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the(top 100), Sydney's most influential people

Fairfax Media's the(sydney)magazine names the NSW Clinical Excellence Commission CEO, Professor Cliff Hughes in their top 100, Sydney's most influential people. "All 100 people had to be renowned within their field and have changed our city in some way," says the magazine's editor, Kirsten Galliott. See how Professor Hughes fits this prestigious mould and breaths life into Sydney's health and medical arena.

Read the article here >>

Clinician Connect Guest Editorial by Cliff Hughes
Blood Watch – seeking excellence in transfusion

There are many myths in medicine about blood component therapy - or blood transfusions. We commonly hear statements such as, "blood helps my patient get out of hospital sooner" or "blood improves healing". It is also a myth that blood is free. There is a perception that blood is safer than ever, and whilst this might be the case in regard to transmissible viruses such as HIV, Hepatitis or vCJD (see insert below), the rate of adverse events from human error, incompatibility reactions, and bacterial contaminations1 are significant. There is now increasing evidence for immunomodulatory effects following transfusion. There is a pressing need to focus attention on patient blood management, the appropriate use of blood products and strategies to reduce, or provide alternatives to, transfusions.

Read the editorial here >>

Cliff Hughes briefs ABC Radio National’s Background Briefing

The 11 March edition of ABC Radio National’s Background Briefing focused on new approaches to national health. Journalist Sharona Coutts painted a picture - with assistance from health experts - of people being urged to take responsibility for self-care, in an attempt to stay out of hospital. The program concluded with an interview with Cliff Hughes about improvements
underway in the NSW health system.

Read the transcript here >>

System error reports ring early alarm bells

Cliff Hughes often sums up what the Clinical Excellence Commission (CEC) is trying to achieve simply as “doing the work better and safer”. He's referring to the work of thousands of health professionals who deliver health care to people across NSW. Professor Hughes and his CEC team are working to achieve change – change from a culture of blame to one of open, transparent and co-ordinated reporting of errors and near-misses throughout the NSW health system. They're making progress.

The changes include the formation of the Incident Information Management System (IIMS). It encourages the 100,000 people who work in NSW Health to report errors so that lessons can be learned and shared openly. Open reporting sets the framework for an accountable and pro-active workforce. We're grateful to News Limited for approval to reproduce an article from the Weekend Australian of 26–27 August 2006. It provides an excellent insight into one facet of the CEC ethic of “doing the work better and safer”.

Read the article here >>

What's new

Professor Charles Czeisler presents 'Fatigue Kills'

9.00am – 12.00 md Monday 27 August 2007
Kerry Packer Auditorium,
Royal Prince Alfred Hospital, Missenden Road,
Camperdown, NSW

The Woolcock Institute of Medical Research, the Clinical Excellence Commission and the NSW Institute of Medical Education and Training invite you to meet Professor Charles Czeisler, a world research leader probing the relationship between errors in the hospital environment and work hours. Professor Charles Czeisler is Director, Division of Sleep Medicine, Harvard Medical School and Chief, Division of Sleep Medicine, Brigham and Women's Hospital, Boston USA. His extensive studies, and those of other experts, all reach the inescapable conclusion that fatigue kills. Following his first Australian presentation, Professor Czeisler will join a panel of Australasian experts on the vexed question of fatigue and its effects on both doctors and their patients. It’s a rare chance to learn about problems, solutions and advances in a field which constantly throws up challenges to both administrators and practitioners going about their business of caring for patients.

Download the brochure here

New Medication Safety Program for NSW Hospitals

The Clinical Excellence Commission today unveiled two new medication safety tools for NSW hospitals. The Medication Safety Self Assessment tools let hospitals identify and reduce medication errors and their causes.

“Safe and appropriate use of medicines is critical to ensuring patient safety in NSW hospitals,” the Commission’s CEO Prof Cliff Hughes said.

With the new tools, hospitals will be able to:

• Clarify opportunities for improvement in safe medication practices
• Establish baseline measures of current procedures and evaluate progress
• Compare their data to aggregate data
• Facilitate discussion about medication safety at all levels of staff

One of the Medication Safety Self Assessment (MSSA) tools focuses on medication safety in Australian hospitals and the other on antithrombotic therapy in Australian hospitals. Each of the tools were developed in the US and Canada and refined for local use by the NSW Clinical Excellence Commission (CEC) and the NSW Therapeutic Advisory Group (TAG)

Read the New Medication Safety Program for NSW Hospitals Release [PDF] >>

New QSA web based feedback form launched

As part of the Quality Systems Assessment (QSA) program, which is a new initiative for the NSW health system and a key component of the NSW Patient Safety and Clinical Quality Program, the CEC has recently launched a web based feedback form designed to allow all health care clinicians and managers who deliver services to the patients and their carers in NSW an opportunity to offer constructive comments and feedback relating to the QSA program. This opportunity to contribute feedback supports the current workshops being run by the QSA project team, which will inform the roll-out of the Program across the eight Area Health Services (AHS), the Children’s Hospital at Westmead, Justice Health and the NSW Ambulance Service later this year.

The Quality Systems Assessment (QSA) program will be a review of the Quality and Safety systems in organisations within the public health system of NSW. It is intended that the QSA is a clinical risk management program, which focuses on current and future risks to patients in a continuous improvement frame.

Learn more about this program >>
Submit feedback >>

Analysis of first year of IIMS data Annual Report 2005-2006

Download PDF

Released by the Minister for Health on 20 December 2006, this inaugural report provides an overview of the first complete year of statewide IIMS data, with a focus on clinical notifications. The report provides valuable insights into the nature and number of clinical incident notifications occurring in the system, and a platform for sustainable clinical improvements. Similar reports will be published annually.

The report complements the Patient Safety and Clinical Quality Program: Third Report on Incident Management in the NSW Health Public Health System 2005-2006, which was also released by the Minister for Health on 20th December 2006.

New tool available to Inform the Patient Safety and Clinical Quality Program

More information

For too long it has been difficult for busy clinicians to get information to support safety and quality initiatives. The CEC has recognized this issue and has engaged the Information Management Directorate (IMD) to provide a document for the benefit of active, busy clinicians. It is acknowledged that the CEC make no representations as to the ‘completeness’ of the information contained in selected publications.  We value your input regarding extra material that would be useful, in addition to extra sources or different ways in which we could make it more useful to you in future versions. It is our aim to maintain the utility of this information with regular updates and additions.