Between the Flags is the largest clinical improvement program undertaken by the CEC and NSW Health. Its aim is to improve early recognition and response to clinical deterioration and thereby reduce potentially preventable deaths and serious adverse events in patients who receive their care in NSW public hospitals. As a valuable patient safety program that has received significant investment from the CEC and NSW Health, identifying that it meets its aim and provides a systems that works, is essential for its continuation and support.

In the evaluation process, BTF has adopted the Donabedian model of Structure, Process and Outcome. The intent is to assess each of the five elements (or interventions) against the aim and the individual objectives. The evaluation of BTF therefore includes both the review of processes implemented and their expected outcomes. The evaluation strategy is summarised below. It includes a number of key performance indicators (KPI) that are collected, collated and used to inform the users of the system and those managing the implementation and continuation of the program.

Between the Flags Evaluation

The program has used a variety of sources for evaluation, including both qualitative and quantitative data. These include:

  • Between the Flags team visit to facilities across NSW
  • NSW Quality Systems Assessment (QSA) website
  • NSW Root Cause Analysis (RCA) Committee
  • Local health district audit data
  • KPI data supplied from the Ministry of Health (included number of Rapid Response calls and cardiorespiratory arrest calls per 1,000 separations)
  • Evaluation of Patient Safety Improvement System (EPSIS) survey pilot report from the University of New South Wales (UNSW).