New WHO Quality Toolkit

"On Monday 20 June WHO launched the Quality Toolkit - a new interactive, online resource for anyone at any level of the health system interested in improving the quality of health services.

The Quality Toolkit provides users with tools to facilitate specific actions to enhance the quality of health services. It is a companion resource to WHO Quality Health Services: a planning guide which provides an outline of key actions to be taken across the health system. The Toolkit then supports these actions with numerous tools. It also enhances understanding of the key interlinkages across the health system when implementing any tool.

The Toolkit incorporates key WHO-published tools and other materials related to quality of health services. It will be updated periodically to reflect new and emerging information relevant to improving quality of health services, including WHO technical products currently under development.

The Quality Toolkit is available at: https://qualityhealthservices.who.int/quality-toolkit

HIFA members are invited to navigate the Toolkit and consider how they might use the tools as part of their improvement efforts. WHO welcomes feedback on the Toolkit qualitytoolkit AT who.int "

Via - HIFA - https://www.hifa.org/

I - IDENTIFY tools and resources relevant to quality of care
M - MAP those tools against improvement needs or identify gaps
P - PLAN implementation of activities for improving quality of care
R - RECOGNIZE interlinkages between technical areas and the process of change
O - OPTIMIZE multi-level action
V - VISUALIZE journeys for improving quality of care
E - ENGAGE stakeholders across the health system

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

IDENTIFY (context) PLAN^ (mental health) RECOGNIZE* needs gaps	IDENTIFY (context) MAP / VISUALIZE PLAN^ (physical health) OPTIMIZE technical areas gaps needs
IDENTIFY (context) ENGAGE needs gaps	IDENTIFY (context) RECOGNIZE* needs gaps

Above rendering idealised and all embedded within spiritual and ethnocultural context.

*Recognition required politically to avoid individual frustration and facilitate (policy ...) coherence.

^Planning should (must) take into account need for parity of esteem between mental and physical health (with triage situations acknowledged).

Source: Jules Storr, Independent Consultant, S3 Global & working with WHO as part of the Quality Toolkit development team - via HIFA

Scope, Space, Nursing, Informatics: Fusion II (care)

After Paolo Perrotta (see post January 20, 2012):

and Paolo Perrotta, (2010). Metaprogramming Ruby, The Pragmatic Bookshelf. p.75.


Imagine being a care coordinator making sense and sense making (Dervin, 2005) your way through a new health and social care referral: here is the care program(me) approach. You jump from care problem, to strength, to further assessment question ... until the care domain priority is resolved. A decision point. That's the initial scope (and in an urgent / crisis situation this is resolved in an instant).

The scope is not defined in a single program, but several in parallel. This is why health and social care is often described as complex. You find yourself in a complex. At this decision point you are at the center of a range of local variables.

You can see bindings all over the scope. p.75.

There are assumptions, hypotheses and bits of data yet to be fully apprehended. It's hard but vital to be aware of what is objective and what is subjective. Why?

Raise your head, and you see that you're standing within an object,

[ a very special object ]

with its own methods and instance variables; that's the current object, also known as self. p.75.

To your immediate left and forward there are instance variables: beliefs, choices, motivation, aspirations, memories ... and the unique ability of this self to use its methods to communicate and interact with other selves, the world and future. You notice a problem. Many of the methods you might expect are not intact. There is a problem with the capacity of memory. Where there should be several parameters in sequence: there is. One. This may even then be lacking. Reading and writing is a problem here.

To the right and forward there is a monthly weight chart, a medication administration chart, BP and pulse are also recorded. There is a history of falls, a fractured femur, and bruising. There is a diagnosis - an inguinal hernia. Two postcodes have you momentarily perplexed. Ah, one is static 'home'; the other is current location and that's a close to home telecare mediated match.
 
Turning first to your right and over your shoulder there is an issue with care management and wandering at night: a vulnerability for this person. Another instance variable then flags mental capacity for a that hernia which needs repair. Respite care vouchers have been issued, but the year's allocation remain unused.

Next, turning around to your left there are details of next of kin and the fact that the carer involved is under a great deal of stress.

Further away, you see the tree of constants so clear that you could mark your current position on a map. p.75.

You are in fact encircled by a series of official identifiers. First at 10 o'clock two first names - these are the names that are given. The names for the person, the individual who is the focus of the referral. At two o'clock a key event for this individual their DOB - date of birth. At four o'clock the digits of the NHS number and a local case record number are captured. Completing the "Full name" at 8 o'clock you find a surname, the family name. It's double-barreled too. An explicit effort to preserve and extend family history and lineage.

Squint your eyes, and you can even see a bunch of global variables off in the distance. p.75.

Global variables.

What lies behind them?

It sounds strange to describe the person as an object, even if the context alludes to informatics.
To confirm this object is special. When you think about it though this object, the patient, the person, the individual, this self has a partner: the healthcare professional.

When we say that positive, high quality care values are global that makes sense. They should be: globally. To say they are variable seems to invite poor quality care, slack standards, inequality, inequity. Acknowledging that standards do vary can help ensure vigilance and that high quality care remains the key aspiration for new learners and experts alike. Nursing and other values are then a global variable that need constant attention and governance.

Identification and Hodges' model

In health and social care the importance of correctly identifying people in your care is drummed into you from the outset. Even before staff are on the payroll or in the lecture theatre everyone knows that common sense shouts "pay attention!"

Drug administration and various other clinical interventions are safety critical:

Right patient - Wrong drug
Wrong patient - Right drug

If in additional to acute clinical scenarios we add information giving and 'social care' then once again identity is key:

Right person(s) - Wrong information
Wrong person(s) - Right information

Information unsurprisingly lies at the
heart of identification
and consequently
safety.

There are four key identifiers that we rely on and they map to Hodges' model beautifully - use them wisely....

GIVEN personal, first name	DATE OF BIRTH
FAMILY NAME	NHS number

Four key identifiers