Human Resources: The Essential Ingredient for a Culture of Quality

Rabab Diab, RN, MSN, CPHQHCAC, Deputy CEO, Director of Education & Consultation

MEDHEALTH Cairo 2014 Thursday, 13 March 2014

Human Resources: The Essential Ingredient for a Culture of Quality

Outline

• Introduction • Healthcare Human Resources in Jordan• Quality and Patient Safety Challenges • Standards for Human Resources Management• Competency based practice• Conclusion

Outlines


Research has been showing that human resources are very essential in developing and sustaining any quality practices in the health sector

• Most of literatures have showed the importance of human resources management on developing the quality of healthcare service (Yu, 2007; Michael, 2009; Patrick, 2011)

• Incentives and providing motivation and use system of bonuses by competencies improve the performance of individuals working in hospitals (McKinnies, 2011)

• Training courses for workers in the hospitals in the area of the dimensions of medical service quality, and to deepen the quality concept between the staff and to achieve the quality dimensions at the best degree (Diab, 2012).

• Perceived safety climate in the relationship of high performance human resources and organizational performance is confirmed.

• The finding suggests that organizational emphasis on safety issues contributes to establishing effective high performance human resources and driving organizational performance (Chan and Mak (2012))

Especially in developing countries or young health care systems, there are many challenges to having and retaining human resources that embrace quality

• Supply of trained Health Professionals in local market

• Insufficient and ineffective professional institutions

• No structured career guidance.

• Brain drain of skilled individuals.

• Inappropriate placement and distribution of work

• Lack of continuous capacity building

• No embracing of latest technologies

• Weak laws and regulations (and / or their enforcement) to ensure continuous medical education

• No real HUMAN RESOURCES systems – everything still is a personnel management world

Outlines


Human Resources in Jordan have different strengths but face several challenges

Strengths Strengths

Established graduate and post graduate education programs

Qualified Healthcare professionals

Good health out come indictors in terms of communicable diseases, infant and maternal health

Challenges Challenges

Lack of leadership competency

Lack of established human resources management programs

Lack of regulations

No policies, procedures, clinical guidelines

Lack of credentialing and privileging system for medical staff

No relicensing system

No mandatory continuous education

No medical liability laws

Although the numbers in Jordan are relatively sustainable….

0

10

20

30

40

50

60

70

14.9

28.3

8.9 6.1

25.617.9

35.4

19

6.2

20.5

9.42.8

15 12.219.3

2

Physicians/10,000 Population2005 – 2012

Bahrain

Egypt

Iran

Iraq

Jordan

KuwaitLe

bLib

ya Mor

Oman

Saudi ..

.

Sudan

Syria

Tunisia

UAE

yemen

0

10

20

30

40

50

60

70

38.635.2

14.1

40.545.5

22.3

68

8.9

44.9

21

8.4

18.6

32.840.9

6.8

Nursing and Midwifery/10,000 Population2005 – 2012

0

10

20

30

40

50

60

70

1.5 4.2 1.59

3.5

13.36

0.8 2.3 2.3 0.27.9

2.9 4.30.2

Dentists /10,000 Population2005 – 2012

Bahrain

Egypt

Iran

Iraq

Jordan

Kuwait

Lebanon

Libya

Moro

ccoOman

Saudi A

rabia

Sudan

Syria

Tunisia

UAE

yemen

0

10

20

30

40

50

60

70

2.5

16.7

2 1.7

21.4

3

12.33.6 2.7 4.4

0.6 0.18.1

3 5.90.4

Pharmacists /10,000 Population2005 – 2012

…Jordan still faces similar challenges for the retention of skilled and patient centered resources

Lack of proactive measures

• No On The Job Training Programs

• Still no Compensation alignment:

• No Career Growth for Professionals

• No Competency based Pay

• Limited professional training institutes,

• Lack of uniform and Structured Programs

• No Licensing body, No accreditation and no affiliation of these programs

Outlines


chemical exposure

Lack of radiation safety

Absence of basic hygiene

Lack of privacy

No fire safety procedures and systems

Untrained staff on basic resuscitation

Lack of leadership competencies

Lack of medical staff management systems

Competency of healthcare providers

No documented policies, procedures, plans,

No clinical guidelines

Not in compliance with laws and regulations regarding fire safety, radiation safety, staff qualifications, and medication management processes.

Lack of qualified staff in quality management , risk management, and infection prevention and control

Reporting culture

Additionally, Quality and Patient safety still faces many challenges in Jordan

12

Developin

g standard

s

Building

Capacity

But to address both challenges “quality issues and human resources challenges” Jordan adopted a two prong approach

Outlines


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Each hospital leader’s job description identifies qualifications that include formal training and experience in health management.

Quality improvement, patient safety and risk management are part of that training.

The leaders have documented formal leadership training within the past two years.

Accreditation standards support the provision of qualified personnel: Leadership!

Leadership competencies

Managing

projects and

programs

Leading organizations

Managing self

and people

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The quality improvement coordinator has knowledge in risk management methodologies.

The quality improvement coordinator completes continuing education activities at least annually to increase knowledge regarding current quality improvement practices and risk management

The standards also require quality improvement coordinator who coordinates QI activities

Quality Plannin

g

Quality Measurement

Quality Improvement

Manage Change

16

The hospital has a risk management coordinator who meets the qualifications outlined in a job description, which includes:

1. Attendance in formal risk managementtraining course or

2. Risk management certificationThe qualifications are met within one year of assuming the position of the risk management coordinator

The risk management coordinator completes continuing education activities at least annually to increase knowledge regarding current quality improvement practices and risk management.

The risk management coordinator participates in training staff on risk management measures.

The standards require a qualified risk management coordinator who coordinates risk management

Risk managemen

t process and program

Safety culture

Patient safety

17

There is at least one qualified nurse, or professional in related field, who coordinates the infection prevention and control activities.

The IPC Preventionist is responsible for the surveillance, data gathering, aggregation and analysis of IPC data.

Infection prevention certification

The IPC Preventionist in the related field has knowledge in quality improvement and risk management methodologies.

The IPC Preventionist completes continuing education activities at least annually to increase knowledge regarding current ICP practices, quality, and risk management.

And the standards also stipulate a qualified nurse, or professional to coordinate the infection prevention and control activities

Microbiology Adult

Learning

Surveillance

Quality Managemen

t

Program manageme

nt

Risk managemen

t

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For example, the tailored certification courses introduce concepts of continuous education while ensuring applicability to the field

practicum

Portfolio assignments Mentorship program

Class room Training Each course consists of different modules The class room training ranges between 6 – 12

days

Pre course Selection criteria Pre course readings and assessment

Certification

Complete Assignments Pass certification Exam

Recertification every 2 years

Recertification

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There are several opportunities in place for human resources development crucial to the quality journey

Enabling Services

Certification coursesCertification courses

Workshops and Trainings

Workshops and Trainings

Knowledge TransferKnowledge Transfer

Not just academic, includespractical and hands on

Rich yearly schedules

Walkthroughs and1 to 1 consulting , coaching and mentoring

Outlines


21

Individuals qualified to perform health care are defined in a policy, according to specific patient populations, e.g. emergency, pediatric, ICU.

Only those individuals permitted by license, certification and/or competency-based testing perform healthcare procedures.

Staff members demonstrate competency in managing patients within their area of work.

Additionally, standards specify that at all times qualified individuals provide health care services in timely and efficient manner.

Additionally, in Jordan, we are trying to promote and push for competence based practice as it clearly supports quality improvement

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DefinitionDefinition

Competency- based practice (CBP) is that it focuses on the ability of healthcare provider to provide safe, consistent care to patients when their performance is measured against valid, reliable and objective evaluation criteria.

AdvantagesAdvantages

Establish recognition for the practice

Establish minimum standards in practice

Establish quality training programs

Establish criteria for evaluation of practice

Establish commitment to good practice

23

Competency-based performance improvement frame work is a very straight forward and goal oriented approach feeding into quality improvement requirements

Need analysis, assessment, and planning

Competency model development

Education modules planning

Learning intervention design and development

Evaluation

Strategic goals, objectives, and business plans

External environment

Internal environment

24

The concepts and methods for developing competency based framework are supportive of quality improvement practices

Competency AssessmentCompetency Assessment

Competencies should be…

Ongoing

Systematic

Demonstrable ( capable of being demonstrated)

Improved

Addressing age-specific issues(if applicable)

Competency ContinuumCompetency Continuum

Competencies should be assessed when

• An individual is hired• During their orientation period

to the position• Throughout employment as

the requirements of the job and needs of the organization change.

Dynamic competencies should exist that address each period separately.

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CBP is continuum with ongoing work, and new education programs need to be developed to address development and changes in healthcare field.

Ongoing WorkOngoing Work

Ongoing competency assessment is NOT annual re-assessment of the initial competencies for the job.

Ongoing competency assessment is a dynamic process that is based on the ever-changing needs required to carry out the organization’s mission and goals.

Ongoing competencies will be different than the initial competencies identified for the job.

Educational ProgramEducational Program

New procedures

New equipment

Maintenance of current competencies

Improve Performance

Outlines


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To address Human resources challenges , interventions need to be introduced on the organizations level, as well as changes in the policy level.

Human resources management is an integral part of quality culture

Established continuous education programs and certification courses one of the key elements in addressing human resources challenges

Advocate for changes in laws, regulations that mandate continuous education to maintain licenses

Policy Change

Post Graduate

Citification Courses

Established Education Programs

based on CBP

Human Resources

Management Programs

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Questions and Comments

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Thank You

Documents

Human Resources: The Essential Ingredient for a Culture of Quality