with priorities And they’re almost asking, and Jeffrey and I were talking about this earlier, they’re almost asking for permission to focus on the 10 things, not the 100 things in order to really do them well As opposed to superficially trying to do good across 100 different things In Scotland we used to call that approach spray and pray, that you just, you had so many priorities to do for your government that everything got a little bit of your time, but nothing went deep And so our responsibility is how can we declutter the landscape And one of those is around data So if we’ve looked at some of the wards and in some wards in some hospitals we’ve got nurses collecting what is the equivalent of 37 hours worth of data And that’s just on one ward and that team of nurses Now they’re not using 37 hours worth of data So there’s part of that is how can we declutter the data landscape So we’re collecting the right information and the right metrics And we’re using it for the right reason, there is this philosophy you should collect once and use often And at the moment the sense out there in the system is we’re collecting often and we’re using some of it some of the time It’s not particularly an effective way to do it We’ve also recognised that we need to have a much more planned approach to capability Internationally there is a formula that we use in healthcare systems to help us work out the critical mass that we need for improvement And I’ve certainly for the last 10 years used the Kaiser one So in a given staff population half a percent of all of our staff should be trained as improvement experts So that’s full-time people quality, safety, redesign, improvement, quality assurance, all of those people should be trained as experts And if you take an average Metro LHD in New South Wales that would be about 60 people, full-time, trained, coaching the system, supporting the system in those roles And behind that the next part of the formula is that in that kind of cohort of nurse managers, clinical leaders, that kind of middle part of the system, we should have 15% minimum of those individuals trained to lead improvement and safety work And in Metro LHD at the moment that’s about 2500 parents in every LHD So when you start to multiply this up by 17, you’re starting to see the challenge that we’ve got on our hands And how incrementally year on year we can start to build a critical mass of people that we can use Now already if I just look at the clinical leadership program that the Clinical Excellence Commission launched many years ago, we now today have over 2000 people across New South Wales who’ve been through the program But quite a lot of them are frustrated because when they go back to their organisations who are not deploying

that expertise We’re not using the skills of people that come out to do that kind of skills development And so before we even start we’ve got an alumni across a number of programs we actually need to start using And I think for organisations like this, how could you connect with some of these people? They are hungry to get involved And we saw last week at the JMO conference, we’ve got 400 JMOs in New South Wales who are hungry to work with all of our organisations So how can we use them? How can we engage them? And the last bit about capability is that there is this proposition that every single board member and every single executive director needs to be trained in improvement science and measurement And if we do that, we would fundamentally change the conversations about what governance means in quality and safety So we’ve got a bit of a challenge there Local accountabilities, I’ll talk a bit about the end which is do we need to rethink what the role of a board is, the role of a chief executive is, in providing that system leadership and permission to make this happen And how do we support them to do it And then lastly the chestnut of measurement and reporting Because we’re still challenged by how real time our information is And how quickly we’re getting it into the hands of clinicians who absolutely want today to know what’s going on today, not what went on a year ago And we need to think about that So we can talk about that So I was going to just reflect on some of the things that I’ve used up until now in my reflections on system performance Way back in 2009 when I first listened to Anthony Staines at Berlin, we were just, we were three years into our patient safety program in Scotland We were starting to get some traction but we hadn’t really thought about the systems component of making it stick And Anthony did his PhD in systems performance and resilience around safety And there’s a whole presentation which I can share with you through Jeffrey to look at But effectively even in those early days Anthony was talking about the characteristics of great organisations And in 2009 it was the organisations that were in the top quartile were Intermountain and Salt Lake City, Cultorum in Jonkoping in Sweden, and the third one in 2009 was Reinier de Graaf in the Netherlands Now if you were looking at that top quartile today, interestingly we’re now six, seven years on, Cultorum and Intermountain are still in that top quartile They’re doing something that sticks They’re doing something that sustains They’re joined now by the Cincinnati’s, by Virginia Mason, by Kaiser, by Salford in England, there’s a whole lot of other organisations have joined in that top group But it’s interesting to see how some organisations have sustained that level of outcomes around improvement and safety And what Anthony said way back then was the characteristics that he saw in those top organisations were in those four domains They were in leadership in culture, so what was the strength of the leadership? Was the organisation orientated to measurement? Did they understand what mattered to patients? Were they connected to stories about their patients, not just the data? What did the leadership bring to support the front line? They were also, even in those days, Colturum had an academy, Intermountain was doing it advanced program, they were setting up very planned approaches to creating the critical mass They all had really good data and information systems And if any of you have been to Intermountain you’ll have seen how sophisticated and real time their measurement system is But really importantly, what his piece of work way back then demonstrated was the other difference in those organisations who were really good at this Apart from those other three characteristics they focused 90% of their attention, their resource, their coaching, their support, right on the microsystem, front line They fundamentally believe that in order to be strong and resilient, that actually you had to understand that all improvement is local

It doesn’t happen in boardrooms, it doesn’t happen in committees, it happens where people touch patients And therefore they designed and organised themselves to make that happen Really fundamental proposition, and I hope you get a conversation today about just what that might mean for us So that was way back in 2009 And then we’ve got our more recent reflections with colleagues that you’ll know in this room, looking still at what that rich tapestry of a high-performing hospital is And you know what, it’s not different That sense of connection to your values, your culture, how much your staff feel engaged in their effort, what leadership you bring to bear is still there So I suppose the reflections for those of us who’ve been in healthcare for a number of years is, the proposition here is not difficult Making it happen is because what we’re talking about here is hard wiring a way of working and a way of being into the fabric and the culture of an organisation that’s going to create the conditions for change And we had a, I was speaking to some middle managers last week and we had a great conversation about the challenge of there, what I was invited them to think about was, is surely the job description of everybody in the middle part of the system is that your job is to create those conditions That’s what the job description is but how much time do you spend doing that? You’re caught in a bit of a hamster wheel of doing what we need to do as opposed to doing what we want to do And how can we create some space around that? So this is in shape, when you look at the six focus points for Kaiser it’s the same So we’ve known what needs to happen, what we need to do is think about across New South Wales, how we connect all of this into our conversation about systems leadership for safety and quality This is a framework that I’ve been using since I came into post because I was introduced to this initially by a gentleman called Alan Frankel when he was working for Pascal Metrics And in the year I’ve been going round each of the local health districts and networks and just finding out from staff where they think New South Wales is And interestingly enough, almost everybody I’ve spoken to has placed their pin that it feels as if we’re sitting between reactive and systematic In some parts of the system they’re feeling more in the reactive, much more in the reactive Some of the feel they’re lifting a bit into the systematic box But everybody’s feeling that we’re doing something that’s not proactive and not predictive at the moment And so part of the proposition for us in this next phase is how can we build on what we’ve done and now help people to think about how you become proactive Because when you start your journey it’s absolutely the right thing to do that you focus on the things that we’re not getting right How do we create better outcomes for patients? How do we look at all the error in our system? How do we find out the defects, the unreliability? How do we source that and deal with it? But if you want to move to the top part of that framework, you’ve actually got to look at the fat end of the wedge, not just the thin end of the wedge And you’ve got to understand what you do right most of the time in order to replicate it You’ve got to understand when you do get it wrong, how you deploy everybody to make sure that you deal with it quickly So you become much more agile rather than feeling that you’re bogged down and being reactive And people are feeling at the moment, we are feeling quite reactive We’re engaged in a number of processes that keep making us look back, not forward And so our responsibilities to think about how do we lift some of that And we can have a chat about that later on today How do we help organisations think predictively about the harem that could happen today and tomorrow, not why it happened yesterday And part of that proposition then is to think about how can we bring some balance to bear on this? Because the reason people are feeling that they’re in the reactive box is because they’re feeling that they’re spending all their time in compliance And you know yourself in healthcare,

we define our self by process measures It’s how much, how many, it’s volume not value But what people are asking for is how they can bring more of a 50-50 balance to spend as much time in the right hand side of that proposition as the left So we still need compliance We need standards We need to standardise our practice in healthcare and we need to support people to do that, every patient, every time But we also need to give people the chance to improve past that standard, to actually think collectively about how they could do more And actually bring more innovation to the workplace Because the challenge with only sitting in compliance is you can stifle innovation, you can stifle the very things that your staff want to bear So our intent is to try and get this more 50-50, and that hopefully will help us lift that as well And if we were more 50-50, what would we know? Those four questions would be much easier for people in the front line to answer every day Because at the moment they’re not able to answer all those questions And yet in the world of improvement, that’s the fundamental conversation that we believe teams should be having So do you know how good you are today? Not last year, and not yesterday, today And the private sector have got a lot to teach us about that If I was the manager of Cole’s supermarket, I would have the metrics in front of me at 12 o’clock every day that would tell me what was going on We need to think about the same level of agility for our clinical teams in healthcare The second one’s also really important because you also have to understand where in your system, in your department, in your service, do you know because you’re looking at the data and you’re talking about it, do you know where your waste is? Do you know where you have variation that’s unwarranted? And do you know how much harem you have in the system? Do you know how many patients that have had a bad outcome? Do you know their names? The challenge here is we need to get past people thinking just about statistics We need to understand that every data point particularly when we talk about variation and harm has actually got a patient at the end of it And how do we do that? I have a colleague that I’ve known in the States that we did some work with Scotland called Jim Conway And Jim Conway was a chief executive and then became a chairman of a board out there and at his board meetings he actually shared the names, the first names and the age of everybody in their system that he wanted the board to know had died a preventable death He made it really personal, every board member went out that room thinking really differently when they saw a conversation that said Annie, six months, and John, 43 years, and not just the number of adverse events they’d had in the system So how can we think about really making this personal? How we compare best in class So there’s two levels here, it’s great to compare ourselves with who’s on our doorstep and we should know how we compare across Australia But actually if we’re being really brave we need to be prepared to compare ourselves internationally We have a few daft sayings in Scotland and when we used to talk about this because we used to love comparing ourselves to everybody in Scotland, particularly as the organisation I was in was the top performing board And then somebody said to us, But you’re just the cream of the crap You’re not being brave enough, be prepared to compare yourself with people who are going to stretch you It’s not good enough So it’s just be brave, it’s a stretch challenge but be brave And do we know our rate of improvement over time, which is how are we tracking what we’re doing in safety and quality? Where are we tracking it and is it on the walls? My ambition would be wouldn’t it be great if we could walk into every department and ward and see the data on the wall that tells us how we’ve improved outcomes for patients Patients love it, they want to know how many days since the last fall How many days since someone had an infection? They want to see that you’re showing your rate of improvement about how you’re delivering care bundles

And they want to see the feedback about what matters to them as well And the whole learning board is taken off We’ve got whole districts this year who are trying to put up on every wall boards that they can, their staff and their patients can see what their focused on and what matters to them And just making it more visible and transparent will actually change the culture And gets everybody talking about it If you have a huddle, every shift around your board, you’re focusing on what matters to you that day So lots to offer there And the other reason I think we’re also in a bit of a tipping point is historically healthcare loves to kind of sit in the world of performance We love a good performance plan We love a good action plan, don’t we? But performance needs to all, if it’s going to mature we need to move past just looking at performance and particularly financial performance, we need to look at improvement And how do we do that? But if we grab this, the other opportunity is we then go to the third curve And the third curve is actually we start working across communities, we start working with agencies that are not just in health We start thinking about working with our local citizens in a fundamentally different way So if you look internationally about how early years has moved on, early years and it’s starting in New South Wales, the conversation in the last six months has changed We’ve got agencies in the room who would never have been in the room together a year ago talking about a joint purpose to improve outcomes for early year children So that improvement methodology that we bring to bear in safety, we can use that and share that with other agencies who’ve all got an interest and have a joint purpose in children, in elder care, in areas like that And I think you’ll find that you’re going to see much more visibility about how we could do that in New South Wales So I’m going to see all the chief executives in New South Wales tomorrow And this is the question I’m going to ask them Because I think there’s a fundamental difference between administering safety and quality as a system that you feel you’ve got to do, as opposed to embedding it as an operational management system It’s very similar in thinking to the philosophy of John Hopkins that if you hard wire this in a different way you’re leading it, you’re directing it, you’re giving permission for your system to engage in it, you’re not just taking it on as a task And how do we actually create the shift change we need in order for organisations to do that? So we’re thinking of focusing on five things, and we’re going to be testing this out with the systems If we really want to think about system leadership then we believe that we need to be talking about these things The first is psychology and that’s about helping everybody in the system understand how we affect change We don’t affect change through policies alone We don’t affect change through regulation alone Behavioural change comes from a very different set of supports And how do we make that happen? We need to think about who we’re going to work with in the system and why I’ve put the adoption curve under there is, I’m a great believer in just spending your time where you’ll have most impact to start with We start by spending our time on the left-hand side of the curve We pull together our clinical leaders who want to get involved We pull together staff and front-line teams who want to drive this improvement and you work with those who want to do it Because you will have some who want to sit on the fence and they won’t come off until the first group show them the data that’s made a difference, and that’s okay because if we got everybody to jump at the same time we just couldn’t manage the support of the system So I’m quite happy for that to be incremental but we need to think about how you support and nurture people who really want to be in the adoptive end, who want to test, who want to prototype, who want to support Because they’re going to need support from the leadership to do that So we’re actually testing the will of the executives in the districts where they sit on that curve and how we can

bring them to bear in making some of this happen The systems approach is what I’ve talked about It’s about understanding that you actually need to think differently if you want to engage in a conversation about improvement and safety being a systems property, it doesn’t happen just at a point of care, we’re all connected And how do we bring all of this together in a systematic way? So that we actually probably need to consider whether we’re really developing leaders in our system to understand systems Our complex, adaptive systems that we work in every day We’re not running a production line, we’re running something that creates value, that’s got a human dimension So therefore it’s messy, it never goes to plan, and one of the big challenges for leaders in systems that are complex, adaptive, and messy, is it means you need to support people to work with emergence, to work in the area of grey Working in healthcare’s not about working in the black and white And the more senior you become, you realise how little you control But that actually needs to be something that we support and develop in people as a confidence The third bit is about, is I talked about the data, so how can we focus on and invest in the systems that are going to get real time data and it’s analysis in the hands of the people who could use it best And how can we do that quickly And lastly, our theory, because if we’re going to go to scale we need a method And at the moment people have got will, one of the things that brought me to New South Wales three years ago was when I talked to the clinicians in the system that I came to, there was clearly will in the system Great people here who want to do the right thing And they understand why but most people are saying that we don’t know where to start, we don’t know how to do it And so we need to create a method, the model of improvement, looking at establishing collaboratives, getting people to start sharing what they’re doing across organisations Because we’re quite siloed in healthcare, we love keeping to ourselves what we’re doing We’d fly to another country before we’d knock on the door of the next LHD That’s just the phenomenon of how we work We would do the same in the UK We would go to America before we would knock on the door in England But that’s a Scottish thing But how do we create more collaboration? There’s six different hospitals want to work on sepsis, well come in the room together, let’s talk about But this bit at the bottom again and how can we use all of those four lenses to support the front line in a way that’s going to make this happen quite differently And the other thing I think we need to think about, and will definitely make a difference is whether we’re prepared to hold lightly the way people work Because the difficulty with big unwieldy mechanisms like health is we’re perfectly designed to take nine weeks to make a decision We have a working group which can last from anything to three months to one I found in Scotland that had been going for seven and a half years And it’s still not found a solution to uniforms or car parking, surprise surprise So there’s the working group and then you’ve got to go committee and you’ve got, we create so many hoops for people that people don’t believe we’re making it easy for them to have a great idea, test it, and get some permissions in the system So we need hierarchy because we need a sense of how we make decisions, how we govern ourselves, so we need that But the proposition, and if you read some of the works of people like John Cotter, his proposition is that you need to create networks in your organisations so people work horizontally And you need to allow people to engage in networks and not know what they’re doing Let them go free, let them have great ideas, let them spontaneously combust in different departments across different organisations and let that grow because if you allow to grow the energy for your improvement and safety work will actually stay there And that will keep your resilience alive It’s part of what should be in the fabric of great organisations If you look at the ones, the private sector that work

really well, they create this really, really well Virgin are a great example of that, they do this really, really well So these are the five things this year we’re going to focus on because we’re about to embark on a five month journey to develop a New South Wales framework for quality and safety What are the components of that framework? We’re going to talk to people about those five things As I’ve said throughout the morning, what governance and accountability processes do we need? And how are we going to establish them? What is the leadership and culture that needs to brought to bear to create the conditions for change? How do we build the right capability that we need in the system? What are going to do to ensure that we have the right metrics from the bedside to the boardroom to the ministry that assure us that we’re doing the right thing and improving the right things and spending our time on the right things And lastly this whole piece about creating reliable microsystems So we want to get into conversation with all parts of New South Wales over the next five months And we’d love you to be part of that conversation And if you want to do some thinking here with Jeffrey and colleagues and come back and give us your thoughts and ideas, it’d be fantastic to come back and continue that conversation with you We want to, on the back of that, then think about how we form a plan to support the system in those areas I think we’ve got a real opportunity And I think we’ll find that we’ve got a massive community of people out there who really want to do this And if we can show them the incremental steps, particularly in the first year or two, to get going, I think we’ll get to a point where New South Wales will be in a place of confidence to move in that next phase and maturity that it’s taken on board everything that’s it’s learnt in its first phase of work and it’s going to use that and this kind of conversation to leverage it into the next phase Thank you I think that practice is not a consistent one I think it would be fair to say that boards, because we don’t have a process that we ask them all to follow What we do expect is that every board should be talking about safety and quality in every board meeting And actually if you follow the direction for boards, there is the proposition that it should be the first thing on a board meeting, and that money should be after safety and quality Every board meeting should start with a patient story So the orientation of a board to understand what’s happening in the system should be strong Now one of the things that I think we want to talk to the boards about is how much of that’s happening in the boardroom and how much of that is being delegated down to the subcommittees for quality So every district has a subcommittee across the district for quality and safety which look at the all metrics which bring together all the clinical leaders and they’re fantastic groups to think and reflect on where the system is at with that safety work But in addition, the boards should all be talking about it I believe every board should know about every significant adverse event that’s happened in their system I think that leadership needs to come from boards So part of what we want to do here is talk to the CEs and the chairman about whether we need to just, is there anything that we could do to support or tighten up that role of boards, of executive teams, and of clinical governance units Because there was there’s been some great work done to look at the role of clinical governance but we’re at a point now, it’s looking a bit different across every system We think we need to revisit that so people understand that clinical governance isn’t responsible for quality and safety, it’s there to support and help the clinical community take responsibility for safety and quality And we need to think about how we do that So it’s going to be part of this cut, it’ll be in the governance circle So we have an opportunity around the data

There’s nothing less, there’s nothing that’s more demotivating than to put effort into collecting something and you don’t know what it, you don’t get any return on it It’s one of the reasons in the new incident management system, we are providing more functionality that when you report an incident you’re actually going to get feedback about what happens to it People like the feedback I think it’s very hard for people at a local front line level to decide what they’re going to stop Because it feels as if it’s coming down the system I think it’s for the leadership of the organisation and for us in the agencies and the ministry to make a view on that I think we need to think about whether we need the process measures that we’ve got, and if we can take some of them out I think we need more agility in being flexible about what we measure So at the moment if you look at our KPIs in the system, so we’ve got a KPI for hand hygiene, we’ve got KPIs for central line infections for instance We’ve got hospitals who because of the great early work on the CEC programs have actually been without a central line infection for 13 months So my question is well why are we still measuring that? So the stuff that’s going well, we should be able to draw and measure much less frequently and you allow teams to put up there something that needs their attention every week But you’ve got to give people permission to do that Our hand hygiene is 84% across the state, it’s the best in Australia, that’s fantastic Well let’s drop that, report less, let’s put something up that we really want to talk about like the rate of falls So I think what we want to explore is whether we could have some overarching indicators that we would like to see at a state level Now that might be things like mortality It might be things like significant adverse events, but allow the local systems to decide what’s the four things you want to work on in order to feed that big dot So over here might want to look at sepsis and deteriorating patients, but actually over here might want to look at pressure injuries and falls and other things So we’re getting quite a good response from the system to do that We’re going to explore that as part of this conversation But I think we’re kind of, if we’re going to get people to take ownership we actually need to give them some room to decide what their local priorities are And so I think there’s room to do that And then keep our eye on the big dot Look, I think there’s an opportunity for us to bring these two worlds together Historically we’ve had research and we’ve had improvement, haven’t we? And people have felt that they’ve actually to make a choice, do I go into the improvement club or the research club? I think the conversation that’s being emanating in New South Wales is a fantastic one because we’re all starting to talk about implementation science, the space that bonds us And thinking about how we could actually have researchers and improvement experts working together, I think opens up a whole space for us to think differently I would love to see more researchers on the ground as part of these teams Particularly because I think there’s a challenge for us that work in that world of organisational development around this because it’s really hard to measure culture as we know I mean there’s so much work being done on it but how are we really going to show that we’re making that difference? And how do we demonstrate that back to the system? I think if we could show more partnerships that we could create, I’d think we’d demystify the whole research improvement conversation And neither of us are in it for judgement And that’s the other thing that should bond us as well So I think we should think about something we could be doing now because the other thing I would notice is we need to start right at the beginning of some of these new bits of work to think about how we demonstrate over time, we’re really showing the shift change Which means we should be talking now, not in a year’s time So any ideas, CEC would love to come and spend some time with you and bounce off some ideas The accreditation framework and the standard,

when I worked in a LHD they were fundamentally at the core and the heart of what we were doing And we would use them and we would talk about them in terms of how we want to develop our practice But what I would notice is we’ve kind of two parallel lines running at the moment And so in that accreditation stream we’ve got teams who intensify their effort around accreditation, normally in the lead up to the survey And we have this six weeks of industrious effort and then it kind of stops And then over here we’ve got all the safety and quality effort My ambition and I would love to think about how we could do this and I think we could is we use the day-to-day practices and the way people are working to be the evidence for accreditation And so we bring the two worlds together and so we don’t end up with people thinking this is an industry This is what we need to do and this is what we want to do People actually see it as the same thing because the quality in safety work every day, they know they can use when they come to their accreditation conversation So I think that’s the other maturity we need in the system between agencies like ourselves and yourselves and the commission, the Australian commission about how we do that But I think there’s a will to get into that because it’s our job to make it easy So maybe just two reflections, one is I think primary care spaces opening up And it’s really interesting that the primary health networks and general practice are now knocking on the door and they want to extend the safety and quality conversation out there I think data, as well as being a clinician, I’m a development practitioner at heart And data’s the best dialogic tool you’ll ever get, it’s the best way to start a conversation So the more we have it, the more we can use it to change the conversation If we, we need to move away from anecdotal discussion to one that’s evidence based Carrie, I’ll draw this to a close, thank you very much to you, thank you very much indeed Thank you

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