Interprofessional Health Care and Quality Improvement: Teams, Systems and Equity
Teams, roles and accountability
Care in New Zealand is delivered by interprofessional teams - nurses, doctors, allied health, pharmacists, health care assistants, kaiawhina and whanau. Know each role and its boundaries. An RN who delegates a task remains accountable for the decision to delegate and must be satisfied the delegate is competent; the delegate is accountable for how the task is performed. Referral, escalation and coordination are professional responsibilities, not favours.
Quality improvement
Quality improvement is systematic, measured change to make care safer, more effective and more equitable. Learn the Model for Improvement: what are we trying to accomplish, how will we know a change is an improvement, what changes can we make - then test with small PDSA cycles before spreading. Draw on clinical audit, indicator data (falls, pressure injuries, medication errors, healthcare-associated infection), incident reports, root cause analysis and consumer feedback. Clinical governance sets the direction and holds the account for quality.
Equity and cultural safety
Quality in Aotearoa includes equity. Examine who is missing out - Maori, Pacific, disabled, rural and older people - and design changes with consumers and whanau rather than for them.
The traps
- Incident reporting is a system-learning tool; fear of blame suppresses reporting and hides risk.
- A root cause analysis that stops at "human error" has not found the cause at all.
- Quality improvement is not research, but it still requires ethical conduct and privacy safeguards.
- A change is not an improvement unless the baseline and the result were both measured.
- Passing an accreditation audit shows systems exist; it does not prove every consumer experienced safe care.
Rule of thumb
No measurement, no improvement: define the problem, measure the baseline, test small, learn, then spread.