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NGĀ TAERO a KUPE: WHĀNAU MĀORI EXPERIENCES of IN-HOSPITAL ADVERSE EVENTS I

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NGĀ TAERO a KUPE: WHĀNAU MĀORI EXPERIENCES of IN-HOSPITAL ADVERSE EVENTS I NGĀ TAERO A KUPE: WHĀNAU MĀORI EXPERIENCES OF IN-HOSPITAL ADVERSE EVENTS I Ngā Taero a Kupe NGĀ WHEAKO PĀNGA KINO KI NGĀ WHĀNAU MĀORI EXPERIENCES OF WHĀNAU MĀORI I RŌ HŌHIPERA IN-HOSPITAL ADVERSE EVENTS 2019 Ngā kaupapa | Contents Ngā mihi | Acknowledgements 1 Ara rangahau | Research approach 15 Ngā kitenga haumanu | Clinician findings 32 Tangohanga | Abstract 2 Methodology 15 Describing adverse events 32 Method 16 Open disclosure and clear Kupu whakataki | Introduction 3 Semi-structured interview process 16 communication 33 Adverse events 4 Participating DHBs 17 Preparedness to review events 34 Commission reporting on Clinician participants 17 Culturally appropriate care 35 national adverse events 6 Whānau Māori recruitment process 17 Improvements 36 Te ara | Approach 7 Recruitment challenges 18 Tātari me te whakakapi | Whānau demographics 18 Arotake tuhituhinga | Literature review 8 Analysis and conclusion 37 Iwi affiliation 19 Unconscious or implicit biases 10 Clinician participants 19 Tātari me te kōrerorero | Dignity and respect 11 Analysis and discussion 38 Open disclosure and clear Ngā kitenga | Findings 20 Describing an adverse event 39 communication 12 Communication issues 39 Ngā kitenga a ngā whānau whakauru mai | Te kaupapa rangahau onāianei | Whānau participant findings 21 ‘Am I being heard?’ and lack of respect 41 The current research project 13 Perceived lack of care 42 Describing an in-hospital adverse event 21 Purpose 13 Preparedness to review events 42 Communication issues 22 Overall research question 13 Culture 43 Perceived lack of care 25 Aim 13 Cultural safety and culturally Whakakapi | Conclusion 44 Objectives 13 appropriate service 27 Reflections from the research team Informed consent 14 Unconscious biases 29 and author 45 Ethics 14 Whānau views to improve system 30 Te rārangi pukapuka | Bibliography 46 Project processes 14 Ngā āpitihanga | Appendices 50 This work is licensed under the Creative Published by Kupu Taurangi Hauora o Aotearoa | Health Quality & Safety Commons Attribution 4.0 International Commission New Zealand, June 2020 License. To view a copy of this licence, visit PO Box 25496, Wellington 6146 creativecommons.org/licenses/by-nc-sa/4.0 ISBN 978-1-98-859927-4 (print); 978-1-98-859928-1 (online) Available online at www.hqsc.govt.nz Enquiries to: [email protected] NGĀ TAERO A KUPE: WHĀNAU MĀORI EXPERIENCES OF IN-HOSPITAL ADVERSE EVENTS 1 Ngā mihi | Acknowledgements This report was prepared by the Health Quality We would also like to thank Ms Audrey Robin (Chief Executive & Safety Commission | Kupu Taurangi Hauora o Officer of Te Kupenga Hauora – Ahuriri) and Ms Teresa Olsen Aotearoa based on the information gathered during (Chief Executive Officer of Kōkiri Marae Keriana Olsen Trust) for their support in identifying and recruiting whānau Māori a research project of whānau Māori experiences of participants. We acknowledge the amazing role your organisations in-hospital adverse events. have in empowering, supporting and caring for our whānau – ngā mihi nui ki a kōrua. We would like to acknowledge all stakeholders who participated in this project. Thank you to all the district health board clinical staff who shared their experiences of and perspectives on managing and reviewing A special mention must go out to all the whānau who courageously in-hospital adverse events. shared their stories with us. It was a privilege to meet each and every one of you, because without you, this project would not have been possible. We hope other whānau take comfort from your example and have the courage to tell their stories to contribute to improving systems for looking after Māori wellbeing. The report name, Ngā Taero a Kupe, refers to the kareao (supplejacks), tataramoa (brambles), tūmata-kuru (spear grass) and ongaonga (nettles), which are called ‘The Obstructions of Kupe’. These are physical and mental difficulties or blockages. They occur when cultural safety and cultural competency are not observed. 2 NGĀ TAERO A KUPE: NGĀ WHEAKO PĀNGA KINO KI NGĀ WHĀNAU MĀORI I RŌ HŌHIPERA Tangohanga | Abstract It is commonly known that Māori, who make up only 19.1 percent of the total population of Aotearoa New Zealand (Statistics New Zealand 2019), experience the poorest health outcomes across the population. To understand and support much-needed change to improve Māori health outcomes within the Aotearoa New Zealand health care system, the Health Quality & Safety Commission (the Commission) completed a research project that investigated whānau Māori experiences of in-hospital adverse events. This project primarily focused on whānau Māori views and experiences of an in-hospital adverse event and how that experience was managed. The Commission considered that understanding whānau Māori experiences of adverse events would enable directed and focused system improvements to occur. Objectives: This study sought to investigate and describe the experiences of whānau Māori make up only Māori who experienced a health care-related Severity Assessment Code 1 or 2 in-hospital % adverse event. Methods: The study was designed using a kaupapa Māori approach, which was applied 19.1 throughout each phase of the project. A range of qualitative methods was applied to data of the population of Aotearoa, collection and the analysis of all information collected from 17 whānau Māori and eight but experience the poorest clinical staff from across the country. health outcomes. Results: Whānau Māori had strong views about the way they were treated when accessing health care. For example, many whānau perceptions of the health care system was poor and as a result whānau were reluctant to access care unless absolutely necessary. Conclusion: The need for change is critical to the quality of care that whānau Māori experience within the Aotearoa New Zealand health and disability system. NGĀ TAERO A KUPE: WHĀNAU MĀORI EXPERIENCES OF IN-HOSPITAL ADVERSE EVENTS 3 Kupu whakataki | Introduction For most people who access health services, the care received goes according to plan and their health is restored. Hågensen et al (2018) state people enter health care services with the expectation that their care will be performed in a safe and beneficial manner. However, Mothibi et al (2015, p 660) claim, ‘health care is a complex, fragmented, and discontinuous system that provides opportunities for systematic failure which can adversely affect patient safety’. Court (2003, p 97) argues, ‘we are unable to guarantee Although patient safety in health care cannot be our patients that the care we provide will do no harm’ and guaranteed, quality health care is a fundamental right of for an alarmingly high percentage of the population, their all health consumers across the globe. Providing quality experience of health care services results in an unintended health care should be considered an ultimate goal that adverse event that causes significant preventable harm each health care service provider aims to achieve. to them (see Merner et al 2019; Hågensen et al 2018; Mothibi et al 2015; de Vries et al 2008; and Court 2003). ... [Q]uality health care is a fundamental right of all health consumers across the globe. 4 NGĀ TAERO A KUPE: NGĀ WHEAKO PĀNGA KINO KI NGĀ WHĀNAU MĀORI I RŌ HŌHIPERA Adverse events In-hospital adverse events are commonly described as claims that, for many years, health care policy frameworks describe patient undesirable and unintended experiences associated with the experience as a core component of health care quality and should sit alongside health care system, which cause unnecessary or preventable clinical effectiveness and patient safety. harm to consumers (Merner et al 2019). To note, de Vries et al Currently, there exists a plethora of national and international research that (2008) say in-hospital adverse events ‘kill’ more people annually examines patient experiences of in-hospital adverse events. Much of the than breast cancer or AIDS. research is aimed at investigating system failures, reducing hospital admissions and learning from patient adverse outcomes associated with the health care In-hospital adverse events are system. However, at present the voices and experiences of carers in patient ‘... [I]n-hospital therefore, a significant problem safety research are limited, and research directed at investigating carers in facing contemporary health care hospitals often focuses on the carer’s general role in supporting the patient adverse events “kill” (Harrison et al 2015) and, despite a rather than their safety-specific role (Robert 2013). more people annually range of collective efforts to improve than breast cancer patient safety, preventable health Examining patient experiences of in-hospital adverse events offers a unique care-associated harm (particularly in opportunity to gain end-user perspectives into what works well, what does not or AIDS.’ hospitals) remains a significant issue work and where necessary system improvements may be needed. de Vries et al (2008) for both clinicians and consumers alike (Lamont and Waring 2015). Regardless of all good intentions to treat patients safely, many patients experience in-hospital adverse events associated with their health care Harrison et al (2015, p 424) suggest quality and safety initiatives are routine for (Sahlstrom et al 2018) and in Aotearoa New Zealand this is particularly improving the efficiency and effectiveness of health care. Hågensen et al (2018) evident for whānau Māori. While limited, research that specifically investigates argue patient safety activities and research
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