Authors (including presenting author) :
WONG CW, CHAN WK, CHAN HM, KUNG HC, TAM SSS, CHAN WT, HUI KLE
Affiliation :
Quality & Safety Office, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong East Cluster, Hospital Authority, Hong Kong
Introduction :
Safety rounds or executive rounds are commonly used in driving for improvement and providing supports to hospital departments, wards or units. Rounds of various kinds have been created for a wide range of aspects or focuses.Frequent rounds and visits to departments or units, however, may impose more or less pressure on department colleagues involved. Extra workload may be generated in addition to their usual strenuous duties. In the light of this situation, RTSKH has launched the Integrated Quality Improvement Visit (IQI Visit) since 2017.
Various safety rounds were integrated locally to minimize the frequency of visits initiated by different parties or subject officers. The composition of the visiting team included HCE, Senior Hospital Management, Q&S subject officers, Nursing representatives, Infection Control Team and OSH. Coordinator.
Objectives :
1.To relieve stress of frontline colleagues by minimizing the frequency of various visits.
2.To establish a comprehensive model of site visits, strive for consensus on reaching mutually agreed improvement measures through multi-disciplinary involvement and discussion.
3.To lay down and execute improvement measures agreed in debriefing sessions after each visit, thus to enhance effectiveness and overcome obstacles.
Methodology :
Hospital Q&S office has strengthened the role to support, facilitate and follow up on the IQI Visit. Starting from February 2018, a modified methodology of IQI Visit has been introduced to facilitate a more efficient and specified visiting process. The new methodology includes pre-visit supports, briefing session, on-site visit, debriefing session and follow-up actions. Before the visit, Hospital Q&S Office communicates with the in-charge of visited departments and provides supports to prepare the visit. At the beginning of visit, a briefing session is conducted by visited department covering the structure of respective department, departmental risk register, recommendations from previous visits / rounds, related follow-up actions and any CQI projects or new initiatives. The briefing session allows the visiting team members to have better understanding on the visited department and facilitates the visit. During the on-site visit, individual visiting team member will focus on concerned areas according to his / her representing stream. HCE communicates with department staff about staff morale and their concerned issues with feedback. Q&S coordinator inspects the visited department / unit through Quality & Safety perspective. Nursing representative focuses on the caring process and nursing related issues. ICT and OSH coordinator concern over the practice and environment with specific aspects. All the findings will be compiled and discussed in the Debriefing Session. Debriefing Session is arranged right after each on-site visit, allowing discussion on findings and any proposed recommendations between visiting team members and representatives from visited departments / units. Departments / units are also encouraged to make requests and suggestions to management team for quality improvement. Bilateral communication can truly be achieved.
Result & Outcome :
Nine (9) rounds of IQI Visits were conducted under this modified methodology in 2018. Feedback and opinion were collected from visiting team members and visited department with separate evaluation forms. 5 points scale were employed for the rating. The feedback was positive. Overall, the Visiting Team Members found that the outcome of IQI Visit was more fruitful when compared with the previous ones. And the Visited Departments / Units expressed that the IQI visit decreased frequency of inspection rounds from different perspectives, pressure and preparatory work were mitigated. They found that IQI Visit was helpful in sustaining continuous quality improvement in their department / Units.
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