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IMPROVING QUALITY OF HEALTH CARE IN GUYANA
Dr. Vivienne MitchellMBBS, DM, MPH
Learning Objectives
Define quality Understand the concept of Total
Quality Management (TQM) Critical incident analysis Identify quality gaps in our
healthcare delivery Recognise that quality is
everybody’s business
Definition
Quality is the degree to which health services for individuals increase the likelihood of desired health outcomes and are consistent with current professional knowledge
IOM, Medicare. A strategy for Quality Assurance, 1990, p21
Definition cont’d
Doing the right thing for the right person at the right time in
the right way
Eisenberg. Testimony to Congress, 1999
Components
A high quality health care system is one which is reliably STEEP
Safe Timely Effective, Efficient Equitable and Patient-Centered
IOM. Crossing the Quality Chasm, 2001
Components
Quality Management System
Plan : Train; establish policies &
procedures; provide resources;
infrastructure; environment
Do : Implement
Check: Monitor SMART (specific,
measurable, achievable, relevant,
time-bound) indicators, data analysis,
audits, customer satisfaction
Act : Corrective & Preventive
action
Total Quality Management
Continuously meeting and
exceeding agreed customer
requirements at minimal cost,
by releasing the potential of all
employees
Principles of TQM - Customer
Identify customer needs :
Patient’s charter
Customer – supplier process flow : Process mapping
Cost Total quality is about
Building quality into our products and services
Preventing failures from occurring
Eliminating the enormous financial waste caused by poor quality
Principles of TQM - Cost
Do the right things - Avoid wrong things done well – blame game; complaints department; unread reports & memos; surveillance & inspection without action
Manage by proactive prevention, not correction
Measure for success Prevention & Appraisal costs vs Internal
& External costs Goal – continuous improvement
Employees
The planned involvement of the
enormous resource of
employees is really the key to
Total Quality success.
Principles of TQM - Employees Management must lead by example Never compromise quality Training is essential Ignorance is expensive! Communicate more effectively – top down,
bottom up and across Recognize successful involvement – News
articles, gifts, “Thank You” for a job well done
Work as a TEAM (Together Each Achieve More)
Input Staff – quantity, quality; match skill
mix to patient needs Physical resources - ?basket to hold
water Accreditation of learning institutions :
NAC, CAMC Accreditation of health facilities:
CAAM-HP Licensure – Medical Council, MOH, NAC Credentialing
Input
Patient charter
Staff sensitive to cultural issues,
changing demography; who will develop
rapport and empathize with patients.
Healthy work environment – no abuse,
exercise, recreational facilities
Process - Internal
Clinical practice guidelines
Regular staff appraisals - Feedback
Eliminate abusive or bullying culture
Encourage engaged, empowered staff
Line of sight
Risk management
Process - Internal
Audit – stocks, records, cases, staffing
Monitoring & Evaluation of indicators
Morbidity/ Mortality Meetings
Process mapping – used to identify
quality gaps
Critical incident analysis - investigate
the REASON for the error.
Critical Incident Analysis
Methods
Materials
Environment
Machines Manpow
er
Money Resources
Root cause analysis – 5 Whys Why did the motor burn out?
Lack of lubrication on the bearings. Lubricate
Why were the bearings not lubricated? The operator hadn’t done his job
Discipline him
Why hadn’t he done his job? He hadn’t realised the need to lubricate
the bearings Tell him
Why didn’t he recognise this need? He hadn’t been properly trained
Train him
Why hadn’t he been properly trained? There was no system for training
operators Develop effective training
systems for all operators
PROCESS - External
International best practices. Internationl Organization for
Standardization (ISO) - habit of excellence
Audit Inspections Risk management
Risk Management “Clinical and administrative activities undertaken to
identify, evaluate, and reduce the risk of injury to patients, staff, and visitors and the risk of loss to the organization itself.”
It is proactive (avoiding/preventing risk) or reactive (minimizing loss or damage after an adverse event).
JHACO Considers patient safety, quality assurance and
patients’ rights. The potential for risk permeates all aspects of health care, including medical mistakes, electronic record keeping, provider organizations and facility management.
Insurance Bureau of Canada
Outcome
Health Indicators
Complaints
Litigation
Patient satisfaction surveys
Staff exit interviews
Medical Tourism
Local care must first be of good
quality.
Health care must be as good as at
home.
Security, safety, political stability
and follow-up care are also
important factors.
Do not build a new facility for
medical tourism.
Change Process
Easier to change situation than
behaviour
Easier to change behaviour than
attitude
Easier to change attitude than
person
Quality Blocks
Reflective Questions
Are we reacting to problems or preventing them?
Are our decisions made for the sake of expediency or for the sake of quality?
Are we tackling sporadic problems or looking for root causes of chronic problems?
Quality Responsibility
Around 80% of problems are caused by Failures in systems Absence of tools Lack of training Inadequate procedures Poor documentation Unclear requirements
Staff needs In order to do a job properly, staff need
To know what to do Requirements
To know how to do it Training
To have the means to do it Skills, tools
To measure performance How they are doing
To take corrective action Ability to respond
Manager’s Responsibility
It is every manager’s responsibility to ensure that their staff have ALL the requirements they need to do their job effectively.
Only then can staff be held truly responsible if things go wrong.
Success factors for change
Respected opinion leaders’ support
Ownership by participants
Participants recognize need for change
Focus on QI rather than on reducing
costs
Combined approaches
Change methods to ensure sustained
change
Recommendations Include quality in the budget, curriculum
and accreditation of medical schools of health facilities Do process mapping Standardize data collection, analysis and
presentation Identify data gaps, e.g. complaints,
medical errors, near misses, litigation, investigation, treatment and prescribing errors
Proactive risk management
IMPROVING QUALITY OF HEALTH CARE IN GUYANA
Dr. Vivienne MitchellMBBS, DM, MPH
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