Li Qun Catherine, Sweetman Greg
Fiona Stanley Hospital, Western Australia, Australia.
Int J Nurs Sci. 2017 Feb 28;4(2):112-116. doi: 10.1016/j.ijnss.2017.02.003. eCollection 2017 Apr 10.
Engaging, enhancing and embedding clinical audit improvement activities into everyday practice to develop capacity, capability and culture in continuous improvement.
Through the implementation of an electronic quality management system called Governance, Evidence, Knowledge and Outcome (GEKO), the key aspects of governance, evidence knowledge and outcomes were able to be applied to quality initiatives. Implementation of the GEKO system incorporated the principles of total quality control and management to include strategic management control and marketing in parallel with leadership strategies.The vision was to motivate staff to enable ownership of the quality cycle of continuous improvement of patient care to incorporate underlying systems and processes that impact on patient care.
A continuous improvement pathway was successfully established 4 months post hospital commissioning. Over 890 (approximately 16% workforce) multidisciplinary and multi-professional staff received training and support for QIs in 12 months; over 535 quality proposals were received on GEKO. Submissions by profession: nursing and midwifery 46% (246), medical 33% (177), allied health 9% (48), pharmacy 5% (27), and non-clinical staff 7% (37). Average new submissions per month were 42. Reviews demonstrated the application of a rapid cycle approach to develop, test, modify and refine improvements and enhanced clinical care.
Appropriate governance structure, processes, extensive education and training together with collaborative relationships are the keys to embed clinical audit improvement into everyday practice. The availability of a quality management system like GEKO is very useful to make QI accessible to all staff.
将临床审计改进活动融入日常实践，以培养持续改进的能力、技能和文化。
通过实施名为治理、证据、知识与结果（GEKO）的电子质量管理系统，治理、证据、知识和结果的关键方面得以应用于质量改进举措。GEKO系统的实施纳入了全面质量管理原则，将战略管理控制和营销与领导策略并行。其愿景是激励员工实现患者护理持续改进质量循环的自主管理，纳入影响患者护理的基础系统和流程。
在医院启用4个月后成功建立了持续改进路径。12个月内，超过890名（约占员工总数的16%）多学科和多专业工作人员接受了质量改进培训并获得支持；在GEKO上收到了超过535份质量提案。按专业分类的提交情况：护理和助产46%（246份），医疗33%（177份），专职医疗9%（48份），药学5%（27份），非临床工作人员7%（37份）。每月平均新提交提案42份。评审表明采用了快速循环方法来开发、测试、修改和完善改进措施，并改善了临床护理。
适当的治理结构、流程、广泛的教育和培训以及合作关系是将临床审计改进融入日常实践的关键。像GEKO这样的质量管理系统的可用性对于让所有员工都能参与质量改进非常有用。
