Getting started

Promoting increased patient, carer and family engagement supports the NSW Government’s CORE Values in health through 'Empowerment' of patients in collaboration with health care providers and 'Putting the patient first'. Empowering patients, carers and families through strategies such as patient and family activated escalation conveys an important message that they are valued as partners in improving safety and quality.

The REACH process aligns with the Australian Commission for Safety and Quality in Health Care (ACSQHC) National Safety and Quality Health Service Standards, Standard 9.9: Enabling patients, carers and families to initiate an escalation of care response.

To undertake an improvement project, there must be an issue or problem that you aim to improve, for example:

• Surveys have highlighted issues with communication and escalation of patient, carer or family concerns
• Your ward/unit has previously implemented REACH but you have had feedback or complaints relating to patients, carers or families not being heard or action taken when they have voiced concerns
• There has been a serious adverse event where patient, carer or family communication was highlighted as an area for improvement.

At this stage of the project, it is about identifying the problem you aim to improve NOT brainstorming solutions.

When determining the focus of an improvement project, some common errors include:

• Selecting a problem no-one is interested in
• Implementing a solution rather than investigating a problem
• Focusing on a process that is currently in transition or unstable, for example, manual to electronic process
• Selecting a problem that is beyond your capability to change or outside your sphere of influence.

All improvement requires change. However, change is not always welcomed or accepted by individuals or teams, even when it is improvement focused. Improvement projects can often struggle to gain momentum if there is considerable resistance from those who will be impacted most by changes.

Assessment of the current unit/ward context is essential to clearly establish the readiness for change. The assessment should investigate the existing culture, communication and team practices, and safety and quality concerns.

If there is an overall lack of enthusiasm and a resistance to change, it is vital this is addressed before proceeding further with the improvement project. For more information see the CEC Safety Culture webpage.

Data will assist in identifying the problem and build the evidence base about why this is an important problem to focus on. Seek guidance from your Clinical Governance Unit or the CEC to identify appropriate sampling numbers and data sources.

Existing data: Examine your health service's data sources such as Mortality and Morbidity Reviews, complaints, Serious Adverse Event Reviews (SAERS)s, Rapid Response data, and patient and carer survey reports.

Baseline data collection: Completing a baseline data collection is an effective way to identify the problem.

Staff and patient stories: Gaining information about the experience of the area of review can provide insights into program processes, show impact, identify unintended consequences, demonstrate innovation and support the quantitative data.

Gap analysis: A gap analysis is designed to look specifically at the REACH process as a whole i.e. patient understanding of REACH, staff experience in escalation, access to resources and organisational culture.

Literature search: Further information can be gathered by searching the literature.

The improvement project brief is essentially a document that outlines your improvement project. It should include what the problem is, why is it important (to patients, their carers and families, staff and the broader community), how long the project will take to do and the approach you will use to achieve an improvement.

A strong improvement project brief should be founded on the supporting data you have collected, take into consideration how the improvement will be sustained and align with your health service's priorities. You can use the improvement project brief to help with gaining support for your improvement project.

It is strongly recommended that you engage with your Clinical Governance Unit to seek support for starting and completing your improvement project and they will be able to link you with local quality improvement experts.

It is also recommended that you contact your local Clinical Emergency Response System (CERS) coordinator, or Patient Safety and Quality Manager, and Patient Representative for more guidance on implementing or improving REACH in your area.

You may also choose to reach out to colleagues in other health services to find out how they approached their REACH improvement work, including their successes and learnings.

Use your Improvement Project Brief to gain a project sponsor. The project sponsor is someone who can provide support and guidance to you during the improvement project. They can help with ensuring appropriate resources are provided and help remove barriers when needed. Ideally, your project sponsor is someone who does not work directly on the improvement project but is in a senior position.

The level of seniority of the project sponsor will depend on the scope of your improvement project (for example, Nurse Unit Manager versus an Executive Director). Ideally you should communicate closely with the project sponsor and provide regular updates.

Your project sponsor will be able to provide guidance on where the governance for your improvement project will sit within your health service.

This will ensure there is operational responsibility for the improvement project and a channel to report back on how the improvement project is progressing. For example:

• At unit/ward level: Integrate project reporting with the existing deteriorating patient or CERS or Safety Quality committee
• At health service/LHD/SHN level: Integrate project reporting with the existing deteriorating patient or CERS or Clinical Governance committee.

Note this is different from your project team structure. Your project team will consist of members who carry out the project interventions.

The improvement project team should be interdisciplinary and include the right people, with the right experiences, expertise, and interest in contributing. For example:

• Team leader
• Quality improvement advisor/expert
• CERS/BTF/MET coordinator
• Patient representative/Complaint's manager/Peer Worker
• People from all areas of the process the improvement project will target, including junior and senior staff
• Consumer and/or carer representative (or interview/survey consumers)
• Consider inviting colleagues who are likely to challenge your project. They can often raise different perspectives or barriers that you may not have considered.

The team leader role is essential, and they will organise and lead the team meetings, ensure delegation of responsibilities and be the 'voice' for the improvement project.

As the team leader, it is essential to assemble a dedicated team who are also committed to actively supporting the improvement project. Improvement projects often fall down when team members are unable to sustain interest or participation in the improvement project, leaving the team leader to carry the improvement project.

The role of the project team includes:

• Evaluating current REACH processes
• Identifying and enlisting clinical champions
• Establishing project aim
• Developing, implementing and evaluating improvement strategies
• Disseminating results and findings.

Once the project team has been established, it is important to make sure everyone is on the same page regarding the problem the improvement project is targeting and what is IN and OUT of SCOPE. Without a well-defined scope, improvement projects tend to grow beyond what is achievable, lose focus of the problem, and fail.

To add members to your  Click icon tab > Add your Team Members.