How to best support healthcare providers meet the NSQHS standards
We are witnessing a global move towards patient safety. Indeed, in the Australian healthcare sector, we are undergoing a period of great change which has been reflected in part by the new set of National Safety and Quality Health Service Standards that became effective on January 1 2013, writes Professor Cathryn Murphy.
The Standards have been established to provide clinicians and healthcare management with a guide of what to do around 10 specific areas including addressing the national burden of healthcare associated infections (HAIs); the most common healthcare complication affecting approximately 180,000 hospital patients a year, occupying almost two million bed days.1
To ensure best practice compliance with the Standards, it will take a concerted and aligned approach by healthcare providers, government, professional associations and the medical industry.
The implementation of the Standards means that there is now one national set of criteria which is detailed and prescriptive, against which all hospitals and day procedure services must be accredited. Clinicians have an obligation to understand and comply with relevant actions in the Standards to ensure the best and safest patient outcomes.
Importantly, the obligation to prevent HAIs does not vary according to healthcare worker type; anyone who works in a healthcare organisation, or interacts with a healthcare organisation can effectively contribute to HAI prevention including the broader medical industry.
NSQHS and the medical industry
Although not identified in the Standards, the wider medical industry will be integral in ensuring best practice compliance. By medical industry, I am referring to all those product and service providers that we work with day in day out, including pharmaceutical and medical devices suppliers as well as contracted environmental service staff.
To support healthcare providers in implementing the new Standards, it will be imperative for the medical industry and its representatives to have both a broad understanding of the Standards and a strong working knowledge in areas directly relevant to their specific product or service offering.
It is important that the medical industry also has a clear understanding of why the Standards came into place, how they are standardising and improving care and some of the initial challenges that healthcare organisations are encountering in their implementation.
It is also particularly important that the medical industry has a solid understanding of the significance of the Standards and the required organisational and behavioural changes for all healthcare workers to ensure compliance and therefore accreditation of their organisation.
To comply with the Standards and ensure standardised best practice, healthcare organisations are reprioritising their activity. The complexity of the Standards may be overwhelming, in particular for some smaller organisations, and where possible the medical industry can make a difference by learning where the pain points are for healthcare providers, engaging clinicians with the Standards and working collaboratively on solutions which could include in-service education programs to support behaviour change aligned with a specific Standard, service or piece of equipment.
From a healthcare provider perspective I have witnessed a mixture of excitement, expectation and some apprehension around the introduction of the Standards but overwhelmingly, having clear information as well as defined boundaries to avoid any misinterpretation has been welcomed by the infection control community and other key stakeholders.
Although we have known the inevitability of the new Standards, it will be interesting to watch the medical industry’s overall response and approach to the Standards and how industry will work with healthcare providers to ensure best patient outcomes.
Working hand in hand
Although not recognised as having an ‘official’ role in the Standards, I see the medical industry as taking on a key supporting role to healthcare service providers in addressing certain aspects of the Standards.
However, to successfully work together, it will take a shift in mindset on the part of both healthcare providers and the medical industry. Medical industry representatives should consider their approach to healthcare providers and take a more solutions-orientated rather than sales-orientated approach to their interactions with healthcare providers. At the same time, healthcare providers should consider how they think about product and service providers and start seeing them as a potential resource to support education and behaviour change initiatives linked to the introduction of the new Standards as well as a major source of research, development and technical innovation.
In-service education programs
In order to support healthcare providers’ understanding, commitment and compliance with the Standards, the medical industry can play a fundamental role by providing in-service training programs and developing educational collateral that reflect the new Standards.
The industry can work alongside healthcare service providers by routinely aligning any product or service in-house training programs with relevant sections of the Standards. Practical training programs would be well received and engaging supportive collateral outlining relevant components of the Standards would be beneficial. Although not yet accessible in all hospitals and day procedure centres, a consideration would be to conduct training through an online setting by hosting interactive forums, facilitating online training classes, hosting online interviews and developing digital tools, for example applications.
Tailoring education programs for each organisation rather than taking a one-size fits all approach would also be welcomed. Although the Standards are streamlined across the nation, every healthcare organisation likely has a unique need and where possible that need should be accommodated within generic educational and training materials that can be customised.
What the medical industry can do to support the Standards
- Formalise internal training programs around the NSQHS for all employees who interact with healthcare providers
- Ensure NSQHS education is a requisite of any medical industry representative’s induction program
- Engage external consultants where internal resources are limited
- Understand the critical ‘pain points’ for your customers (healthcare providers) by knowing what questions to ask
- Align all product and service support material, in particular in-service training programs, with the relevant Standard/s to assist healthcare providers with compliance
- Develop initiatives to support behavioural change particularly in areas where ‘compliance fatigue’ is a key challenge to achieving compliance
- Use networks to distribute collateral and communicate key messaging
- Encourage sales representatives to focus on product and service solutions that support the NSQHS, rather than sales alone. Where possible, share knowledge and best practice examples from across the healthcare industry.
Supporting Standard 3 compliance: hand hygiene fatigue
Healthcare providers can look to the medical industry for expertise and leverage their access to resources, particularly in the area of marketing and behavioural change, whereby the products and services they provide align with a particular Standard.
Healthcare workers are repeatedly informed and educated about best practice. There are many requests and pressures upon healthcare workers as part of targeted improvement campaigns. These can result in the healthcare sector becoming saturated with constant demands for improvement. Specific messages are easily lost or ignored and healthcare workers develop a sense of “improvement fatigue”. To gain and retain the attention of healthcare workers and to encourage sustained behaviour change, medical industry can play a key role when communicating in this area.
In HAI prevention and control under Standard 3 hand hygiene is a clinical priority area.
Some of the intent within the Standards is ambitious in terms of having clinicians comply with hand hygiene 100 per cent of the time, however medical industry is in a unique position to take a creative role in educating and providing support consistent with the National Hand Hygiene Initiative. There are opportunities for additional support through new technologies, new engineering, more creative and engaging educational collateral, through product formulations and research and development.
The future of standardisation
Now is the time to act. The medical industry understands better than most the importance of standardisation and getting the desired outcome. For the new NSQHSs to reach their full potential, efforts need to be concerted, considered and collaborative involving healthcare providers, government, professional associations and the medical industry. This collaboration is critical to ensure that the level of quality and safety of healthcare delivered to all Australians is safe.
Engaging the healthcare consumer
Every Australian ultimately consumes healthcare on some level and the standardisation of healthcare practices in Australia means consumers can and should expect equivalent care irrespective of where and in which setting or sector they receive that care.
Consumers are now more informed regarding the quality of Australian healthcare. They are also now part of the solution. Patients and carers play an important role when healthcare organisations demonstrate their commitment to the Standards. It is imperative that consumers are aware of their unique role in questioning non-compliance and asserting their right to safe, standardised care consistent with the Standards.
One area that patients and carers can make a significant difference is in the area of infection prevention and control. It can however be difficult to engage customers so creative approaches should be used to communicate key messages to consumers.
One of the most simple ways carers and families can make a positive impact on infection prevention is by ensuring hand hygiene is performed before and after visiting a patient. Given that hand hygiene involves product interaction and behavioural change, it is one of the more obvious areas healthcare providers can reach out to product suppliers for support through leveraging industry experience and expertise in developing behavioural change programs and educative collateral.
There is also an opportunity for healthcare providers to leverage the medical industry’s distribution networks to drive reach and frequency of messaging. This is useful for communication routinely and especially during times of outbreak.
Sharing best practice
Industry could also play a fundamental role in providing support to healthcare workers by applauding and demonstrating enthusiasm towards the Standards and the anticipated patient outcomes. Increasingly we are seeing the government publishing performance data publically, and one way that the medical industry could support healthcare workers is by facilitating best practice sharing and establishing recognition systems that highlight exemplary healthcare service providers and centres of excellence. This will aid transparency, foster healthy competition and support healthcare organisations understand how to achieve exemplary compliance rates and showcase what they have been doing well.
Engaging at all levels
Representatives of the medical industry work across all levels within a healthcare organisation, from nurses and clinicians right through to the senior leadership team.
Behavioural change champions can be influential ambassadors to support engagement with the Standards, an example being the leadership team within hospitals promoting best practice in the area of hand hygiene compliance, and also an area faced by much ‘compliance fatigue’ . There is an opportunity for industry to engage senior clinicians to support local improvement efforts by acting as case studies in collateral and educational programs thus further encouraging behavioural change across an organisation.
Making standards a key driver
The Standards also provide a broad overarching direction to medical companies and should be a key consideration when developing new products. It would, for example be valuable for healthcare providers if product labelling of existing products indicated how the product reflects the Standards and if new products are developed specifically with meeting the Standards in mind.
Professor Cathryn Murphy is a leading global infection prevention and control expert. Cathryn has consulted nationally and globally to clinicians, governments and the medical industry since 1995. She has served voluntarily on the boards of several large national and international professional associations including AICA, APSIC and APIC. She is the only Infection Control Professional to have been elected President of their national association (AICA) and subsequently the world’s largest professional association for infection prevention, APIC.
Productivity Commission 2009, Public and Private Hospitals, Research Report, Canberra
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