Reshaping the rules at Hutt Valley DHB

Staff at Hutt Valley District Health Board (DHB) are being encouraged to speak up if they think an aspect of patient care isn’t working, or is unnecessary, and suggest a better approach.

Reshaping the rules is an innovative initiative being led by the DHB’s chief medical officer Sisira Jayathissa. It has aspects of the Choosing Wisely* campaign, says Dr Jayathissa, but is broader.

'The DHB supports Choosing Wisely – the clinical recommendations are part of what we do. We also pose the four Choosing Wisely questions to all patients at clinical appointments.

'Reshaping the rules goes beyond just clinical aspects of care, and looks at anything that might be preventing good patient care.

'For instance, every day, people get frustrated because there are things that are done for no reason.

'For example, a consultant was doing a round on the geriatric ward on a weekend and someone asked him if a patient was allowed to be given food. When the consultant queried why that question was being asked, the nurse said it was because the patient had had a gastroscopy the day before, and the last time that happened, staff had been told to check with doctors before giving food.

'That had become a rule, but it was a completely unnecessary one. The consultant was able to confirm that waiting for clearance from a doctor before giving food in this situation was not required.

'It might sound like a minor thing, but for a frail elderly patient, not eating can see them lose condition very quickly, within a day.”

Dr Jayathissa says Hutt Valley DHB recently relaunched its values – ‘Always caring, Can do, In partnership, Being our best’.

'As part of this, we talked to a number of patients and staff. For staff, micromanagement and bureaucracy was one of their biggest frustrations. So this feedback fitted in well with Reshaping the rules. It’s about inviting people to challenge the status quo.'

Staff who want to make a suggestion can do so through the Reshaping the rules tab on the DHB’s intranet. The suggestions are given to the DHB’s Choosing Wisely Steering Committee or directly to Dr Jayathissa.

Dr Jayathissa says the initiative gives a message to staff that their experiences and suggestions matter.

'I’m excited about Reshaping the rules, but like many things, it takes time. I talk about it at orientation – we are trying to create a social momentum. I am hoping that in time people will really see its value.”

*About Choosing Wisely

Choosing Wisely New Zealand supports reducing unnecessary tests, treatments and procedures in health care.

It promotes a culture where low value and inappropriate clinical interventions are avoided, and patients and health professionals have well-informed conversations around their treatment options, leading to better decisions and outcomes.

The campaign is multi professional – engaging doctors, nurses, pharmacists, midwives and other health professional groups – as part of an international community of Choosing Wisely initiatives taking place around the world.

Choosing Wisely encourages patients to ask their health professional four questions:

• Do I really need this test or procedure?
• What are the risks?
• Are there simpler, safer options?
• What happens if I don’t do anything?

See the Choosing Wisely website for more information: www.choosingwisely.org.nz.