One in 10 New Zealanders uncomfortable asking doctors whether a test or treatment is necessary

Source: Health Quality and Safety Commission

One in 10 Kiwis don’t feel comfortable asking their doctor about whether a treatment or test is necessary, a survey by Consumer NZ and the Council of Medical Colleges has found.

The annual survey was carried out as part of the organisations’ Choosing Wisely campaign, which encourages people to ask their health professional four questions when a test or treatment is suggested:

  1. Do I really need this test, treatment or procedure?
  2. What are the risks?
  3. Are there simpler, safer options?
  4. What happens if I don’t do anything?

Consumer NZ chief executive Sue Chetwin said people should feel able to question health care treatment options.

‘Understanding why your doctor is considering a test – and weighing up the benefits and risks – is every patient’s right.

‘Ask what is likely to happen if you do – or don’t – have a test or procedure. Are there potential side effects? What are the chances of getting results that aren’t accurate? Could that lead to more testing or another procedure?

‘Just by having these discussions you and your doctor will be clearer on what is the best thing to do for your health and wellbeing.’

The survey also found 21 percent of consumers felt their doctor had recommended a test or treatment that wasn’t necessary. Of those, 24 percent said they went ahead and had it anyway. Eighteen percent ignored the doctor’s recommendation.

Thirty-five percent of consumers felt some tests or treatments did not benefit the patient.

While most felt their doctor always (40 percent) or often (30 percent) involved them in decisions about their care, one in five thought this only happened sometimes.

Choosing Wisely medical director Dr Derek Sherwood said there is mounting evidence that more tests and procedures don’t always equal better care.

‘While modern medicine has given us more ways than ever to diagnose and treat illness, sometimes, the best option may be to do nothing.

‘Tests, treatments and procedures have side effects and some may even cause harm. For example, CT scans and x-rays expose you to radiation; overuse of antibiotics leads to them becoming less effective; a false positive test may lead to painful and stressful further investigation.’

As well as encouraging patients to ask their doctor about tests and treatments, the Choosing Wisely campaign has comprehensive information for health professionals about which tests, treatments and procedures to question.

Choosing Wisely sponsors are the Council of Medical Colleges, Southern Cross Health Society, Pacific Radiology and PHARMAC. Consumer NZ and the Health Quality & Safety Commission are Choosing Wisely partners, and there is wide health sector support for the campaign.

See the Choosing Wisely website for more information or download a copy of the survey results (156KB, PDF).

Last updated 05/04/2019

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It’s Advance Care Planning Day – start your plan today! Ko te Rā Whakarite Mahere Manaaki tēnei – tīmatahia tō mahere i tēnei rā!

Source: Health Quality and Safety Commission

It’s Advance Care Planning Day – start your plan today! Ko te Rā Whakarite Mahere Manaaki tēnei – tīmatahia tō mahere i tēnei rā!

5 Apr 2019 | Advance Care Planning

Today is Advance Care Planning Day and Kiwis are being encouraged to start planning for their future health and end-of-life care.

Advance care planning addresses important questions such as where you would want to be cared for if you could no longer care for yourself, what type of care you would like towards the end of your life and specific worries you might have about your wellbeing, being ill or dying.

You can kōrero with your whānau about your wishes for future health care using the advance care planning guide available at www.myacp.org.nz.

‘Advance Care Planning Day is an opportunity to start your plan today. It’s a timely reminder to talk to your loved ones and health care team about future treatment and care preferences,’ says Ria Earp, chair of the Health Quality and Safety Commission’s Te Rōpū Māori (Māori advisory group).

‘You don’t have to complete your plan all in one go, the important thing is to make a start. Having an advance care plan makes your values and beliefs clearer for your doctors and whānau. It is a gift to your whānau to guide them in the future.’

Wellingtonian Cheryl Cameron has lived with Parkinson’s for more than 11 years and came to the idea of advance care planning when she had an emergency visit to the hospital.

‘It made me think about at what point I would want to stop medical intervention. So, I’ve written down my wishes, and my husband Gary and I have shared it with our children, so that they all know my thoughts if they’re confronted with hard decisions.’

She says her family is very accepting of her decisions and reassured that she’s thought about the care she does and doesn’t want if she is ever unable to speak for herself.

A copy of her advance care plan is also lodged with her GP.

‘It’s very freeing knowing that it’s done. And, of course, it’s easily updated any time.’

Kuia Keri Kaa of Ngāti Porou is receiving palliative care and has come to realise how important it is for her to be cared for by her community within a Māori context and speaking te reo Māori.

‘Since I got sick, I started fretting for home. I didn’t think being cared for by home people was important, but it is.’

Keri says we all need to prepare for our final days.

‘When people are dying, a lot of them are frightened, as I am, because they don’t know where they’re going. But everybody has to go sometime. You’ve got to make sure your canoe is ready and that you’ve got your paddle on board, because you’ve got to have an ending to the story.’

Keri and Cheryl are part of the six New Zealanders who feature in Kia kōrero | Let’s talk, a campaign that encourages people to plan for their future health care, with a focus on what matters to them.

The advance care planning programme is led by the Health Quality & Safety Commission and supported by district health boards.

Start your plan today at www.myacp.org.nz.

Last updated 05/04/2019

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Importance of good patient-clinician communication to be emphasised at Choosing Wisely forum

Source: Health Quality and Safety Commission

Kaushiki Roy will be one of the consumer voices at the Choosing Wisely forum, Continuing the Conversation. The forum will take place at Te Wharewaka o Poneke in Wellington on Friday 10 May, 2019.

The Choosing Wisely campaign encourages health professionals to talk with patients about unnecessary tests, treatments and procedures; and patients to discuss with their health professional whether they really need a particular intervention. Registrations are open for the forum.

Kaushiki is a singer and writer who works full-time in a busy project and portfolio office in Wellington. She migrated to New Zealand in 2007 and lives on her own in an inner-city apartment. She will tell the Choosing Wisely forum about the difficult medical decisions she is having to make, the importance of good communication between patients and clinicians, and emphasise the need for patients to be seen as a whole person.

‘After a planned hysterectomy in 2016, the pain I had would not go away and I had a number of tests,’ she says. ‘I was finally diagnosed with Cushing’s disease, a rare condition linked to having too much cortisol in your body.” Symptoms of Cushing’s disease include weight gain, thinning skin and fatigue. Kaushiki had also been recently diagnosed with glaucoma.

‘Since being diagnosed, I have had two surgeries and have received advice about further surgery I may need to have. More surgery is likely to seriously impact my quality of life, however uncured Cushing’s is not an option. So it is extremely difficult for me to know what to do.’

As Cushing’s is a disease impacting multiple systems, one of the key challenges Kaushiki has faced is aligning the different medical specialties – neurosurgery, endocrinology, ophthalmology and general or internal medicine.

‘I ask my doctors, ‘please see me as a whole person’.’

Kaushiki ensures her specialists communicate with one another and cross-check treatment plans – but this is not always an easy process. Getting through each day is a challenge. Her medication has many unpleasant side effects and she worries about losing her vision and independence.

‘I think hard about each decision I make about my health and wellbeing, and look at all the options. I need to feel reassured that any decision to have surgery or medication is the right one for me, and not just because these treatments are on the prescribed pathway.’

She says having medical professionals discuss the pros and cons of tests and treatments with their patients and allowing them time to come to their decisions is an essential part of clinical communications and effective care.

‘It is so important clinicians talk across disciplines, so the patient can align their care and feel seen as a whole person.’

The Choosing Wisely forum provides an opportunity for health professionals to learn more about how to develop and extend their Choosing Wisely work.

Forum speakers include:

  • Kirsten McCaffey, Director of Research at the Sydney School of Public Health and Director of the Sydney Health Literacy Lab. Kirsten has an international reputation in shared decision making, health literacy and the assessment of psychosocial outcomes
  • Associate Prof Sue Crengle from Otago University’s Department of Preventive and Social Medicine, who will discuss Choosing Wisely and equity
  • Dr Robyn Lindner from Choosing Wisely in Australia, who will discuss successfully implementing the campaign, and evaluation.

As with last year’s forum, there will be commentary from consumers on all sessions. There will also be a repeat of last year’s popular special interest groups, including Choosing Wisely 101 for those just learning about this work.

Depending on interest, other workshops will cover:

  • Spreading the message
  • Choosing Wisely and allied health
  • Choosing Wisely working in nursing
  • Choosing Wisely and medical education
  • Choosing Wisely and pharmacy
  • Choosing Wisely in general practice
  • Choosing Wisely and medico legal issues.

The Choosing Wisely campaign is gaining momentum in New Zealand. Seventeen district health boards are involved in Choosing Wisely work and it is supported by a number of PHOs and GP practices. Thirty-one medical colleges, specialty societies and health practitioners’ associations are now linked to the campaign. Over 154 lists of tests, treatments and procedures that should be questioned have been developed, along with 45 patient resources.

Last updated 04/04/2019

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Health Quality & Safety Commission e-digest – Issue 97 online now

Source: Health Quality and Safety Commission

Ngā ihirangi | In this issue

Whakapai i te kounga me te haumaru | Quality and safety improvement

  • Keri Kaa’s story
  • Commission acknowledges skill and dedication of health professionals responding to terror attack

Whakaheke mōrearea | Reducing harm

  • Blog: Whanaungatanga is for everyone
  • New national maternity early warning system aims to reduce maternal morbidity
  • Medicine information leaflets now available in te reo Māori | E wātea ana ngā mātārere mōhiohio rongoā ināianei i roto i te reo Māori
  • All draft Frailty Care Guides now available for testing
  • Waitematā DHB oxygen toolkit now available
  • Reducing harm from falls: Recommended evidence-based resources 2019
  • New partnership between Commission, ACC and the Major Trauma National Clinical Network
  • Patient, family and whānau escalation: Kōrero mai projects – what we know so far

Pūrongo me te whakamārama | Reporting and commentary

  • Quality and safety marker report: October–December 2018
  • Changes to national coordination of the Perinatal and Maternal Mortality Review Committee
  • New study finds significant benefits tied to Serious Illness Conversation Guide

Mahi ngātahi me mātou | Work with us

  • Senior specialist advisor – Family Violence Death Review Committee (closes 5pm, Friday 5 April)
  • Programme coordinator, trauma (closes 5pm, Friday 5 April)
  • Quality improvement advisor, trauma (closes 5pm, Wednesday 10 April)

Ngā hui huhua | Events

  • Serious Illness Conversation Guide training
  • Continuing the conversation: A Choosing Wisely forum
  • Is the quality and safety agenda stalling?
  • International Forum on Quality & Safety in Healthcare

Last updated 04/04/2019

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Is the quality and safety agenda stalling?

Source: Health Quality and Safety Commission

Is the quality and safety agenda stalling?

  • Event start: 21 Aug 2019 9:00am
  • Event end: 21 Aug 2019 4:30pm
  • Location: Michael Fowler Centre, Wellington

The Health Quality & Safety Commission is hosting a workshop with Professor Mary Dixon-Woods, the most recent event in our Open Forum: International Speaker Series.

About the workshop

Challenges in providing consistently high-quality, safe care are common to health systems worldwide.

Many disease areas have seen steady improvement over time, and the safety and outcomes of most surgical procedures have improved. However, in other ways quality has stalled. Variations in intervention rates, outcomes and evidence-based practices remain and have proven remarkably difficult to change. Some indicators show worsening performance in areas such as access and equity.

Quality improvement science has been viewed as a way of addressing many of these challenges by enabling the delivery of better efficiency, value, consistency and experience of care.

It is now almost 20 years since Don Berwick visited New Zealand to participate in the launch of our initial national quality improvement strategy. Despite a steady increase in knowledge of quality improvement science and patient safety methods and tools, we continue to face many of the same challenges. Our improvements are often slow to implement and become embedded.

Workshop aim

This Open Forum asks:

  • has the urgency gone out of the local and national quality agenda?
  • why is quality improvement not happening fast enough?
  • what needs to happen to address these challenges and quicken the pace?

Who should attend?

Anybody with an interest in quality improvement in health care should attend this workshop.

Draft programme

The draft programme is available to download (220KB, PDF).

Registration information

Individual registration: https://hqsc.eventsair.com/mdwforum/register
Group registration: https://hqsc.eventsair.com/mdwforum/groups

Cost

Earlybird: $180+GST (until 31 May 2019)
Standard: $250+GST (from 1 June 2019)

About Professor Mary Dixon-Woods

A fellow of the Academy of Social Sciences, the Academy of Medical Sciences, and the Royal College of Physicians, Mary Dixon-Woods is Director of THIS Institute and The Health Foundation Professor of Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge and Professorial Fellow at Homerton College.

Mary leads a programme of research focused on healthcare improvement, healthcare ethics, and methodological innovation in studying healthcare. She is Co-Editor-in-Chief of BMJ Quality and Safety. She served on the National Advisory Group on the Safety of Patients in England, which produced the Berwick report in 2013. She also served on the review of information technology in the NHS led by Professor Bob Wachter, which reported in 2016. Mary was the Harveian Orator for the Royal College of Physicians in 2018, the 500th anniversary of the College’s founding.

More information or enquiries

Contact Jess Bilton at events@hqsc.govt.nz or phone 04 901 6040.

Last updated 03/04/2019

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Medicine information leaflets now available in te reo Māori | E wātea ana ngā mātārere mōhiohio rongoā ināianei i roto i te reo Māori

Source: Health Quality and Safety Commission

Medicine information leaflets now available in te reo Māori | E wātea ana ngā mātārere mōhiohio rongoā ināianei i roto i te reo Māori

2 Apr 2019 | Medication Safety

A series of medicine information leaflets for New Zealand health consumers, My Medicines, is being made available in te reo Māori.

My Medicines leaflets are developed by a team at Canterbury District Health Board made up of doctors, pharmacists and a non-medical person to help them keep to plain language.

One of the barriers for consumers to access and use information about their medicine is the information not being available in their own language. As te reo Māori is one of the official languages of New Zealand, My Medicines is making the information available in te reo.

The My Medicines leaflets provide information about medicines in plain language that can be understood by most New Zealand adults. The leaflets include important points to help people make good decisions about taking a medicine. To avoid overloading people with too much information, not every possible detail is included.

At present, My Medicines includes 388 information leaflets. Among those available in te reo Māori are: allopurinol, amoxicillin – oral, aspirin – low dose, atorvastatin, cilazapril, metformin, metoprolol, omeprazole, prednisone and warfarin.

More leaflets in te reo Māori will become available as more translations are completed.

You can access the leaflets in two ways:

  1. Go to the My Medicines website (mymedicines.nz):
  • Click on a button or menu item in the top banner to find medicines sorted by name.
  • Or use the ‘Search My Medicines’ search box.
  1. Go to the New Zealand Formulary website (nzf.org.nz):
  • In the ‘New Zealand Formulary – Home’ menu, click on ‘Patient Information Leaflets (PILs) Index’ and choose a leaflet available in te reo Māori.
  • Or use the ‘Search NZF’ search box (the leaflets are in the ‘Patient advice’ section near the bottom of the page).

If you have questions about your medicine, talk to your pharmacist, nurse or doctor.

Last updated 03/04/2019

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New national maternity early warning system aims to reduce maternal morbidity

Source: Health Quality and Safety Commission

New national maternity early warning system aims to reduce maternal morbidity

2 Apr 2019 | Patient Deterioration

A new system is being rolled out to help clinicians quickly respond to deteriorating health in pregnant women in hospital.

Arawhetu Gray, co-chair of the Maternal Morbidity Working Group, says while the great majority of pregnancies are without incident, occasionally when a pregnant woman is in hospital her health may deteriorate.

‘Most women are healthy during their pregnancies; however, a small number of women become ill. It is important that these women are identified quickly to prevent deterioration and ensure an appropriate response.’

The national maternity early warning system establishes a consistent process and pathways for recognising and responding to a pregnant or recently pregnant woman’s deterioration. This is especially important for women and clinicians who move between different hospitals and different district health boards (DHBs).

The system is a joint initiative of the working group and the Health Quality & Safety Commission, with input from DHBs and relevant professional colleges. It has been tested in three sites in 2018 before being rolled out from March this year across New Zealand.

Dr Seton Henderson, co-chair of the working group, says the early warning system will bring national consistency to this important area of maternal health.

‘The maternity early warning system will give clinicians the tools and information they need to respond more quickly and effectively when a pregnant woman’s health is deteriorating.’

‘It includes a nationally consistent maternity vital signs chart that reflects the different physiology of a woman’s body during pregnancy. The chart includes a calculated early warning score for early recognition of deterioration, and localised escalation pathways to ensure a quick and effective response.’

By June 2020, the aim is for the system to be monitoring all pregnant woman admitted to hospital in Aōtearoa New Zealand, who require repeated observations.

‘We are pleased with the success of the system during the testing in 2018 and look forward to a successful roll-out across the rest of the country.’

Related downloads

Frequently asked questions about the maternity early warning system (130KB, PDF)

Last updated 03/04/2019

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New partnership between Commission, ACC and the Major Trauma National Clinical Network

Source: Health Quality and Safety Commission

This week ACC, as lead sponsor of the Major Trauma National Clinical Network, reached agreement with the Health Quality and Safety Commission (the Commission) to support the national programme of work by delivering:

  • quality improvement across the trauma system, to create a system that learns and evolves
  • analytics and research so our work is data-driven and based on evidence
  • a long-term outcomes survey to enable us to understand how injured people cope at home so we can better support their recovery.

The three-way partnership between the Commission, ACC and the Major Trauma National Clinical Network signals a five-year relationship where we will work together to realise our goals of fewer deaths due to trauma, less disability for those that survive, and cost savings across the health system. This agreement is a significant milestone in our efforts to achieve a world-class trauma system in New Zealand.

Last updated 27/03/2019

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Changes to national coordination of the Perinatal and Maternal Mortality Review Committee

Source: Health Quality and Safety Commission

The Perinatal and Maternal Mortality Review Committee (PMMRC) is making changes to its publication plans for 2019 and how the committee will undertake its work. These changes mean we will not hold our usual conference in June 2019, and will produce a data-focused report later in 2019. This does not signal any other change to the PMMRC’s usual work.

The chief purpose of the PMMRC conference, usually held in June, is to convey the messages from our annual report, however we are not able to publish an annual report by June. We are planning to publish a data report updating important perinatal and maternal datasets later in 2019, but this report will not be published soon enough to inform a national conference.

There are several reasons for the temporary adjustment to our regular reporting and conference cycle.

Firstly, there have been substantial changes in PMMRC’s membership, including several new members joining the committee and the appointment of Mr John Tait as chair in June 2018. This has encouraged valuable committee discussions about our strategic direction. The most important of these has been our responsiveness to requests from the Health Quality & Safety Commission (the Commission) and from the sector for a stronger response to inequity in perinatal and maternal outcomes, particularly for Māori. We feel the discussions to reshape our committee priorities will pay dividends in future reporting and to health outcomes in general.

Secondly, we recently held a tender process for PMMRC’s epidemiology services, which have been provided by Auckland UniServices for many years. In July 2018 during a routine open procurement process, UniServices withdrew its epidemiology services from the contract they held with the Commission and chose not to tender for future work. A replacement provider will be announced shortly. The time taken for the procurement process reduced our analytical resources at the time we would normally be preparing the bulk of our annual report.

From July 2019 the national coordinator role will be brought in-house to the Commission. This will be a dedicated, full-time role. The coordinator will continue to work with local PMMRC coordinators to ensure high-quality data collection and valuable local improvement initiatives continue. Extra resources have also been allocated to allow sufficient handover with UniServices. Similarly, the data administrator role will be transitioned to the Commission.

Notwithstanding the change to our 2019 schedule, there are no current plans to change PMMRC’s structure, focus, outputs or budget. We plan to return to our usual practice of a report and a national conference in 2020.

Last updated 27/03/2019

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New study finds significant benefits tied to Serious Illness Conversation Guide

Source: Health Quality and Safety Commission

New study finds significant benefits tied to Serious Illness Conversation Guide

25 Mar 2019 | Advance Care Planning

A new US study has found significant benefits tied to the Serious Illness Care Program, as published in JAMA Internal Medicine and in JAMA Oncology this month.

The study shows the Serious Illness Conversation Guide improved serious illness conversations between patients and their oncology clinicians in the US. This led to significant reductions in emotional suffering for patients with advanced cancer.

The conversations were centered on what matters most to patients, with 90 percent of patients discussing goals and values. As a result, the proportion of patients with moderate to severe anxiety and depression was reduced by half, and the anxiety improvements were sustained for at least 24 weeks.

This study is the first to demonstrate meaningful improvement in patients’ mental health symptoms from serious illness conversations and addresses the most common barriers to communication in a US clinical setting.

Developed by Ariadne Labs, the guide is a set of structured questions drawn from best practices in basic palliative care. This serves as a framework for clinicians to explore topics that are crucial to gaining a full understanding about what is most important to patients. The guide has been adapted for use in Aōtearoa.

In association with the Choosing Wisely Forum, the Health Quality & Safety Commission is offering three-hour Serious Illness Conversation Guide training on Thursday 9 May. The training helps clinicians feel more confident to have quality conversations with seriously ill people.

For more information and to register, visit the Serious Illness Conversation Guide event page on our website. 

Links to Publications (limited access):

Evaluating an Intervention to Improve Communication Between Oncology Clinicians and Patients With Life-Limiting Cancer: A Cluster-Randomized Clinical Trial of the Serious Illness Care Program” 

Effect of the Serious Illness Care Program in Outpatient Oncology, A Cluster-Randomized Clinical Trial

Last updated 25/03/2019

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