Ray Marshal was admitted to Coledale in December 2019. He spent a total of five months in rehabilitation with two re-admissions to the acute hospital due to complications. Unfortunately, in Ray’s first two months his condition worsened and he was diagnosed with a rare muscular disease that attacks his primary muscle groups. Before admission he had been completely fit and independent, riding motorbikes and making musical instruments.
I thought Hello. I’m bound for a wheelchair for the rest of my life
When Ray was re-admitted to Coledale Hospital he thought he had lost his independence. As it turns out, the team at Coledale weren’t giving up that easily.
The Clinical Team
Suzanne Lide signed up for the CEC’s Executive Clinical Leadership Program (ECLP) to expand her skills. This program, aimed at senior clinicians, introduces participants to quality improvement tools such as driver diagrams and run charts . Participants undertake an improvement project which is related to a process or clinical service in which challenges have been identified to put these techniques into action on a real project.
In the ECLP, participants are encouraged to find a problem worth solving. Suzanne identified statistics for patient rehabilitation outcomes at Coledale Hospital were outside the Australasian Rehabilitation Outcome Centres national benchmark data recommendations. Reconditioning following a medical or surgical illness was chosen as the outcome measure as it was noted that the patient length of stay was double the national average for the reconditioning impairment codes. She also found Coledale Hospital patients who presented for reconditioning had a higher Rockwood frailty score and co-morbidities than the national average.
With the problem found, the next step was to find potential solutions in collaboration with the Coledale team.
We completed brainstorming sessions with the whole team and used a quality improvement framework we had used for preventing falls, that is, weekend therapy programs. The idea was that rehabilitation programs could be consumer driven and didn’t need to stop at weekends. When programs continued through weekends, recovery times would improve. Usually program patients would be passively told what to do, we turned that around so patients could continue to work on their recovery over the weekends with the nursing team to guide them.
As part of the ECLP learning program, participants create detailed posters explaining the project, improvement activities and measurement of outcomes.
Ray attended the gym twice a day every day and was 100% determined to beat the illness. We slowly saw him reverse the effects of his illness, and with the help of his entire team and his supportive family, Ray, at 83 years old walked out of hospital. He regained his independence with activities of daily life which at times still required the use of a wheelchair, however he improved in all of his functional outcomes by greater than 50-80%. He never let his resolve waiver and acted as motivation and support for other patients and staff around him
Suzanne Lide participated in Cohort 22 of the Quality Improvement Academy’s Executive Leadership Program and completed her course as one of 43 participants with a graduation ceremony on 3 March 2020.
The CEC’s Quality Improvement Academy (QIA) is one of the CEC’s key enablers to provide leadership in safety and quality in NSW to improve health care for patients. The QIA aims to support local health districts and specialty health networks to build and sustain the capability needed to support our joint improvement effort. Improvement Science and measurement for improvement is incorporated into the teaching in many of the Academy offerings, including the Executive Clinical Leadership Program and Foundational Clinical Leadership Program.
A central premise of the Academy’s programs is that leadership occurs at all levels in health care and is not dependent on the role of the individual. Leadership learning is based on:
- the process of leading a set of activities that improve the delivery of safe clinical care, and
- the set of attributes required to lead a team, unit, facility, stream or cluster.
Since 2007, the Quality Improvement Academy, has educated over 3,500 leaders across NSW Health as graduates of the Foundational or Executive Clinical Leadership Programs.
In 2019-20, the CEC educated 63 NSW Health staff in the Executive Clinical Leadership Program and 249 graduates in Foundational Clinical Leadership Program through the Quality Improvement Academy, building patient safety and quality capability. Education in improvement science also played a fundamental role in the year’s outcomes for the CEC’s Mental Health Patient Safety Program.
Wendy Jamieson holds a Master of Science in Applied Statistics. She has over twenty-five years’ experience in quality management in healthcare with leadership roles in Victoria and NSW. In 2009, she joined the CEC as a member of the Quality Systems Assessment (QSA) team, developing and managing the QSA On-site Visit and Verification Program. In 2015, Wendy was appointed as the Senior Manager of the CEC's Quality Improvement Academy where she managed the Improvement Science and Clinical Leadership Programs with over 400 participant enrolments each year. Wendy is a RABQSA-AU & BSBAUD402B Certified Auditor and successfully completed the ISQua Fellowship Program in June 2014, the CEC Executive Clinical Leadership Program in August 2014 and the USA Institute for Healthcare Improvement Improvement Advisor Program in February 2019.
We want the staff of NSW Health to continually try to improve the care that they give.