[PDF] - PROBLEM AREAS LACK OF ORGANISATION HOW HOW TO TO ACHIEVE ACHIEVE PDF Document

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Dr. Rajiv Mohan
Dr. Rajiv Mohan
Dr. Rajiv Mohan
Dr. Rajiv Mohan

M.S, F.R.C.S. M.S, F.R.C.S. M.S, F.R.C.S. M.S, F.R.C.S.

Mohan Eye Institute ,New Delhi Mohan Eye Institute ,New Delhi Mohan Eye Institute ,New Delhi Mohan Eye Institute ,New Delhi

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Quality improvement is an important goal in all

clinical practice

Basic ingredients are
Commitment of clinicians
Monitoring of data on processes and patient

care

Active support of management.
Evaluation of trends in the practice patterns

However many practicing group do not routinely identify or, examine their quality problem

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Objectives of Managing Quality

Managing Managing Managing Managing Quality Quality Quality Quality serves serves serves serves mainly mainly mainly mainly to to to to achieve achieve achieve achieve two two two two goals goals goals goals : : : : Efficient and Effective Performance Efficient and Effective Performance Efficient and Effective Performance Efficient and Effective Performance

An improvement in the quality of the care provided also results in cost savings. In order to ensure efficient (economical) and effective (operative) patient care, there must be interaction between the medical, nursing and infra-structural measures .

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Objectives of Managing Quality

Managing Managing Managing Managing Quality Quality Quality Quality serves serves serves serves mainly mainly mainly mainly to to to to achieve achieve achieve achieve two two two two goals goals goals goals : : : : Improving Improving Improving Improving Patient Patient Patient Patient Care Care Care Care

In many instances, the hospital staff is not aware of the quality of its own services because they receive no feedback. Quality assurance is intended to provide them with information on the quality of their performance. In cases of inefficiency, the reasons for the deficiencies must be sought. The next step is to initiate measures to improve the situation.

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HOW HOW HOW HOW TO TO TO TO ACHIEVE ACHIEVE ACHIEVE ACHIEVE QUALITY QUALITY QUALITY QUALITY Every evaluation requires yardsticks for reference. Quality can only be measured once specific perceptions of the targets have been defined. Quality is therefore the rate of compliance with pre-defined targets. Efforts are made to strive for the best possible quality, which can be obtained with the available resources. This is what is executed and evaluated in the course of managing quality.

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PROBLEM AREAS

LACK OF ORGANISATION
LACK OF STRUCTURE
LACK OF INFORMATION
LACK OF PROCESS

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2 thus…….

We can find many other such quality

deficits in hospitals.

Often they go completely

unnoticed and therefore not dealt with.

Systematic quality assurance work will

contribute towards removing quality deficits .

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Quality Assurance Approaches

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Measuring quality Defining quality Improving quality Although the QA Triangle highlights the three core quality assurance activities in its vertices, there is actually a range of sub-activities related to each core QA activity

Quality Assurance Approaches

The triangle shape appropriately suggests that there is no "correct" or even

ptimal sequence to initiate QA activities.

The order will depend on the capacity of the healthcare system or facility and the interest of the providers.

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Determinants of quality in healthcare

Improvement of health service is a long drawn relentless process. It can be achieved by implementing a carefully planned program of quality management. The program has to be –

Precisely planned & meticulously executed. It should be a continuous ongoing process. Staffs at all levels has to be trained, involved & committed. There are no shortcuts. It involves a major change in the organizational culture. Hiring an outside consultant can be advantageous. Board of management has a crucial role to play. Programme has to have a precise time schedule.

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There should be commitment from the top Educating the management and staff Formation of quality management team Awareness campaign and development of quality culture Defining key improvement objectives Development

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quality policy and quality manual for the

rganization

Training of top management Training of lower staff

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Steps of implementing quality in a hospital :

Identification and mapping of the organization’s process Development of hospital information system Formulation of criteria and standards Implementing the program Internal audit Mock survey Detection of non conformities Implementing of corrective measures External certification & accreditation 12

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3 Quality of Inpatient Services

It is recommended that the overall quality be divided into quality components. Diagnostics, therapy and care

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an adequate quality accompanied by planned and adjusted time schedules and sufficient documentation to improve monitoring and the tracing

f documents, analysis of the duration and result of the

individual steps, specific competence of physicians, nurses, physiotherapists, etc.

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Managing Quality in Inpatient Services – In General

Some of the Quality attributes of a patient friendly hospital are as below : Approach and entrance Display of important information Parking and traffic control Help and guidance

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Managing Quality

Out patient and emergency services Waiting area In patient areas Discharge process Patient’s participation in decision making Cost of treatment Ethical consideration Respect for privacy and dignity of patients Psychosocial support Healthy environment Convenience of relatives Dietary and canteen services Information/education of patients / public Image of the hospital

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Managing Quality

Technical Technical Technical Technical performance performance performance performance Access Access Access Access to to to to services services services services Effectiveness Effectiveness Effectiveness Effectiveness of

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care care care Efficiency Efficiency Efficiency Efficiency of

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f service

service service service delivery delivery delivery delivery Interpersonal Interpersonal Interpersonal Interpersonal relations relations relations relations Continuity Continuity Continuity Continuity of

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f services

services services services Safety Safety Safety Safety Physical Physical Physical Physical infrastructure infrastructure infrastructure infrastructure and and and and comfort comfort comfort comfort Choice Choice Choice Choice

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Managing Quality

Quality assurance measures should aim to identify existing quality deficits and initiate a process of change. Hospital staff members should not resign themselves to accepting existing deficiencies. They should neither put up with nor be satisfied with an unsatisfactory situation, as this would prevent them from the proper discharge of their duties. The management, in particular, must be aware that it is their task to provide good quality. Everyone working in a hospital should therefore view the Guidelines as an invitation and incentive to start introducing quality assurance measures as quickly as possible.

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Quality Provided by Doctors, Nurses and Medical-Technical Staff

Structurally oriented quality assurance takes into account the doctors who are treating the patients, the nurses and the providers of medical-technical services, their qualifications and other information relevant to their person or specific tasks, as well as the administrative and financial aspects which influence the treatment process. These facts are known to have a strong impact on the treatment process and the treatment results. In view of this, a hypothesis has been formulated according to which a sufficient number of well-qualified staff, supported by high-quality and efficient technical equipment and the proper

rganization, are in a position to provide high-quality services

and thus achieve the desired quality of treatment results.

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QUALITY ASSURANCE FROM THE POINT OF VIEW OF THE PATIENT

Patient Patient Patient Patient service service service service point point point point : : : :

Quality Assurance from the Point of View of the Patient-Complaints Meetings with patients Suggestions Breakfast or lunch meetings Patient questionnaires

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QUALITY OF STRUCTURE QUALITY OF STRUCTURE QUALITY OF STRUCTURE QUALITY OF STRUCTURE

The category "structures" comprises the characteristic features of a hospital, The quality of structures is mainly determined by: the number and qualifications of all staff members the organisational structure of a hospital the financial resources of a hospital and the operating resources available at a hospital In itself, the structure of a hospital says little about the quality of its care. However, it has a decisive influence on how performance is conducted. A hospital must meet certain structural requirements in order to be able to provide services at all.

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QUALITY OF STRUCTURE QUALITY OF STRUCTURE QUALITY OF STRUCTURE QUALITY OF STRUCTURE

Materials :

Supply from all the stores should be timely, in adequate quantity &

f high quality.

Support services :

Since the ward unit is dependent on a large number of other departments such as CSSD, Laboratory, house keeping, pharmacy…etc; the performance of these activities must be of high quality.

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QUALITY OF PROCESS QUALITY OF PROCESS QUALITY OF PROCESS QUALITY OF PROCESS

Protocol for receiving the patients on admission in the ward
Protocol for briefing the patient, after having been received in the

ward about the schedule of activities in the ward, visiting hours and visitors, rights and responsibilities of the patients, system of grievance redressal…etc

Protocol for identification of patients for various procedures
Protocol for administration of medication and observation for side

effects

Protocol for maintenance of emergency trays / crash carts to deal

with sudden emergencies

Protocol for collection of blood samples

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QUALITY OF PROCESS

Protocol for receiving telephonic instructions from physicians
Protocol for transfer of patients
Protocol for dealing with / managing common emergencies n the ward
Protocol for obtaining consent
Protocol for nursing care , including all types of specialized nursings
Protocol for maintenance of records
Protocol for maintenance of confidentiality of the patients and the

records

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QUALITY OF PROCESS

Protocol for dietary management of the patients
Protocol for action in case of death of the patient
Protocol for action in case of a missing patient
Protocol for action in case of discharge of a patient
Protocol for action to obtain the feedback following discharge
Protocol

for action in case

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indenting, storing, issuing and accounting of items from stores

Protocol for action in case of narcotics & psychotropic substances
Protocol for action in case of receipt & storage of sterile items

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5 QUALITY OF PROCESS

Protocol for action in managing the equipments
Protocol for action in case of bio medical waste
Protocol for management of physical environment like temp.,

noise, odour …etc.

Protocol for housekeeping
Protocol for action in case of accidental needle stick injury
Protocol for action in case of disinfection/disposal of patients’s

infected body fluid/excreta

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QUALITY OF PROCESS

Protocol for action in case of any breakdown in services
Protocol

for action adequate communication with reliable backup

Protocol for safety and security of patients
Protocol for action in case of fire
Protocol for action to be taken to register the adverse /

sentinel events

Protocol for maintenance of privacy and dignity of the patients
Protocol for maintenance of initial and subsequent assessment
f nutritional status of patient

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QUALITY OF OUTCOME QUALITY OF OUTCOME QUALITY OF OUTCOME QUALITY OF OUTCOME

System
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written feedback from patients/attendants and doctors as well

Incidence of medication error in the ward
Incidence of sampling errors in the ward
Incidence of noso comial infection in the wards
Incidence of any harm to the patient because of negligence in

performance of duty by the nursing or other category of staff like – bed sore, hot water bottle burn …etc

Record of complain received against the behavior of the staff

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QUALITY OF OUTCOME QUALITY OF OUTCOME QUALITY OF OUTCOME QUALITY OF OUTCOME

Incidence of delay in the preparation of discharge documents
Record of complain received against the quality of the dietary service
Record of deficiency in the maintenance of patients medical records

as pointed out by medical audit committee

Incidence of violation of patients privacy by the staff / visitors
Incidence of any hazard
Nurse response time , after a call from the patient

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QUALITY ASSURANCE PROGRAMME

Concrete measures to eliminate quality deficiencies
Monitoring of results
Continuous quality improvements
Quality appraisal
In practice, different methods of procedure have proved successful.

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CONDITIONS CALLING FOR QUALITY ASSURANCE MEASURES

The patient has been refused admittance to a hospital. The hospital stay is considered too long. The out-patient treatment does not provide the proper care. Specialists are not sufficiently consulted. Complications occur on an increasing scale. Secondary diagnostics are neglected. Rehabilitation is insufficient, inadequate

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incorrectly prescribed.

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CONDITIONS CALLING FOR QUALITY ASSURANCE MEASURES

Referral letters addressed to the outside doctor in charge of

further treatment are delayed

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provide insufficient information.

Patients are not sufficiently informed.
Adequate diagnostics was not performed.
The amount of diagnostics performed was excessive.
Treatment includes a large number of patients.
Treatment entails a number of risks.
Serious consequences can be expected with the type of

treatment performed.

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CONDITIONS CALLING FOR QUALITY ASSURANCE MEASURES

There was not sufficient indication for the type of treatment

performed (e.g. biopsy).

Treatment showed no success.
It

was not possible to establish whether diagnostics

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treatment were started in time.

State-of-the-art diagnostics or treatment were not performed.
The dignity of dying patients was not sufficiently respected.
The quality of treatment, therapy and care was less than

desired.

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CONDITIONS CALLING FOR QUALITY ASSURANCE MEASURES

Quality

standards concerning care and therapy were not applied and/or existing ones were not examined for validity.

Medical services were not sufficiently documented.
Organisational aspects are not based on the patient.
Insufficient offer or attendance of further training courses.
Reactivating care is not practiced comprehensively.
Increase in complications caused by a lack of basic care.
Lack of prophylactics.

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CONCLUSION CONCLUSION CONCLUSION CONCLUSION

The quality of services depends on the sum total of all the activities discussed under the process factor All these activities need to be carried out in a well trained manner To eliminate the margin

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errors and ensure high quality of services , it is essential that the procedures and protocols about all these activities are standardized and all staff are made to follow the standatd procedures in letter and spirit.

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BASIC INGREDIENTS FOR PROVIDING QUALITY HEALTH CARE SERVICES

TIME MONEY MANPOWER COMMITTMENT

THE ROAD AHEAD THE ROAD AHEAD THE ROAD AHEAD THE ROAD AHEAD

Quality of healthcare is not something that is a matter of choice. It is something that we owe to our fellow human beings, to our children and to the posterity.

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