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First, Do No Harm – a successful patient safety campaign

As the First, Do No Harm campaign draws to a close it is timely to reflect on the achievements relating to patient safety and quality improvement for the Northern Region.

The Northern Region Health Plan was developed in July 2011 and one of its key components was for a patient safety campaign linked to improving the patient’s experience, strongly supported by the Region’s four DHBs – Northland, Waitemata, Auckland and Counties Manukau.

By October that same year, First, Do No Harm was underway with the appointment of a Clinical Lead and Programme Manager.

The aim of the campaign was to promote systematic changes to improve quality and safety and to minimise harm and reducing pressure on health services. The Northern Region has taken a lead on a sector-wide regional approach to reducing healthcare associated harm and worked with the Health Quality and Safety Commission’s National Patient Safety Campaign to ensure alignment with this work.

Improving collaboration and creating a way to knowledge-share saw effective improvement in many areas. First, Do No Harm developed close working relationships with DHBs, raised awareness of issues and shared change ideas, data and learning across the Region.

The campaign has been effective in building the WILL to work in new ways to improve quality and safety and it has strengthened the links between focus areas such as infection prevention control, medication safety and peri-operative harm. There has also been more engagement with national and regional quality managers allowing for greater input and influence into the national patient safety and improvement agenda.

Throughout the duration of the First Do No Harm campaign, greater cooperation and improved relationships between acute care and ARRC facilities developed with teams working on joint projects, and more effective partnerships formed with DHBs supporting improvement activities.

Resources developed by District Health Boards (DHBs) are now readily shared across the Region and teams come together to share and learn how to make improvements and to support each other.

The First, Do No Harm campaign focussed on:

  • Setting clear aims.
  • Co-ordinating and managing formal collaboratives, including learning sessions.
  • Maintaining and communicating overviews of collaborative progress.
  • Providing a central point for reporting measurement data.
  • Supporting the improvement process with specialist involvement where required/requested.
  • Facilitating sharing and learning across the collaborative teams.
  • Developing and communicating the implementation of ideas
  • Celebrating successes.
  • Creating a system for measuring progress.
  • Identifying and providing best practice and bundles of care.
  • Facilitating regional collaboration and dissemination of ideas.
  • Cultivating change agents.
  • Assisting in providing a link with national initiatives.
  • Promoting a patient-centred approach.
  • Fostering consumer engagement.

Key outcomes achieved by First, Do No Harm include:

  • The establishment of regional outcome measures that have supported the improvement efforts.
  • Data collection and information use as a key driver to learn and improve care processes.
  • Trust established enabling sharing of data and information across the DHBs and the age-related residential care (ARRC) sector.
  • Over the period of the national and regional patient safety campaigns, the region has developed closer working relationships, raised awareness of issues and shared change ideas and learning across the region.
  • The development and sharing of regional resources to support improvement efforts, such as change packages and other tools.
  • 850 clinical staff have been supported with training and access to resources.
  • The development of a partnership approach with the national Open for better care campaign to support shared regional and national outcome goals. Regional approach to national patient safety awareness activities such as April Falls, International Stop Pressure Injury Day and Patient Safety Week.
  • Reduction in duplication of effort by sharing resources and collaborating on the development of regional projects and resources, such as the regional transfer of care envelope, St John falls’ project, patient information resources, etc.
  • Growth in the engagement and capability of the ARRC sector to participate in quality improvement to reduce harms in care settings. Approximately 100 facilities in the region have engaged in training sessions. This work has led to a number of ARRC teams undertaking further improvement projects.
  • The establishment of baseline rates for falls and pressure injuries from the ARRC facilities submitting data is providing key information on current levels of harm and identifying where there may be valuable learning and opportunity for improvement.
  • Increasing care providers developing skills and knowledge in undertaking improvement projects. Providing learning sessions, customised mini learning sessions and coaching for teams in DHBs and ARRC.
  • Reduction in healthcare associated infections (HAI) – support of the national programmes such as preventing central line associated bacteremia (CLAB) infection and surgical site infection that have resulted in the decrease in HAI across the region.
  • The falls project has had some success in reducing some of the lower levels of harm in two DHBs. Major harm has been a more challenging area to achieve the targeted outcomes. The region has established and agreed measurement processes with accompanying definitions that support a more robust process to analyzing the effectiveness of the changes being made.
  • Regional reduction in harm from pressure injuries by 36%. The Northern Region rate for grade 2 pressure injuries and above is approaching the best found in the literature.

As First, Do No Harm shared the resources of 1000 Lives patient safety campaign of Wales at the commencement of its campaign, so have many others accessed resources on the First, Do No Harm website and learning sessions and presentations over the last few years. The campaign has not only been successful within the Northern Region, but has also provided shared learning for other areas of New Zealand, parts of Australia and the Pacific Islands.

Thank you to all those who have been involved with the campaign over the last five years and we know that the good work will continue under the guidance of the new Northern Region Patient Safety Network.

View Patient Safety Network article.