University of Technology Sydney

92022 Improving Quality and Safety in Health Care

Warning: The information on this page is indicative. The subject outline for a particular session, location and mode of offering is the authoritative source of all information about the subject for that offering. Required texts, recommended texts and references in particular are likely to change. Students will be provided with a subject outline once they enrol in the subject.

Subject handbook information prior to 2024 is available in the Archives.

UTS: Health
Credit points: 6 cp
Result type: Grade and marks

Anti-requisite(s): 96326 Improving Safety and Quality in Healthcare

Description

This subject covers the essential knowledge that clinicians, health service managers and project officers need concerning error management and safety and quality improvement. It enables students to appreciate why errors occur in healthcare delivery and the contemporary approaches to reducing errors and improving the safety and quality of health services. Topics covered include the origins of error and risk; the management of error and risk from human factors and health systems perspectives; the elements of clinical governance; the relationship between clinical cultures, quality and adverse events; the monitoring, analysis and investigation of incidents from national, state and local perspectives; incident reporting systems and the processes used in Australian healthcare settings; and lessons learned from healthcare inquiries. Team-based, personal and interpersonal skills in open disclosure are addressed, as well as complaint management and the importance of patient and family engagement, and appropriate organisational communication following errors. International approaches to safety and quality in healthcare delivery are also discussed. An emphasis is placed on error reduction and meeting national standards within health services settings.

Subject learning objectives (SLOs)

Upon successful completion of this subject students should be able to:
A. Critically appraise contemporary legal, ethical, regulatory and professional frameworks and strategies designed to maintain or improve patient safety within the healthcare environment;
B. Propose improvements in safety at an international, national, state and local level through error analysis, risk management and error reduction techniques;
C. Determine relevant and contemporary techniques and tools for analysing, reporting and managing error in healthcare delivery;
D. Create a variety of ways in which complex issues can be effectively communicated for a variety of target audiences.

Course intended learning outcomes (CILOs)

This subject also contributes specifically to the following graduate attributes:

  • Critique, interpret and synthesise data and research findings to develop safe, effective and evidence-based solutions to healthcare challenges (1.1)
  • Propose relevant problem-solving and human factors theories to the analysis of common issues inherent in the management and evaluation of healthcare services (1.2)
  • Initiate and explain change management methodologies appropriate to improving healthcare outcomes (1.3)
  • Value and choose highly effective and sensitive communication with diverse populations to enable positive and sustainable change in healthcare practice, policy and research (4.1)
  • Determine and recommend modes of communication necessary to optimise outcomes across differing audiences, purposes and contexts within healthcare practice (4.2)

Teaching and learning strategies

This subject is designed to assist students to understand the complexities associated with improving safety and quality in the multidisciplinary health service environment. Even minor positive changes in one section of the system can potentially have a major negative effect in other sections, so approaches to improving safety and quality need to look at the entire healthcare ecosystem. This subject is undertaken in a blended approach with students attending six half-day seminars accompanied by integrated learning in the online environment. The first two seminars are coordinated by academic staff, however students will be responsible for the organisation, facilitation, and identification of an industry guest speaker for the last four seminars. This approach to teaching and learning is responsive to the needs of postgraduate students who need to balance study with their professional and personal commitments, and to health service employees who need to show leadership within their sector in order to improve quality outcomes. The first two seminars should also provide a model for them to follow in the organisation of their seminars.

Pre-session learning
Students access online learning resources such as podcasts, videos and literature prior to attending face-to-face on-campus seminars to improve their confidence in approaching the proposed content, afford them time to construct questions for the industry speakers, and facilitate discussion in class, resulting in shared learning, experiences and reflections. The specific sessions will be detailed in this subject outline and all resources will be located on UTSOnline. Evidence of engagement with the pre-session learning resources, demonstrated by informed contribution to in-class discussions, will contribute to the individual assessment component (20%) of Assessment Task 4.

Seminars and online learning materials
This subject benefits from both the real time delivery of content and access to resources via UTSOnline, including podcasts, videos and learning resources. Face-to-face on-campus sessions, in the form of seminars, enable students to engage with experts from industry who apply theoretical models to daily practice. The industry guest speakers will prompt research inspired group discussion of contemporary approaches to safety and quality improvement and extend students’ reflection on quality frameworks from a local, state, national and international perspective. Each on-campus seminar addresses a different approach to improving safety and quality, and will assist students to quickly clarify complex descriptions and terminology associated with a variety of approaches, and engage with controversial or confronting topics such as mandatory error reporting, health service accreditation and clinical culture resistance.

An unmoderated discussion forum will also be established, and students are encouraged to provide their opinions on controversial statements posted by the Subject Coordinator. Media pieces that expose safety and quality issues within the health system at the time of the subject will also be identified, and students will be asked to provide comment on ways to improve safety and quality outcomes relevant to the scenario. By engaging in peer communication, students will be exposed to a variety of perspectives and this will assist them to develop comprehensive evidence based approaches to lead safety and quality improvement in their clinical setting. Evidence of engagement in peer communication will contribute to the individual assessment component (20%) of Assessment Task 4.

Case based scenarios and collaboration
Ethical and legal cases are used to help students explore the approaches to improving safety and quality in healthcare. Real and hypothetical cases depict situations related to error and will explore issues related to the individual, team and healthcare organisation. Students will collaborate and use these scenarios to learn concepts, interpret information, identify potential safety risks, form judgements on risk reduction and develop solutions to mitigate risks. Self, peer and teacher feedback is provided to develop students’ judgement.

Assessment range
Students will be exposed to a variety of assessment modes, including a position statement, formal correspondence to a patient’s family, construction of a video, construction of a podcast, peer assessment, individual reflection and team organisation of a seminar. Feedback will be provided on assessments to ensure students can identify areas for development and areas of sufficient expertise. Students are encouraged to use contemporary educational technology. Some of the assessment will use a case study approach, with the student asked to assume a designated management role in a hypothetical health service.

Early low-stakes feedback will be provided via two methods:

  • dedicated discussion forums for each assessment item, where students can enter questions about the task expectations and receive clarity via answers and suggestions from the Subject Coordinator;
  • early feedback on evidence of engagement with the pre-session learning resources, demonstrated by informed contribution to in-class discussions, will be received prior to the census date.

Continual feedback will be provided via four methods:

  • informal quizzes at the commencement of each seminar, focussed on the preparatory activities for each seminar;
  • peer communication and Subject Coordinator contributions to the unmoderated discussion forum throughout the semester;
  • peer communication, individual and Subject Coordinator contributions to the seminar discussions, where a range of topics are controversial and will lead to debate;
  • progressive assessment tasks, worth 20%, 20%, 20% and 40%.

Content (topics)

  • Clinical governance
  • National approach to improving safety and quality
  • Error and human factors analysis (major focus - basic focus 92603)
  • Influence of organisational culture on patient safety
  • Incident disclosure (major focus – basic focus 92603)
  • Tools for achieving safety and quality
  • Resilience in health services
  • Accreditation - process and operational view
  • International, national, state and local approaches to data collection and reporting (major focus - basic focus 92638)
  • Incident management systems (Riskman, IIMS, AIMS)
  • International approaches to safety and quality
  • Healthcare safety and quality inquiries

Assessment

Assessment task 1: Position Statement on Commitment to Safety and Quality Improvement

Intent:

This early, low stakes assessment item focusses on understanding the context of safety and quality improvement within health service delivery. Health professionals are required to describe safety and quality concepts to the community, and this task provides the students with the opportunity to convince a group of teenagers that these concepts are important and highly regarded. Students will receive feedback on the selection of the key elements and also the appropriateness of the level of health literacy demonstrated in the postion statement.

Objective(s):

This assessment task addresses subject learning objective(s):

A, B and D

This assessment task contributes to the development of graduate attribute(s):

1.1, 1.2, 1.3, 4.1 and 4.2

Type: Essay
Groupwork: Individual
Weight: 20%
Length:

500 words (position statement style)

Criteria:
  • 60% Designs a clear and succinct position statement addressing health service safety and quality improvement demonstrating a depth of knowledge about safety and quality within a clinical governance framework [Synth]
  • 20% Validates perspectives through correct interpretation of relevant and current literature (> year 2006) [Eval]
  • 10% Presents information according to the health literacy of the school students [Synth]
  • 10% Produces correct grammar, spelling, formatting, style (position statement - essay) and bibliography [Synth]

Assessment task 2: Complaints management

Intent:

This assessment item focuses on complaints management and how it is positioned within a safety and quality framework. Health professionals often have to respond to complaints from receivers of care in a professional, compassionate and respectful manner, and this task will provide the students with an opportunity to construct a reply to a family, based on both substantiated and unsubstantiated issues. Students will receive feedback on their approach to this family's issues, and suggestions to improve the compassion and respect displayed in the letter.

Objective(s):

This assessment task addresses subject learning objective(s):

A, B, C and D

This assessment task contributes to the development of graduate attribute(s):

1.1, 1.2, 1.3, 4.1 and 4.2

Type: Case study
Groupwork: Individual
Weight: 20%
Length:

500 words (letter style)

Criteria:
  • 10% Deconstructs the information in the letter to correctly identify the issues raised by the Dimitri family [Analy]
  • 30% Composes a compassionate and respectful response to the validated issues based on contemporary safety and quality frameworks [Synth]
  • 30% Composes a compassionate and respectful response to the unsubstantiated issues based on contemporary safety and quality frameworks [Synth]
  • 20% Compiles a clear and succinct letter of response to the Dimitri family, which is easily understood and adheres to contemporary complaints management frameworks [Synth]
  • 10% Produces correct grammar, spelling, formatting and style (letter) [Synth]

Assessment task 3: Healthcare Reporting Analysis

Intent:

This assessment item focuses on healthcare reporting and how it can be analysed to contribute to a safety and quality framework. Students will be analysing a number of healthcare organisation indicator reports during the 6th seminar, with the Subject Coordinator demonstrating a framework to guide the analysis. This task will provide students with the opportunity to independently analyse a report, as health professionals are often asked to assess why a particular unit/department/clinical stream is not performing at the same level as their peers. Students will receive feedback on the completeness and accuracy of their interpretation.

Objective(s):

This assessment task addresses subject learning objective(s):

C and D

This assessment task contributes to the development of graduate attribute(s):

4.1 and 4.2

Type: Report
Groupwork: Individual
Weight: 20%
Length:

10 minute audio file

Criteria:
  • 20% Differentiates correctly the elements of the report demonstrating a depth of knowledge of contemporary health service evaluation techniques in relation to clinical indicators [Analy]
  • 60% Deconstructs and discovers the qualitative meaning of the report demonstrating a depth of knowledge of healthcare reporting [Synthy]
  • 20% Produces a clear and coherent audio explanation of what the results are indicating [Synth]

Assessment task 4: Organisation of Safety and Quality Improvement Seminars

Intent:

This assessment item focuses on how to lead a seminar for peers on safety and quality improvement approaches within the healthcare system. Health professionals often have to organise inservice and educational opportunities for their peers on safety and quality topics, and this task will provide students with the opportunity to organise 4-hour seminars for peers and staff addressing specific safety and quality topics and receive feedback from self, peers and the Subject Coordinator.

Objective(s):

This assessment task addresses subject learning objective(s):

A, B, C and D

This assessment task contributes to the development of graduate attribute(s):

1.1, 1.2, 1.3, 4.1 and 4.2

Type: Exercises
Groupwork: Group, group and individually assessed
Weight: 40%
Length:

240 minutes + 5-10 minute individual video (submitted no later than 2 weeks following the seminar through Turnitin as an Unlisted YouTube URL) + Peer Evaluation score + Team Evaluation score

Criteria:

Group Assessment (50%):

  • 20% Analyses and reframes the issues identified in the seminar demonstrating a depth of knowledge of their impact on patient safety and quality [Synth]
  • 20% Recommends contemporary and achievable options to resolve the issues demonstrating a depth of patient safety and quality knowledge [Eval]
  • 20% Generates activities that are clear, relevant to the seminar theme, peer-oriented and encourage audience participation. [Synth]
  • 10% Validates perspectives through correct interpretation of relevant and current literature (> year 2006) [Eval]
  • 20% Awards an average mark from the summation of the audience evaluation forms. [Eval]
  • 10% Awards an average mark from the summation of the team evaluation. [Eval]

Individual Assessment (50%):
100% Reflects on the seminar, addressing areas such as the perceived successes, challenges, team dynamics, level of content, relevance of identified resources and approaches that would be altered with the benefit of hindsight. Over the six study days students will be assessed for evidence of participation in online and class discussions and evidence of engagement with pre-workshop activities.

Required texts

Wolff, A. & Taylor, S. 2009, Enhancing patient care: a practical guide to improving quality and safety in hospitals, MJA Books, Sydney.

The following documents are required in electronic format - there is no need to print them out:

Australian Commission on Safety and Quality in Health Care (ACSQHC). 2011, National safety and quality health service standards, ACSQHC, Sydney, NSW. www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf

Australian Commission on Safety and Quality in Health Care (ACSQHC). 2013, Australian open disclosure framework, ACSQHC, Sydney, NSW. www.safetyandquality.gov.au/wp-content/uploads/2013/05/Australian-Open-Disclosure-Framework.pdf

Australian Council for Safety and Quality in Health Care (ACSQHC). 2005, Complaints management handbook for health care services, ACSQHC, Sydney, NSW. www.safetyandquality.gov.au/wp-content/uploads/2012/01/complntmgmthbk.pdf

Australian Council on Healthcare Standards (ACHS). 2016. Australasian clinical indicator report 2008-2015, 17th edn, ACHS, Sydney, NSW. www.achs.org.au/publications-resources/australasian-clinical-indicator-report/

NB this report will be distributed to all students in hard copy on the 6th on-campus session.

Recommended texts

Bate, P., Mendel, P. & Robert, G. 2008, Organizing for quality: the improvement journeys of leading hospitals in Europe and the United States, Radcliffe Publishing, Oxford.

Runciman, B., Merry, A. & Walton, M. 2007, Safety and ethics in health care: a guide to getting it right , Ashgate, Aldershot, UK.

Other resources

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Tel: 1300 ASK UTS (1300 275 887)

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For other resources/ information refer to the Faculty of Health website (www.uts.edu.au/about/faculty-health), the Health Student Guide (www.uts.edu.au/sites/default/files/uts-health-student-guide.pdf) and UTSOnline at: https://online.uts.edu.au/webapps/login/

UTS Library
The Library has a wide range of resources, facilities and services to support you including textbooks, subject readings, health literature databases, workshops and bookable study rooms. There is also a team of librarians to help you with your questions available via online chat, phone and in person. W: lib.uts.edu.au, Facebook: utslibrary, Twitter: @utslibrary Tel: (02) 9514 3666.

Improve your academic and English language skills
Marks for all assessment tasks such as assignments and examinations are given not only for what you write but also for how you write. If you would like the opportunity to improve your academic and English language skills, make an appointment with the HELPS (Higher Education Language & Presentation Support) Service in Student Services.

HELPS (Higher Education Language & Presentation Support)
HELPS provides assistance with English language proficiency and academic language. Students who need to develop their written and/or spoken English should make use of the free services offered by HELPS, including academic language workshops, vacation intensive courses, drop-in consultations, individual appointments and Conversations@UTS (www.ssu.uts.edu.au/helps). HELPS staff are also available for drop-in consultations at the UTS Library. Phone (02) 9514 9733.

Please see www.uts.edu.au for additional information on other resources provided to students by UTS.