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November | Whiringa-ā-rangi 2025
Tēnā koutou
I joined the Health Quality & Safety Commission Te Tāhū Hauora in August.
It is a privilege to be working here, and to be closer to the coalface of clinical practice again.
Over the past three months I’ve enjoyed getting across the details of the work the Commission does to support system-level quality and safety improvements across the health sector.
Some of this work is highlighted in this final newsletter for 2025, with more to come in our 2024/25 Annual Report to be published before the end of the year.
I recently took part in Ō Mātou Reo: Our Voices 2025 – an event run by the Commission that places consumers, their whānau and communities at the heart of conversations about our health sector. You can read more about this below.
I particularly appreciated the opportunity to speak with consumers, and gained valuable insight into our consumer function.
Finally, I’d like to acknowledge former Chief Executive, Dr Peter Jansen, who retired for health reasons at the start of this year.
His leadership, and that of members of our executive leadership team who stepped in until my appointment, has enabled the Commission to continue operating at the highest standard during times of change and uncertainty.
Thank you to Peter, to all of the Commission staff, and to the wider health workforce and consumers for your ongoing commitment to system improvements that deliver real benefits for New Zealanders.
Ngā mihi
Prof Sunny Collings
Chief Executive | Tumuaki
Sepsis quality improvement package
It’s estimated that sepsis affects up to 1% of people in Aotearoa New Zealand each year – more than 50,000 people.
Together with experts from across New Zealand, we’ve updated a set of tools and created new resources and learning material to support a standard approach to the early recognition and treatment of sepsis in hospitals.
The aim is to give health care workers tools they can use in their day-to-day work to help diagnose sepsis early, save lives and achieve better long-term outcomes for patients and their families.
Celebrating consumer voices in health
On 30 October, over 250 consumers, whānau, community members, health providers and leaders gathered to share experiences, insights and aspirations for the health system at Ō Mātou Reo: Our Voices 2025.
The event opened with a video message from Minister of Health, Hon Simeon Brown, followed by an address from our Board chair, Rae Lamb, who said: “When we centre our health system on the needs and voices of our communities, we create a safer, higher quality and culturally responsive environment for all”.
A series of speakers, panels and workshops explored the many different voices and experiences of consumers and whānau from across New Zealand.
Trauma project – expressions of interest open
A project that aims to ensure all patients with major trauma receive the specialist community rehab and support they need after being discharged from hospital will begin early next year.
Expressions of interest are now open for project teams from hospitals, community rehabilitation or other services keen to take part.
The quality improvement project - The path of making things right: Te ara whakatika - is from the Trauma National Clinical Network - a partnership between Health New Zealand | Te Whatu Ora, ACC and Health Quality & Safety Commission Te Tāhū Hauora.
Participation in DEWS
Work on a phased national roll-out of the Deterioration Early Warning System (DEWS) in aged residential care facilities is underway.
DEWS is designed to support health care staff working in aged residential care to identify and respond to a person who could be acutely unwell.
It was developed through a co-design project with aged residential care providers.
Information on DEWS and the indicative timeline for phase one of the roll-out is available on our website.
Care guide for health care assistants
We’ve published a new national resource for health care assistants caring for frail older people living in aged residential care.
The care guide covers 20 topics including guidance on mental and physical health, standards of care, a chapter on tikanga Māori for kaumātua and has been aligned with the RN Frailty Care Guides. It replaces the original caregiver guide that was developed by Waitematā DHB in 2010.
The Commission collaborated with the Waitematā DHB Gerontology Nursing Service and a team of aged residential care quality leads to update the clinical content and add a te ao Māori perspective to the guide.
New major injuries measures
New Zealand has played a part in the development of the first globally accepted health outcomes measures for patients suffering serious trauma injuries.
The Patient-Centered Outcome Measures for Major Injuries were released by the International Consortium for Health Outcomes Measurement (ICHOM) earlier this year and are the subject of a recent article in the eClinicalMedicine journal published by The Lancet.
The Major Injuries Set (MJI) will measure improvements in the quality of care from acute trauma to rehabilitation and chronic disability.
The MJI working group included representatives from 11 countries. The Commission’s Clinical Lead – Rehabilitation Trauma, Kat Quick, was one of two New Zealand clinicians involved.
Other recent publications
COPD in people aged 45 and over
This new Atlas domain highlights variation in the prevalence, admissions, and medicine use of people estimated to have Chronic Obstructive Pulmonary Disease (COPD).
Health and disability sector harm (adverse) events infographics
The infographics highlight key findings from analysis of harm (adverse) event reporting for the 2022/23 and 2023/24 years.
National chest injury guideline
This new guideline provides a foundation of clinical guidance that hospital services can adapt for use within the context of their local infrastructure, capacity and capability.
It aims to ensure that all people who experience chest injury receive consistent and comprehensive care while in hospital, and consistent advice to support rehabilitation.
Access the National chest injury guideline
Access the Caring for your chest injury patient information handouts
System Safety Strategy update
We are continuing to develop the ‘System safety strategy’ for the health sector in collaboration with sector agencies.
The strategy is a priority in the Government’s policy statement on health 2024-27, and will focus the health system on how to collectively improve quality and safety.
We have undertaken wide consultation, established high level principles and are developing some actions that will support safer care for patients and whānau.
We will be undertaking a final round of consultation and releasing the strategy in the first half of 2026.
Cultural considerations when caring for kaumātua
Providing safe high-quality care requires health professionals to include and respect the unique cultural needs of diverse peoples.
Our new video series supports health professionals working with kaumātua (Māori older adults) and their whānau in aged residential care and other care settings.
Each video introduces a key concept to support holistic, strengths-based care for kaumātua.
The videos complement the Frailty care guides | Ngā aratohu maimoa hauwarea.
Community-acquired pressure injuries
The Commission is leading a quality improvement project to strengthen prevention, early recognition, and at home care of pressure injuries.
Māori and Pacific peoples aged 55 and over who are living and cared for at home are more at risk of pressure injuries due to long-term health conditions, reduced mobility and barriers in access to timely care and support.
This quality improvement project will focus on Māori and Pacific peoples living at home in Counties Manukau, Auckland, and use a co-design approach, working in partnership with Māori and Pacific peoples, consumers, whānau, aiga, carers, and healthcare workers to identify what’s not working and to design practical solutions together.
A project working group will guide and support this mahi, bringing together Māori and Pacific consumers, clinical experts, home care and community service providers, and Commission staff.
To learn more or get involved, contact the team via communitypressureinjuries@hqsc.govt.nz
Aotearoa Patient Safety Day: paediatric sepsis
Sepsis moves fast. Be faster.
Aotearoa Patient Safety Day is a commitment to consumers and healthcare workers that our health services strive to provide the best and safest care possible, every time.
This year we will mark the day on Monday 17 November, with a focus on paediatric sepsis.
Sepsis develops quickly in children. It’s vital to move fast to identify, diagnose and treat sepsis.
Visit our website for social media tiles and resources.
The following opportunities are available for consumers to contribute to health system improvement:
- Have your say: experiences with antidepressants
- EOI: take part in research on the role of lived experience partners in mental health
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