The Clinical Governance Assessment Project (CGAP) was jointly commissioned by the National Health Board, the Health Quality and Safety Commission (HQSC) and the District Health Boards (DHBs) through DHB Shared Services (DHBSS). The research work for the project was led by the Centre for Health Systems, University of Otago, and so was both an assessment of the present situation with clinical governance in DHBs as well as an independent study designed to promote discussion and debate. The project represented a partnership arrangement in that various activities associated with the research were undertaken by the DHBs themselves, in collaboration with the Centre for Health Systems, with facilitation and support from DHBSS.
The survey data analysed in this report was collected in May-June 2012. The CGAP involved one of the largest and most complex health professional workforce surveys ever conducted in the New Zealand’s public health care sector as well as site visits and interviews with 165 managers and health care professionals in 19 of New Zealand’s 20 DHBs. Three questions in the survey were designed in collaboration with HQSC in order to obtain data on participant perceptions of aspects of the quality and safety of health care delivery in DHBs. The three questions were:
- Health professionals in this DHB work together as a well-coordinated team.
- Health professionals in this DHB involve patients and families in efforts to improve patient care.
- In this clinical area, it is easy to speak up if I perceive a problem with patient care.
This report contains a detailed analysis of these three quality and safety questions and provides a baseline against which future analyses may be compared. The endings of the broader CGAP are contained in a separate report.
This report is structured as follows. First, it overviews the importance of quality improvement in health care and methods for evaluating staff perceptions of the quality of care and the service delivery environment, situating the CGAP survey and quality and safety questions.
Second, it outlines the methods for the survey. Third, the report presents analyses of the three quality and safety questions. The final section discusses the findings.
Key findings of note include that:
- Fifty-seven percent of respondents believe health professionals in their DHB work together in well-coordinated teams;
- Seventy percent of respondents agree that health professionals involve patients and families in efforts to improve patient care;
- Sixty-nine percent of respondents agree that it is easy to speak up when they see problems with patient care;
- There were significant differences between DHBs in responses to the three questions;
- There were associations between DHBs perceived by respondents to have enabled strong clinical leadership and decision making and stronger performances on the three questions;
- Females had significantly higher odds of responding more positively than males to the three questions;
- Younger respondents had lower odds of responding more positively to the teamwork and patient involvement questions;
- Older respondents had higher odds of respondingmore positively to the question about speaking up;
- Respondents with more than �ve years experience in the New Zealand health sector had lower odds of responding positively to the teamwork and patient involvement questions;
- Respondents with more than 15 years service had higher odds of responding positively to the speaking up question.