Welsh Campaign aims to save 1000 Lives.
Subject: Health promotion (Planning)
Wellness programs (Planning)
Author: Manchester, Anne
Pub Date: 02/01/2009
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2009 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: Feb, 2009 Source Volume: 15 Source Issue: 1
Topic: Event Code: 220 Strategy & planning Computer Subject: Company business planning
Geographic: Geographic Scope: United Kingdom; New Zealand Geographic Code: 4EUUK United Kingdom; 8NEWZ New Zealand
Accession Number: 194904186
Full Text: A national patient safety campaign, launched in Wales last year, aims to reduce avoidable hospital deaths by 1000 and episodes of harm by 50,000 over two-years. The 1000 Lives Campaign's focus is on changing the way hospitals work in order to make lasting improvements to safety and quality.

Head of the Faculty for Health Care Improvement in Wales and a spokesperson for the campaign, physician Mansel Aylward, visited New Zealand earlier this month to discuss with Ministry of Health, union and other officials the possibility of collaborating on a similar campaign here.

Speaking to representatives from NZNO, the Public Service Association, Council of Trade Unions and the Association of Medical Specialists, Aylward said he would like to see closer relationships between Wales and New Zealand developed to support a national patient safety campaign. Links had already been formed with British Columbia in Canada, he said.

"Wales and New Zealand have much in common. Our populations are similar and we face similar issues around social deprivation among certain sectors of society, and health challenges like diabetes and smoking. Over the years, we have run a number of health promotional campaigns, but results show these do not work with 25 percent of the population where the highest prevalence of disease is found. We are just not reaching these people, largely due to socioeconomic factors."

There were differences between the two countries, however, in particular the tack of any private involvement in health delivery in Wales. "The founding principle of the Welsh National Health Service (NHS) is sacred: it is publicly owned and without payment. Access is through the GP," Aylward said.

The concept for the 1000 Lives Campaign originates from the Institute for Healthcare Improvement in the United States where a very successful 100,000 Lives Campaign has been run. Over an 18-month period, 122,000 lives were saved in more than 3000 hospitals. Similar initiatives are being run in other countries, including Denmark and Scotland.

"Studies in Wales and internationally show that between three and 17 percent of hospital admissions result in unintentional harm to patients," said Aylward. "At least half of these incidents are to some extent preventable. In Wales, we want to aspire to a world class health system but first of all, we have to decide what the benchmark for such a system would be. This is a question we would Like to engage with New Zealand on."

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Getting people to buy into the campaign in Wales had initially been difficult, Aylward said. "The Welsh Assemby was reluctant to Let the public know that people were dying in hospital, but most people know that hospitals can be dangerous places. In the United Kingdom, for example, 25 percent of those admitted without an infection will come out with one. The campaign has helped us look at these infection rates and incidents where people have been given the wrong drugs or the wrong operations. Errors in care are believed to Lead to a one in 300 chance of accidental death."

Changing the culture of blame was the key to getting people on board, Aylward said. "We had to get everyone in our hospitals enthusiastic about the campaign--administrators, health professionals, even the cleaners. Representatives were then able to discuss any critical incidents that had occurred and examine the failings in the system that had Led to them. Once people could see the fault lay with the system, not with themselves, they began to have more open discussions. To change the system, you have to be able to talk about the deaths that shouldn't have occurred and the harm that could have been prevented. It took about six or seven months to get all NHS trusts and local health boards to sign up to the campaign."

The Faculty for Health Care Improvement comprises a number of groups responsible for different initiatives, eg infection control, reducing surgical complications and improving critical care. Ten system Level indicators have been developed, including, in secondary care, the number of cancelled operations, delayed transfers of care, emergency department (EDs) waiting times, returns to EDs within 27 days, ambulance arrival times and staff absences due to illness. "People were already collecting a lot of data. We just had to ensure they collected the right data."

System level indicators have also been developed for primary care, eg the percentage of people with diabetes and the number of children being immunised.

A major issue identified during the campaign's development, said Aylward, was health Literacy. "We discovered a number of adverse incidents was due to people not understanding instructions. Seven percent of adults in Wales have a reading age of five, so it is hardly surprising some cannot understand even basic words like 'toxic'. We are now training health professionals to check whether people can read and understand what they are being told. Health professionals need to learn how to explain things in simpler terms."

Adviser to the Ministry of Health and Middlemore Hospital intensive care specialist David Galler, who hosted the meeting with Aylward, said New Zealand's national Quality Improvement Programme had still "to capture the hearts and minds of people and the government" He would like to see a national campaign on patient safety, a campaign that hospital administrators, health professionals, politicians and the public could really identify with. "The successful Quit Smoking Campaign could be used as a model. A memorandum of understanding between Wales and New Zealand would enable us to share our experiences and strategies that really work."

NZNO professional nursing adviser, Anne Brinkman, who attended the meeting, predicted significant hurdles if New Zealand tried to replicate the Welsh campaign, when the health funding structures of the two countries were so fundamentally different. "A lot more questions need to be asked about the campaign's intended process, particularly how well patients and nurses would be engaged in it," she said.

A key to any campaign's success, Galler said, was to ensure the right data from district health boards (DHBs) and non-government organisations was collected. "Much of what is being collected currently is not really very useful."

An avenue for supporting a national quality improvement campaign could be through the health sector tripartite process in DHBs, which involves government, management and unions, he said.

Report by co-editor Anne Manchester
Gale Copyright: Copyright 2009 Gale, Cengage Learning. All rights reserved.