Ensuring Effective Coverage: The Role of Quality Management and Accreditation

Sylvia Sax RN BSN MPH

Institute of Public HealthUniversity of Heidelberg

GIC Forum on Health and Social Protection; Universal Health Coverage: From Promise to Practice, August 26-27 2013, Bonn

Universal Health Coverage

Financial PackageService Package

Quality within health care/service and health system

Guiding principles for selecting mechanisms for managing quality

• Adopt a health systems approach• Select and introduce mechanisms based on the

context (i.e. health system, managerial, cultural, human resource capacity)

• Adapt ‘evidence based’ models using local leadership

• Involve/take account of actors at all levels• Focus on the end-user (the patient, the client)

Examples of quality management mechanisms we can use

• Standards, criteria, indicators – using self-assessment and/or external peer

assessment such as accreditation, certification– Participatory quality improvement using quality

circles, action-teams or audits • Guidelines such as clinical guidelines • Checklists, campaigns, QI/QM projects – such as the Peter Pronovost ICU checklist, the WHO

SAVE LIVES: Clean Your Hands campaign and the WHO High 5s Project

STRUCTURE PROCESS OUTCOME

LICENSING

CERTIFICATION Accreditation

Registration to Accreditation

Registration

Source: Bernd Appelt, GIZ

Country mechanisms for assuring quality in healthcare and services

New Zealand

Kenya

Kazakhstan

• National Health and Disability Service Standards• Contracts with service specifications, quality standards and health information

requirements• Self-assessments and external evaluation • Clinical guidelines, access criteria and booking systems, needs assessments• Health and Disability Commissioner

• Kenyan Quality Model (2001) including healthcare standards and evidence based medicine

• Linked to National Health Insurance (2004)• Strengthened through GIZ supported Integrated Quality Management System with

technical assistance of consortium of evaplan Consulting at the University of Heidelberg and AQUA-Institute GmbH

• Refocusing National Healthcare Accreditation System from regulatory approach to quality management including self-assessments and peer surveyors

• Development or revision of context-specific healthcare standards, for instance Blood Safety and Medical-testing Laboratories

• Introducing context-specific clinical guidelines• Reform of Medical Education

A few referencesAdam, T. & de Savigny, D., 2012. Systems thinking for strengthening health systems in LMICs: need for a paradigm shift. Health Policy and Planning, 27(suppl 4), pp.iv1–iv3.Atun, R., 2012. Health systems, systems thinking and innovation. Health Policy and Planning, 27(suppl 4), pp.iv4–iv8.Braithwaite, J. et al., 2012. Comparison of health service accreditation programs in low-and middle-income countries with those in higher income countries: a cross-sectional study. International Journal for Quality in Health Care, 24(6), pp.568–577.Øvretveit, J., 2009. Does improving quality save money? A review of evidence of which improvements to quality reduce costs to health service providers. London: The Health Foundation.Peabody, J., 2006. Why we love quality but hate to measure it. Quality Management in Healthcare, 15(2), pp.116–120.de Savigny, D. & Adam, Taghreed, 2009. Systems thinking for health systems strengthening, World Health Organization, Geneva. Shakarishvili, G. et al., 2010. Converging health systems frameworks: towards a concepts-to-actions roadmap for health systems strengthening in low and middle income countries. Global Health Governance, 3(2). Available at: http://www.ghgj.org/Shakarishvili_Converging%20Health%20Systems%20Frameworks.pdf

Shaw, C., 2004. Toolkit for accreditation programs: some issues in the design and redesign of external health care assessment and improvement systems. Melbourne, Australia: International Society for Quality in Health Care.Swanson, R. et al., 2012. Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change. Health Policy and Planning, 27(suppl 4), pp.iv54–iv61.Travis, P. et al., 2004. Overcoming health-systems constraints to achieve the Millennium Development Goals. The Lancet, 364(9437), pp.900–906.Walshe, K., 2009. Pseudoinnovation: the development and spread of healthcare quality improvement methodologies. International Journal for Quality in Health Care, 21(3), pp.153–159.

• Atul Gawande: http://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine.html• Peter Pronovost : http://www.youtube.com/watch?v=YKm8NUmPg58• WHO Safe Surgical Checklist: http://www.who.int/patientsafety/safesurgery/ss_checklist/en/