QIP - EBR

Enhancing Communication Quality Project 2013 Page: 1

Quality Improvement Project

At

The Aga Khan Hospital for Women & Children, Kharadar

Establishing

Electronic Database

for Conservation of

Birth Records

Spreading Over 7

Decades


Contents Quality Project Plan Summary ...................................................................................................................... 3

1.0 Introduction ...................................................................................................................................... 4

2.0 Rationale for selection of Quality Project ......................................................................................... 4

2.1 The Problem ........................................................................................................................................ 5

3.0 Relevance to Quality & Safety Policy/ Vision/ Core Values .............................................................. 5

4.0 Quality Project Goal ................................................................................................................................ 5

5.0 Project Methodology .............................................................................................................................. 5

6.0 Project Plan ............................................................................................................................................. 6

6.1.1 Data Collection ................................................................................................................................. 6

6.1.2 Brainstorming................................................................................................................................... 7

6.1.3 Action Plan ....................................................................................................................................... 7

7.0 Project Implementation .......................................................................................................................... 8

7.1 Establishment of an Electronic Database: .......................................................................................... 8

7.2 Pilot Phase: Entry of data for the first decade .................................................................................. 12

8.0 Project Outcome ................................................................................................................................... 13

8.1 Data Summary ................................................................................................................................... 13

9.0 Project Sustainability ............................................................................................................................ 14

10.0 Acknowledgement .............................................................................................................................. 14


Quality Project Plan Summary

Project Title: Establishing Electronic Database for Conservation of Birth Records

Spreading Over 7 Decades

Project Duration: November, 2012 – June, 2013

Project Class: Departmental - Non-Clinical

Project Category: Service Improvement for Customers Project

Department: The Aga Khan Hospital for Women & Children, Kharadar

Project’s Identification: The project was identified through analyzing Client’s

feedback.

Project Team:

Members Designation Role

Mr Irfan Valliani Manager,

Administration

Team Leader

Mr Muhammad Bilal Hardware Technician Member

Mr Alidino Khowaja Admin Officer Member

Mr. Asghar Dinar MR Incharge Member

Ms Saba Akber QIPS Officer Member

Project Methodology:

Organizational Continuous Quality Improvement Model of Plan-Do-Study-Act

(PDSA), as defined and described in the AKUH Quality Improvement and Patient

Safety Program.


1.0 Introduction

The Aga khan Hospital for Women & Children, Kharadar is one of the oldest

hospitals of the country. Its establishment dates back to the year 1924, long

before the formation of Pakistan. Initially known as the Janbai hospital, the entity

functioned as a maternity home. With the introduction of an advanced general

surgery unit for women, the maternity home now functions as a full-fledged

hospital for women and children. Even till today, the hospital is known for its long

history of services in maternal health.

2.0 Rationale for selection of Quality Project

With the passage of time, the need for proper documentation has increased. As

the national policies and procedures strengthen, citizens are required to abide by

the requirement of legal documents. Among all of the kind, birth certificate is the

one that has now become an essential document for every person.

Recently, it was identified that the clients, who were born decades ago, would

approach the Medical Records department with a request for their birth

certificate. In response to such requests, the old records were reviewed and it

was identified that the hospital holds a manual record of birth, starting from the

year 1942.


2.1 The Problem

At the Aga Khan Hospital for Women & Children, Kharadar, the birth records are

maintained from 1942 were in registers, and their retrieval, preservation and

storage was a tedious task.

3.0 Relevance to Quality & Safety Policy/ Vision/ Core Values

* Provision of access to the essential information

* Application of Technology

4.0 Quality Project Goal The project aimed at:

*Establishing an electronic database for conservation of the birth records, which

are in hundred thousands.

*Converting the manual records into the established electronic database (A

decade per year), from 1942 to 2010

5.0 Project Methodology Deming’s PDSA Cycle had been selected as project methodology.


6.0 Project Plan

Nov-Dec, 2012 Jan – Mar, 2013 Apr- Jun, 2013

Problem Identification

Planning

Establishment of the

electronic database

Pilot: Birth record

entries (2001-2010)

System Audits

6.1.1 Data Collection

Data collection based on the clients’ feedback which included:

1) Written/verbal feedback

2) Requests for birth certificates

On an average, the medical record department gets 15 requests per month for

the issuance of birth certificate from people who were born in the past years.

Depending on the year of birth, the time taken to prepare the certificate varies

from 3 to 10 days.

Often, the staff gets verbal feedback from the clients about faster service in terms

of tracking back their data.

In the month of March, a written feedback was also received which said that:


6.1.2 Brainstorming

The project team conducted brainstorming session in which the problem was

analyzed and the plan for establishing an electronic database was formalized.

6.1.3 Action Plan

As per the plan, the project is divided into three phases:

Phase Strategy Timeline Responsible

01 Establishment of the

Electronic Database

March, 2013 IT department

02 Pilot : Entry of data for

the first decade

June, 2013 MR department,

Manager,

Administration

03 All remaining data

entries (from 2000-1942)

June, 2015 MR department,

Manager,

Administration

Also, it was decided that the entries would be made starting from 2010 and going

back to the 1942. During the pilot phase, the data for the first decade (2010-2001)

would be entered.

“I was born in 1985. Today when I came … and asked for the birth

certificate, it took a lot of time. I would suggest that you maintain a

database of all the past records.”


7.0 Project Implementation

7.1 Establishment of an Electronic Database:

For the conservation of the entire data, an electronic database was established,

specifically for the birth records. The technical summary of the database is as

follows:

Server side language: ASP.Net C#

Database: Microsoft SQL server

The administrative login rights were issued to only those responsible for entering,

viewing or approving data. Entry of data was divided into three task management

levels:


Level 1: MR Assistants enter the data from the manual

registers.

Using the “Add New” option in the “Bolt On” menu, MR assistant can fill in the

Birth record entry form containing essential information about the baby.


Once the form is filled and saved, the data goes into the “Work list” and can be

accessed for the task management level 2.

Level 2: The MR In Charge reviews the entered data.

At this level, the MR In charge uses the “Review” option from the Work list menu,

selects the batch (Month and year) and rechecks all the data entered in level 01.


Here, the MR in Charge has three options:

Delete: In case of Wrong or duplicate entry

Edit: In case of Wrong or incomplete entry

View: The birth record entry details

The correct reviewed entries are selected. Using the “Approve Selected” option,

the data is transferred to the Level 3.

Level 3: The Manager, Administration approves randomly

selected data

All the data reviewed in level 2 is now approved by the manager, administration.

Using the “Approve” option, the manager gets an access to the batch wise;

computer generated random selection of entries.

This is the final level of the process. At the end of this, the data is saved.


The application also provides an option for the printing of birth certificate, in case

if the client requests for one. The certificate has been designed on the standard

AKUH birth certificate format.

7.2 Pilot Phase: Entry of data for the first decade

The pilot phase started from March, 2013. During this phase, the data for the first

decade (2001-2010) was entered in the established application.

Over 18,000 entries were recorded, reviewed and approved.


8.0 Project Outcome

The project has yielded the following outcomes:

1. Accessibility: An easy access to the birth records from the past.

2. Increased External customer satisfaction: So far 17 birth certificates have

been issued through this system, resulting in no complaints from the clients

requesting.

3. Increased Internal customer satisfaction: Since, the MR staff will no longer

need to refer back to the manual registers, the satisfaction level has

increased.

4. Decreased chances of errors: The three task management levels ensure

error free record

5. Improved Efficiency: Access to the data and printing of birth certificates

requires a few clicks only.

6. Sustainability of the Birth Record: Electronic database has ensured that the

data will be preserved and sustained.

8.1 Data Summary


9.0 Project Sustainability

At the end of the third phase of this project, every birth record from 1942 will be

available to the user. Also, it is recommended that this application be integrated

with the current application so that all the birth records could be accessed from a

single source.

10.0 Acknowledgement The project team acknowledges the efforts, coordination and cooperation of the

following individuals/ departments:

Dr Huma Naz (Administrator, AKHW&C, Kharadar)

Mr Ali Dino Khowaja (Administrative Officer, AKHW&C, Kharadar)

Medical Records Department (AKHW&C, Kharadar)

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QIP - EBR