Kevin Hardy met with Carrie Marr, Chief Executive of the NSW Clinical Excellence Commission at the Nepean Blue Mountains Local Health District inaugural forum – ‘Achieving Better Health’. Carrie is one of the keynote speakers.

Kevin: How has the role of the Clinical Excellence Commission over the past three years that you have been with the Commission?

Carrie: The Clinical Excellence Commission is similar to other agencies internationally which take the lead for their jurisdictions around safety and improvement. Historically those agencies probably emerged in response to issues about compliance and governance and were established with that key function. What we’ve seen over the last few years though is a shift to more of a balance between focus on compliance assurance governance and a focus on improvement transformation sustainability. 

Kevin: You mention science. What is the role of science and how is that developing? 

Carrie: In the world of improvement we talk about improvement science and it’s important for us to work with hospitals and health care organisations to help them build a critical mass of staff who understand improvement science. They’ve got the knowledge, the skills and the tools which support change in areas like measurement, understanding the theory of change and understanding how they test for change in a way that creates sustainability. Big bang change, really works. 

Kevin: Organisations like the Clinical Excellence Commission exist in different parts of the world, different health systems. How connected is the CEC to those organisations? You obviously compare notes, talk, do you actually measure yourself against those organisations or measure performance in other ways?

Carrie: New South Wales Health regularly measures itself against international benchmarks around healthcare outcomes and quality and safety and we have an international – almost network alliance – between ourselves, America, the nations of the UK, Scandinavia and New Zealand.

What we’re finding is that we’re all in a very similar place and therefore the challenge for us all is one that we could collectively collaborate on because we’re all sitting with the challenge of being in a position of responding to harm in the system about 10% of the time. How can we pull that up? How can we create more harm free care? So actually our ambition is 99% rather than 90% and that’s an international challenge at the moment.

Kevin: How does leadership affect what you’re trying to do? What are the qualities of leadership which support what you’re trying today?

Carrie: So the value proposition for us around safety and quality is that it all starts with culture and leadership. And in a hospital or health care system, if that leadership and culture isn’t positive and strong then the opportunity to create real improvement is actually going to be a challenge. So the role of the leader essentially for us is to create the conditions for improvement and for change.

Kevin: How should your organisation then feature in the development of future leaders?

Carrie: Currently we already train and develop future leaders through the CEC. We have an executive clinical leadership program where we bring senior clinicians and senior leaders from NSW together, regularly, twice a year. We talk to them about the theory of improvement and safety but we talk about the practice of leaders. How their mindsets, their behaviours, their values will actually impact on the change they achieve.

Kevin: You were recruited by HardyGroup from Scotland to come to Australia. How long did it take you to adjust to a different system and learn its nuances and subtleties?

Carrie: It is a bit different from Scotland, particularly because we had moved away from the model of foundation trust and we have a whole system approach. We had our community services and our hospitals, our public health system, our commissioning system is all one so it was different when I came here. I found it didn’t take me too long to connect with staff in NSW, understand their challenges because actually, they’re very similar to the conversations we would have with allied health, nursing and medicine in the UK.

Kevin: If there were two or three key challenges for safety and improvement going forward. What are they? The things you really think are important to be paying attention to for the system to pay attention to. 

Carrie: If you listen to the staff in the system they would say to you that it’s firstly about permission. They need the leaders and the senior managers in their system to give them permission to improve. They want to know that on a day to day basis, if they’ve got an idea, they can test it. They can carry out that experimental change. So that’s the first. There’s not enough of a culture of permission given. Secondly, leaders need to move away from thinking safety and quality as projects. It’s about a system commitment to fundamentally changing the way you do your business.

Kevin: There’s lots of talk that goes on about putting the patient at the centre of everything. What does that mean to you?

Carrie: It means to me that we need to person centred in everything we do as opposed to being professionally centred. But that has two sides, it has the person centred lens of a patient, a family, a carer, a community and it has the person centred lens of the staff and the workforce in an organisation. Because, what we do know from international evidence is the two strongest indicators that will tell you whether you’re safe and reliable as an organisation is the feedback from your patients and families and the feedback from your staff.

Kevin: What is the CEC role going forward, when systems have a fully developed integrated care system so it’s not just about hospitals and what happens there, it’s about what happens outside of hospitals in the community and so forth.

Carrie: Well my experience in Scotland would tell me that at the moment, in NSW we tend to focus our work and our development in hospitals and with hospital staff. The opportunity about systems integration is that real change could happen if we get general practice, if we get community staff, hospital staff, consumers all in the room together- because what patients are asking us to remember is they visit a hospital six days a year but they’ve got to manage their own conditions for the other 359 and we need to understand that far better as professionals. 

Kevin: What question am I not asking you? What other thoughts go through your head as we sit here and go – he’s not raising this particular point? For instance I might think, is there one thing internationally we should really be focusing on for the future in safety and improvement? 

Carrie: My mind would go back to leadership. So the question I suppose we tend to not ask ourselves is the one about how we actively think about our plan to succession, our plan to develop leaders, our plan to develop chief executives who actually will lead this conversation and hold those mindsets and behaviours that are required. Are we really targeting recruitment in a way that will bring us the right people to drive this level of change at scale and hold that within the culture? 

Kevin: Carrie, I know that you were a keynote speaker this morning at the conference. Time does bear down us and I really appreciate your time, it’s been fantastic, thank you so much.

Carrie: Thank you Kevin.