PR as Innovation in Volta Region

7/29/2019 PR as Innovation in Volta Region

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SUBMISSION OF ENTRIES FOR AWARD FOR INNOVATION IN PUBLIC

SERVICE AS PART OF ACTIVITIES TO COMMEMORATE THEUN/AU PUBLIC SERVICE DAY, 2012

1.0 BACKGROUND

The Ghana Health Service (GHS) is one of the agencies under the Ministry of

Health established by Act 525, 1996 of the Parliament of the Republic of

Ghana.

The Volta Regional Health Directorate being an outpost of the Headquarters

of Ghana health Service is mandated to plan and carry out activities and

programmes aimed at achieving the core objectives of the Ghana Health

services as indicated in Act 525 of 1996, which are stated below.

as required by the 1992 constitution. It is responsible for implementation of

national policies under the control of the Minister for Health through itsgoverning Council - the Ghana Health Service Council at Regional Level.

1.1 Mandate of the Volta Regional Health Directorate

To provide and prudently manage comprehensive and accessible health

service with special emphasis on primary health care at district and sub-

district levels in accordance with approved national policies.

1.2 Vision, Mission and Objectives of Volta Regional Health

Directorate


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The Mission of the Volta Regional Health Directorate as adopted from theMinistry of Healths Mission Statement is to contribute to socio-economic

development and wealth creation by promoting health and vitality, ensuring

access to quality health, population and nutrition services for all people living

in Ghana and promoting the development of a local health industry.

Source: GHS SP Document/MOH National Health Policy

The objects of the Volta Regional Health Service are to:

Implement approved national policies for health delivery in theRegion


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Determine charges for health services with the approval of theMinister of Health

Provide in-service training and continuing education Perform any other functions relevant to the promotion, protection

and restoration of health.

2.0 BACKGROUND ANALYSIS AND RATIONALE FOR INNOVATION

(PEER REVIEW)

2.1 Background

The Core function of any health care system borders on quality service

delivery aimed at saving life, preventing disabilities and ensuring that

individuals are able to reproduce themselves with minimum risk.

As part of its functions, Ghana Health Service is supposed to adopt and settechnical guidelines to achieve policy standards set by the Ministry of Health

and performs any other related functions that will ensure sustainable health

financing as well as promoting, protecting and restoring of health.

2.2 Rationale for Introducing Peer Review

Many Health facilities were facing infrastructure problems countrywide. Apart

from Infrastructure gap and deteriorating state what exists is not properly


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Many fact-finding missions were just amazed at the depth of the problem

such as:

In response, establishment introduced Quality Assurance practices at all

levels of the healthcare system. At the level of national headquarters,

Quality Assurance Department was established; cadres were sent for

training and positioned; policy documents were drafted to guide actions.

Regional Quality Assurance teams were established with forays ofinstitutional Quality Assurance teams became the norm and reports were

written every year [But as . Put it]

Policy documents were gathering dust within the enclaves of the Ministry of

Health and Ghana Health Services whilst the deterioration continued at

institutional level. The traditional methods of monitoring and supervision

were unable to arrest the decaying situation.

E.g. from publication to support

What were the interventions, activities and progarmmes implemented to

achieve these and what is the problem or the gap.

However, the Independent Review team of Programme of Work (POW)-2006


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round. Only 38 percent have 24 hour electricity supply and 29 percent

had no electricity at all. Infection prevention and control: Soap was available in only 70

percent of service delivery areas and only 54 percent of facilities had

gloves in all relevant service areas. While 67 percent of facilities had

functioning equipment for high-level disinfection or sterilization, only

51 percent had both the equipment and staff who knew the correctprocessing time.

Service availability: A full package of RCH services 21 was available

in only 28 percent of facilities. Seventy-two percent of hospitals but

only 13 percent of all facilities had all items necessary to provide

quality 24-hour service. All hospitals but only 26 percent of clinics hada qualified health care provider

Facility management: Only 23 percent of all facilities had a

management committee that holds documented meetings at least

twice a year; only 14 percent had documented QA activities. Seventy

percent of facilities had received external supervision in the 6 months

preceding the survey. Forty-nine percent of health workers had

received in service training in the previous 12 months


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managers to quality; and an absence of quality maintenance mentality or

culture. In spite of so much investment in quality assurance within theGhana Health Service; quality of health services are still uncoordinated,

leading to wasteful duplication - a consequence of all these is inadequate

monitoring and supervision of post intervention activities. This document

also laments the non-compliance with guidelines on basic patient care,

workplace safety and poor staff working environment.2.2 Historical Nature of Monitoring and Evaluation in Ghana Health

Service.

The purported aim of Monitoring in the Health sector; essentially is to

track and ensure that key elements of the Health Sector performance

regarding inputs, activities/processes, and results remains on their projected

trajectory. This affords policy/programme implementers to:

Determine the extent to which the policies/programmes are meeting

desired targets, identify possible inhibitory factors and designed

possible interventions to overcome them. ion track and to make any

needed corrections accordingly;

make informed decisions regarding operations management and

service delivery;

ensure the most effective and efficient use of resources; and


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So what is the problem? Is the problem due to challenges with the process

or the methodology? Is this in consonance with the findings of the GHS

2007-2011 strategic plan?

The Ghana Health Service 2007-2011 Strategic Plan identified that there is

insufficient monitoring and supervision across all levels of the GHS,

contributing to a general lack of commitment and little accountability for

performance. Inadequate support and oversight from the national level to

the regional and district levels through supervisory visits and performance

appraisal also leads to reduced morale and sometimes indiscipline of lower-

level managers

Self-assessment or routine assessment of individual performance within GHS

is lacking probably due to non-functional appraisal system with no uniform

tools for assessment and if available not well disseminated and shared with

all managers.

2.3 The Hospital Strategy document of the Ministry of Health also

highlighted the following:

Monitoring and Supervision systems with the hospital are weak. (what

is the evidence) Hospital managers have not considered monitoring

and supervision as crucially important in effective management.

Monitoring tools have not been well-developed and disseminated.

There seems to be no accountability and responsibility on the part of

managers to measure performance of hospitals


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frustrating one in spite of various interventions undertaken as stated in the

Quality Assurance Strategic Plan for Ghana Health Service 2007-2011 asfollows:

1. Establishment of a Quality Assurance Department in the Institutional

Care Division of the Ghana Health Service with a substantive head, a

deputy and a secretariat.

2. Since mid-2004, the department has targeted support from QualityHealth Partners, a project largely dedicated to improving quality of

care in GHS and a range of private institutions. It has targeted 30

districts with more than 200 health facilities.

3. Production and cataloguing of numerous policies and operational

guidelines and standards on care

4. Production and use of tools for monitoring and supervision.

5. General in-service training to improve competencies of staff

6. In-service training focused on quality assurance and customer care

7. Supervision and monitoring visits focused on quality of care. Visits

from national level to regions and from region to other levels were

carried out quarterly


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2.5 The Emergence of Peer ReviewIn 2007, the Medical Superintendents Group (MSG), Volta Division, at a

conference held in Ho agreed to make Peer Review an Instrument of

Monitoring their own service delivery activities. In the conference

communiqu, it was suggested that Peer Review be made such an

Instrument in the entire health sector at all levels in the country.In the Volta Region, in 2009, Peer Review has assumed exactly the

competitive nature as envisioned by the Medical Superintendents Group-

Volta Division. The Director General in his 19th January, 2010 letter on the

2010 Direction of Ghana Health Service in the Implementation of the 2010

Programme of Work directed Regional Health Directorates to institutionalizethe Peer Review mechanism and District League Performance table and

introduce schemes to motivate lower level managers to perform. (Can you

please look at the problem statement again? It appears that the problem as

indentified is scatted in various document. Can we reorganized it into a

paragraph or a page supported by evidence from all these documents)

2 6 Rationale for the Peer Review


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Build functioning teams since health care delivery is teamwork

3.0 THE PEER REVIEW

3.1 What is Peer Review?

Peer reviewis the evaluation of creative work or performance by otherpeople in the same field in order to maintain or enhance the quality of the

work or performance in that field

1

.

In our case, it is since as bringing peers together to serve as an

organizational Mirror through which reviewed hospitals sees his

performance; whether meeting the approved Standards of WHO, National

and Regional using an agreed checklist. Through this means, Organizational

performance Diagnoses are made and Prescriptions given instantly at the

point where the diagnosis is made. At the end of the Diagnosis process, a

full discussion or feedback session is usually held on the identified gaps. In

so doing, Participants in effect also learn from the process and back at their

facilities initiate moves to correct the deficiencies and new ways they found

in their sister facilities.

3.0 Detailed Description of Peer Review Process


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The Process

The following are the Processes we have gone through to implement this

innovation:

1 Developed an Assessment tool or checklist for the assessment

2 Developed a Code of Principles to guide the behaviour ofReviewers, Reviewee, Reviewed Facility, Referees, and Reviewing

Facilities.

3 Prepared a Schedule for all the Hospitals. You can ballot for the

Period the Hospital should be reviewed or prepare the date for each

Hospital.4 Hospitals Identified Accredited Reviewers with a Minimum

Qualification determined by the Regional Health Directorate

5 Train all the Accredited Reviewers to understand how to

administer the Checklist or the Assessment tool.

6 Regularly invite the Hospitals to the Peer Review.

3.1. Methodology of the Peer Review Process


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Facebook Group has also been created to inform all hospitals about the

Hospitals that will be reviewed.

2.3 Pre-monitoring Session on the day of PR

The Pre Monitoring activities include:

Assembling of Heads of Departments/Units of the Institution being

Peer reviewed and Participants from other sister facilities.

Discussion of the Checklist and other procedures/methods

(Observation, Interview, Records review etc.) to be adopted during the

Monitoring Session so as to ensure that all participants are conversant

with the Checklist and the Procedures.

Grouping of participants and assigning different areas on the Checklist

to them to monitor.

2.4 Monitoring Session

During the Actual Monitoring and Supportive Supervision Session:

i. Peers visit all Units/Departments of the Hospital to observe,

interview, review records and ask staff to demonstrate some

procedures before scoring the Hospital per the checklist. The


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2.5 The Post Monitoring Session

The Post monitoring session activities include:

a) A staff durbar organized for all the members of staff for each

Hospital visited. At least all Units/Wards/Department of the Hospital

were represented during the dissemination.

b) Presentations by the various groups are then made.c) Discussions of the results are made and the reviewed facility is

allowed to make clarifications on the groups findings.

d) Scores are collated in the various thematic areas on the checklist

e) Strengths and weaknesses of the facility are identified

f) The reviewed facility shares its strategy on the best performingarea.

g) The Peers and the host then agree on a specific poor performing

area and carry out a problem solving session to assist the reviewed

facility overcome the specific problem.

h) Closing remarks are done by the Regional Director or hisRepresentative and the Chairman MSG.

i) Lunch is served and participants depart thereafter


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the main Peer Review Checklist. This period is also used to assess whether

efforts were initiated to correct issues raised during the main Peer Review.

Tools for the Process

Budget

4. ACCOMPLISHMENTS OF THE PEER REVIEW4.1 Intermediate Results

4.1.1 Availability of Service Inputs

Every hospital is expected to acquire some basic inputs for quality Service

Delivery. In the era where most facilities were neglected and occasionally

monitored for these inputs, it was difficult getting these inputs for servicedelivery. This attitude demoralizes the Staff to perform to meet the required

standards. On the day of Peer Review when these items are assessed,

Management of the Hospitals make frantic efforts to acquire these basic

inputs which will be used regularly. Hitherto, it was difficult seeing

appropriate Waste Bins in the Hospitals, but now every Hospital has theappropriate Waste Bins, appropriately colour coded and appropriately lined.

In addition basic Emergency Equipment were acquired and being used


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and Staff to officially lodge their complaints. Managements were also tasked

to regularly deal with these complaints.

4.1.3 Readiness for Mass Casualty Incidence Management

As part of the process of improving Emergency and Mass Casualty Incidence

Management, systems has been created in the Region to put the Region in

readiness for Managing Mass Casualty situations where the resources maybe inadequate in one facility. In addition, basic equipment and Medicine

needed for providing Emergency Services were ensured in all the Hospitals

in the Volta Region.

4.1.4 Infection Prevention and Control

In order to ensure patients are not infected in the Hospital, all Hospitals areconveniently using Chlorine Based Disinfectant. In addition, the process

ensured the availability of the appropriate Soap, Stand-by Water systems

etc. to ensure that at least social hand washing is being done. In addition

knowledge of staff on barrier nursing has been enforced.

4.2. IMMEDIATE RESULT

In terms of immediate results the table below depicts how the Health


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moderate and chronic casesdefine such effectiveness.

1

Mass Casualty Incidencemanagement

To give focus and organizationin the Management of MassCasualty

To develop systems andcapacity to manage Masscasualty that goes beyond ourEmergency rooms. ForExample occurrence ofearthquakes, landslides, etc.

System for Emergency

To ensure there is a system tomanage emergency situations

Emergency Trays(availability andadequacy) -minimumcontent of emergencytray

To ensure basic equipment anddrugs available to enhancemanagement of emergencies.

To ensure uniformity in theManagement of Emergency inall facilities.

To draw attention to whatshould go into the Emergency

TrayTo reduce time spent onmanaging emergencies

Occupational Health and

Safety issues e.g.i. Personal Protective

Clothing

ii. Barrier Nursing

iii. Floors (Non-

slippery, Noexcavation)

iv. Fire Prevention

(FireExtinguisher &

Appropriate

use)

Safety of staff and patients

cannot be compromised underany circumstances andtherefore steps must be takento protect them.

To stimulate Management to

pay attention to protection ofstaff


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(Availability, StaffKnowledge about it)

motivation to bothmanagement and the entire

staff.SP involves having broadoutlines of local content ofactivities (includinginnovations) directed atexecuting the objectives ofMOH/GHS

need a Strategic Planhowever, hospitals like any

other organization needs tohave a focus exactly what astrategic Plan is meant to do.

Action Plan (Availablein all units, meet

standard action planrequirement,Proportion ofimplementableactivitiesimplemented)

Action plan operationalizesstrategic plans and reduces SP

to work packages that caneasily be managed

To give uniformity actionplans

To ensure implementation ofactivities once they areplanned

Weekly Cash flowstatement (available)

To guide expenditure decisions To ensure flow of financialinformation to management

members this hitherto is notthe case.Help in Management decisionmaking.

To help prevent financialmalpractices

Q t l Fi i l

To determine financial viabilityand monitor budget

performance.

To ensure flow of financialinformation to management

members this hitherto is notthe case.Help in Management decisiontaking.T h l i


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Referral Policy

Waste Management

Maternal Health Audit

Customer Care Policy/Guideline

High Staff Motivation to assist Management of the Hospitals.

Basic Service delivery Inputs are available to staff to deliver quality

Service

4.3 EXTENT TO WHICH INNOVATION HAS BEEN MAINSTREAMED ORDEPEND ON LOCAL RESOURCES

The implementation of the Peer Review ensured that Revenue generated is

plough back into the service delivery judiciously. More equipment to were

being purchased to ensure quality of Service Delivery to clients e.g. Patient

Monitors, Emergency Units constructed and well equipped for serviceimprovement, In some instances creativity of staff being exploited to the

advantage of the facilities etc


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5.0 CHALLENGES ENCOUNTERED

The following were the Challenges encountered in implementing the Peer

Review:

1. The initial Checklist used during the first cycle had some subjectivity in

it.2. Some outlier behaviours were identified in some facilities

3. Sustainability of gains made during the day of the Peer Review was a

challenge

4. Confrontation as to who should participate in the peer review and carry out

assessment, number of participants per facility became an issue as was the basisfor awarding scores in certain thematic areas

5. A problem solving session which was one of the salient parts of the program

during the first cycle died down in the second cycle due to lack of time.

6.0 MEASURES ADOPTED TO MITIGATE CHALLENGESIn order to mitigate these challenges, the following steps were taken:

a) The Checklist was reviewed to ensure the objectivity of the


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c) Another feature of the second cycle Peer Review was the introduction of the

Regional Directors Score to encourage innovation using local resources and

staff participation.

d) A code of principle was also developed to guide the behavior of the

Participants (Reviewed Facilities and Reviewing facilities) and the referees

(Regional Health Directorate)

e) Training was done for those selected by the various Hospitals as their

accredited reviewers to ensure uniformity of the assessment at the various

zones the Region was divided into.

APPENDIX A

OVERALL PERFORMANCE OF GHANA HEALTH SERVICE HOSPITALS


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LEAGUE TABLE OF PERFORMANCE OF HOSPITALS

Hospital 2nd Round 1st Round % Change

2nd Round

Position

1st Round

Position

Peki 94.8 87.4 8.5 1st 1st

St. Anthony 91.8 56.4 62.8 2nd 18th


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Krachi 77.9 51.5 51.3 13th 20th

MMCH 77.9 64.6 20.6 14th 12th

Adidome 76.7 55.8 37.5 15th 19th

Jasikan 75.6 70.8 6.8 16th 8th

Battor 73.9 62.3 18.6 17th 15th

Anfoega 69.6 57.9 20.1 18th 17th

VRH 63.0 61.4 2.6 19th 16th

Nkwanta 60.4 62.6 -3.4 20th 14th

Comboni 55.5 65.6 -15.4 21st 11th

Ho Poly 53.1 42.9 23.8 22nd 22nd


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IMPROVING THE EXISTING INFRASTRUCTURE THROUGH PEER

REVIEW

INFRASTRUCTURE OF KRACHI HOSPITAL BEFORE THE PEER REVIEW

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IMPROVING THE EXISTING INFRASTRUCTURE THROUGH PEERREVIEW AT KRACHI

HOSPITAL

POLICY ON SEGREGATION OF WASTE BEING ENFORCED

THROUGH PR

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WASTE MANAGEMENT PROCESS IN HO MUNICIPAL HOSPITAL

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WASTE SEGREGATION SHADE (IN FRONT) MULTIPURPOSE INCINERATOR(BEHIND)

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STAKEHOLDER INVOLVEMENT/COLLABORATION IN HOSPITAL ADMINISTRATIONAND MANAGEMENT

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INTERIOR ENVIRONMENT ENCOURAGING STAFF TO PERFORM WITHCHEST OUT AT HOHOE HOSPITAL

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HOSPITAL ENVIRONMENT IN ST. ANTHONYS HOSPITAL,

DZODZE

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ENSURING THE COMFORT OF CLIENTS IN OUR HOSPITALS

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WARDS IN KRACHI WEST DISTRICT HOSPITAL BEFORE PEER REVIEW

AND AFTER THE PEER REVIEW

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CLIENTS BATHROOM IN MARGRET MARQUART HOSPITAL BEFORE AND

AFTER PEER REVIEW

NEW MATERNITY BLOCK CONSTRUCTED AT MARGRET MARQUART HOSPITAL TO

HELP ACHIEVE THE MDG 4 &5

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NEW PHARMACY BLOCK COMMISSIONED FOR ST. JOSEPH CATHOLIC

HOSPITAL, NKWANTA

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DISTRICT HOSPITAL SOGAKOFE IMPROVEMENT IN THE EXTERNAL ENVIRONMENT

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Documents

PR as Innovation in Volta Region