Quality improvement in New Zealand pediatric anesthesia: National quality direction, patient experience, equity, and collaboration

Abstract

The current priorities of the quality and safety of patient care in New Zealand at a central government level are described, with a focus on equity and patient experience. Priorities between stakeholders differ. We report the current quality activities of New Zealand pediatric anesthetists in relation to these governance aims, seeking gaps and suggesting future directions to align governance priorities and local activities. International relevance is also outlined. New Zealand Māori experience health inequity. Complex systemic factors including those of systemic racism and prejudice contribute to the inequity. The specific contributions to health inequity from pediatric anesthetists are unknown but could include aspects of cultural safety, delays in treatment and treatment deficits. Patient experience is correlated positively with other quality domains. Peri‐operative patient experience tools require outcomes of interest that matter to patients, including relevant cultural safety domains. Risk identification and critical event review contribute to local learnings in departments and institutions, and more widely to national and binational (with Australia) learnings. Several collaborative projects in Australia and New Zealand, whilst not primarily quality improvement projects, may improve pediatric anesthesia. These collaborations include a pediatric anesthesia professional network, a curriculum for a pediatric anesthetic fellowship, contributions to a document on standards for pediatric anesthesia, and a national quality group researching key performance indicators across New Zealand.

Worldwide journey in pediatric anesthesia quality and safety

“…That themed issue described the initial application of these sciences to improving the quality of pediatric anesthesia care. As evident in the current issue, these sciences have been adopted widely by departments in Europe, Asia, and North America with evidence of improved quality 3–13 . Also evident is the variability in pediatric anesthesia quality across the world, noted by the lack of basic infrastructure and clinicians to deliver optimal care in low‐ and middle‐income countries, and persistent healthcare inequities in minority populations in high‐income countries 7,11,12 …”

“…As evident in the current issue, these sciences have been adopted widely by departments in Europe, Asia, and North America with evidence of improved quality. [3][4][5][6][7][8][9][10][11][12][13] Also evident is the variability in pediatric anesthesia quality across the world, noted by the lack of basic infrastructure and clinicians to deliver optimal care in low-and middle-income countries, and persistent healthcare inequities in minority populations in high-income countries. 7,11,12 It is instructive to review the definitions and the key steps in the journey to improving quality and safety.…”

“…[3][4][5][6][7][8][9][10][11][12][13] Also evident is the variability in pediatric anesthesia quality across the world, noted by the lack of basic infrastructure and clinicians to deliver optimal care in low-and middle-income countries, and persistent healthcare inequities in minority populations in high-income countries. 7,11,12 It is instructive to review the definitions and the key steps in the journey to improving quality and safety. Quality is broadly defined in industries through metrics of the product-or service-oriented to the customer into three domains.…”

“…For example, Drs. Taylor et al 12 report the quality inequities for the indigenous Māori children in New Zealand. Similarly, in the United States, we know that perioperative mortality is higher in African American children, even within the same risk stratification cohorts.…”

Closing the global quality gaps in pediatric anesthesia

“…Taylor and colleagues have described the state of QI & Safety Analytics in Australia and New Zealandand. 8,9 The infrastructure is well-developed, and health quality metrics are mandatorily reported to the central government. Despite well-established systems, in this special edition, Taylor and Jowsey state that "metrics lack the granularity to pediatric anesthesia directly".…”