Quality AssuranceOrientation Program

Quality Assurance Cell,

State Health Society, Bihar

Quality

Ability of service to satisfy the needs & expectation of users & to meet the purpose for which it is designed.

Appraisal of healthcare facility & services in

terms of –

core healthcare services.

safety & hygiene.

comfortable atmosphere.

facilitation when a healthcare seeker

visits.

Ambience.

Perception of QualityQuality may mean different things to different

people.

For poor people - Quality in health services means accessibility and availability of services when in need at minimum cost.

For services provider - Quality means timely availability of services with minimum infection rate.

For community as whole- Quality means availability, accessibility, affordability with positive impact in the environment.

For state - Quality means ensuring health care services which is based on the concept of equity, which makes services available, accessible, affordable, and high level of infection control.

Quality Management SystemIt is an approach which encourages health facilities to

analyze the requirement of service user, define the processes and keep the processes under control for consistency.

Identify the gaps in service delivery, trace its root causes & then suggests solution to close this gaps so that its effect is sustainable.

Corrective & preventive measures - Regular review of actions taken & result so that the problem doesn’t occurs again & again, it plans & implement system so that whenever gap emerges it gets resolve at the point of emergence.

ANY SUSTAINABLE CHANGE IN TERMS OF INSTITUTIONALISATION OF QUALITY ASSURANCE (QA) WILL

COME FROM WITHIN THE SYSTEM & NOT FROM OUTSIDE.

“ITS WE WHO CAN IMPROVE THE QUALITY TO OUR SYSTEM”

Why is quality needed in healthcare system

Quality in healthcare is not a matter of choice, it is mandatory, as it can cost life.

Benefit users by ensuring quality of service provision.

Ensure efficient utilization of resources.

Provide for transparency and accountability in the functioning of the healthcare system.

Generate a sense of pride and achievement for the health care providers.

Quality:

Is a continuous process that has to be sustained for continual

improvement.

State’s focus Area in Quality Assurance

Formation, orientation & regular (monthly) meetings of QA committee. (For FY

2012-13 FMR code :- B.15.2)

Hospital level quality improvement as per standards. (For FY 2012-13 FMR code

:- B.15.2+ RKS, Hospital maintenance grant,untied fund, MCH/FP funds,etc.)

Quality certification of hospitals

Qualitative operationalization of Facility Based Newborn Care Units

(NBCC/NBSU/SCNU) {For FY 2012-13 FMR code :- A.2.2.2};

labour rooms,, Family Planning Corner (FP Corner)

Death review – Especially maternal deaths

QUALITY ASSURANCE COMMITEE

-COMPOSITION, ROLES & RESPONSIBILITIES

Formation & strengthening of Quality Assurance Committees

State Quality Assurance Committee

(Chairperson - Principle secretary – Health, Co-chairperson – Executive Director, SHSB)

Regional Quality Assurance Committee

(Chairperson – Regional Deputy Director)

District Quality Assurance Committee

(Chairperson – Civil Surgeon)

Facility level Quality Improvement Group

State Quality Assurance

Cell:-1. QA Nodal Officer 2. Consultant –MCH

– QA3. Consultant –FP –

QA4. Quality Assurance

Manager

Nodal Person - Regional Program Manager. Supported by R (M&E)

Nodal Person - District Program Manager. Supported by DPC

Nodal Person - Dy. Superintendent /MOIC. Supported by Hospital Manager / Health Manager

Regional Quality Assurance CommitteeFunctions of RQAC :-

Monitoring of health facilities & guiding the District level teams on development of processing for

ensuring quality health care services from that facility.

Ensuring adherence of treatment protocols on public health management and to ensure delivery of

quality health care services focusing more on the medical colleges, district Hospital and FRUs.

Planning, controlling, management of the medical staff, demography and bio-statistic, management

of research in health care, epidemiology and community health and strategic management.

Ensuring proper functioning of the Hospital Management information system and will also ensures

and monitor the maintenance of the medical records, as prescribed.

Management of health and related services within the medical colleges/hospital premises to

achieve optimal care by providing staff with managerial leadership, experts advice and opinion to

aid diagnosis, management and treatment of patients

To provide quality of care through the monitoring and evaluation of services, development of

protocols, supervision of staff and continuing education

Review the cases of maternal & infant deaths and report from cases of adverse

outcomes/complications in maternal, neonatal health & child health.

To provide technical inputs to the medical colleges/District Hospital/FRUs within the division for

improving their functioning.

{ks=h; xq.koÙkk ;dhu uksMy vkWfQlj ds dk;Z ,oa ftEesnkfj;kW %&

 fu;fer RQAC dk cSBd le; ls lqfuf’pr djuk@djokukA cSBd dh dk;Zokgh lss izeaMy ds lHkh

ftyksa vkSj jkT; LokLF; lfefr dks voxr djuk@djokukA

{ks=h; xq.koÙkk ;dhu lfefr dh xfrfof/k;k¡ ;kstuk ds vuqlkj lle; fu"iknu djuk@djokukA

blds vfrfjDr fdlh Hkh izdkj ds QA need based activity dks djokukA

ftyk xq.koÙkk ;dhu lfefr (DQAC) dh ekfld cSBd fu;fer djokus gsrq vko’;d dne mBkukA

ftyk xq.koÙkk ;dhu lfefr (DQAC) dks vko’;drkuqlkj rduhdh lg;ksx iznku djukA

izeaMy varxZr lHkh ftyksa esa py jgs xq.koÙkk ;dhu dk;ZØeksa dh izxfr dk i;Zos{k.k

fujh{k.k djuk@djokuk rFkk lle; vuqikyu lqfuf’pr djokukA

vLirkyksa dks FFHI, ISO, bR;kfn izek.khdj.k ds fy, fuf’pr le; lhek ds vanj rS;kj djokukA

xq.koÙkk lq/kkj dk;ZØeksa dh izxfr gsrq jkT; o ftyk Lrj ds lkFk liasioning djrs gq,

HkkSfrd ,oa foÙkh; izxfr dks lqfuf’pr djokukA

izxfr izfrosnu dks ¼izk:i esa½ fu;fer :Ik ls jkT; LokLF; lfefr dks HkstukA

jkT; ds }kjk le;≤ ij ekaxh xbZ tkudkfj;ksa ;k funsZ’kks dk lle; vuqikyu djuk@djokukA

{ks=h; xq.koÙkk ;dhu uksMy vkWfQlj & {ks=h; dk;ZØe izca/kdA dk;ksZ ds lle; fu"iknu esa {ks=h; M & E Hkh mÙkjnk;h gksaxsA

District Quality Assurance Committee

Functions of DQAC:-

• Meet once every month.

• Develop half yearly action plan of district for quality assurance intervention in the facilities (Based on facility

wise planning for infrastructure strengthening and strengthening of services at the facility).

• Provide technical and managerial guidance to blocks on the implementation of action plan for improving the

quality of services in the facilities disease control programme service delivery in the state.

• Monitor the Quality Improvement of programme and track progress based on identified quality indicators at

each level e.g. Sub Centres, PHCs, SDHs, District Hospitals and Medical College. Also keep a check whether

the facilities are providing the essential service package as per standards and protocols being adhered to.

• Review the cases of maternal & infant deaths at facility level and report cases of adverse

outcomes/complications.

• Collecting information on all hospitalization cases related to complications following sterilization as well as

sterilization failure.

• Processing all cases of failure, complications requiring hospitalization, and deaths following sterilization for

payment of compensation.

• Reviewing all static institutions, i.e. government and accredited private / NGOs and selected camps providing

sterilization services and safe abortion services, for quality of care as per the standards laid down, and

recommending remedial action for institutions not adhering to the standards.

• Conducting medical audits from time to time of all maternal & infant deaths and deaths related to

sterilization and sending reports to the State QAC office.

• Review & monitor the quality of trainings under RHC II/National disease control programmes organized at

state & district level and undertake follow-up of selected sample of trainees during field visits.

• Review of different community based interventions, implementation of schemes under MNCH.

• Plans QAC visits and make necessary preparations for visit to facilities and use the standardized QA

Checklists to conduct assessment and debriefs the Medical Officer In-charge of the facility with guidance on

what actions needs to be taken.

• Compiles findings during the visits at the district level and distributes the District Summary Report and

discusses these at the monthly meeting with medical officers. Forward the minutes of the monthly QAC

meeting and actions to be taken to the concerned officials; regional and state QAC.

• Shares the district visit reports with State Committee on monthly basis and initiates actions based on

recommendations from state committee. To address the state level actions, the district has to take the

initiation and pursue the state authorities and follow-up.

• Keeps a record of follow-up and actions taken so that these can be reviewed on subsequent visits to the

facility.

• Ensure empanelment of doctors at district level performing sterilization operations & maintain / update their

databases.

Cont….

ftyk xq.koÙkk ;dhu uksMy vkWfQlj ds dk;Z ,oa ftEesnkfj;k¡ %&

ftyk xq.koÙkk ;dhu lfefr ds cSBd dks flfoy ltZu dh v/;{krk esa izR;sd ekg djokuk( cSBd esa

vLirkyksa ds xq.koÙkk ;dhu ls lacaf/kr fy;s x;s fu.kZ;ksa ls lHkh vLirkyksa ds DS/MOIC dks

voxr djokukA

ftyk xq.koÙkk ;dhu lfefr dh xfrfof/k;ksa ds ;kstukuqlkj lle; fu"iknu lqfuf’pr djokukA blds

vfrfjDr fdlh Hkh izdkj ds QA need based activity dks djokukA

ftyk varxZr lHkh p;fur vLirkyksa ¼ISO, FFHI, bR;kfn½ esa py jgs dk;ksZa dh izxfr dk i;Zos{k.k

fujh{k.k djuk@djokuk rFkk lle; vuqikyu lqfuf’pr djokukA

buds vfrfjDr ftys ds vU; lHkh vLirkyksa (PHC, SDH, RM, DM) esa xq.koÙkk lq/kkj dk;ZØe dks

ykxw djus ds fy, ;kstukc} rjhds ls visioning cum gap analysis exercise djokuk] action plan cuokuk

rFkk mlds vuq:Ik dk;Z djokuk A

vLirkyksa dks FFHI, ISO, bR;kfn izek.khdj.k ds fy, fuf’pr le; lhek ds vanj rS;kj djokukA le;≤ ij

Vhe xBu dj vLirkyksa ds xq.koÙkk izxfr dk ewY;kadu djkukA

xq.koÙkk lq/kkj dk;ZØeksa dh izxfr gsrq jkT; o {ks=h; Lrj ds lkFk liasioning djrs gq,

HkkSfrd ,oa foÙkh; izxfr dks lqfuf’pr djokukA

lHkh vLirkyksa ls izkIr izxfr izfrosnu dks layXu dj ftyk Lrj ds izxfr izfrosnu ds lkFk jkT; dks

rFkk mldh izfrfyfi {ks=h; Lrj ij miyC/k djkukA lkFk gh vLirkyksa ds xq.koÙkk lq/kkj lacaf/kr

QksVks] documentary, testimonial bR;kfn le;≤ ij jkT; dks miyC/k djokukA

jkT; ds }kjk le;≤ ij ekaxh xbZ tkudkfj;ksa ;k funsZ’kks dk lle; vuqikyu djuk@djokukA

ftyk xq.koÙkk ;dhu uksMy vkWfQlj & ftyk dk;ZØe izca/kdA dk;ksZ ds lle; fu"iknu esa DPC Hkh mÙkjnk;h gksaxsA

ftyk xq.koÙkk ;dhu uksMy vkWfQlj ds dk;Z ,oa ftEesnkfj;k¡ %&

ftyk xq.koÙkk ;dhu lfefr ds cSBd dks flfoy ltZu dh v/;{krk esa izR;sd ekg djokuk( cSBd esa

vLirkyksa ds xq.koÙkk ;dhu ls lacaf/kr fy;s x;s fu.kZ;ksa ls lHkh vLirkyksa ds DS/MOIC dks

voxr djokukA

ftyk xq.koÙkk ;dhu lfefr dh xfrfof/k;ksa ds ;kstukuqlkj lle; fu"iknu lqfuf’pr djokukA blds

vfrfjDr fdlh Hkh izdkj ds QA need based activity dks djokukA

ftyk varxZr lHkh p;fur vLirkyksa ¼ISO, FFHI, bR;kfn½ esa py jgs dk;ksZa dh izxfr dk i;Zos{k.k

fujh{k.k djuk@djokuk rFkk lle; vuqikyu lqfuf’pr djokukA

buds vfrfjDr ftys ds vU; lHkh vLirkyksa (PHC, SDH, RM, DM) esa xq.koÙkk lq/kkj dk;ZØe dks

ykxw djus ds fy, ;kstukc} rjhds ls visioning cum gap analysis exercise djokuk] action plan cuokuk

rFkk mlds vuq:Ik dk;Z djokuk A

vLirkyksa dks FFHI, ISO, bR;kfn izek.khdj.k ds fy, fuf’pr le; lhek ds vanj rS;kj djokukA le;≤ ij

Vhe xBu dj vLirkyksa ds xq.koÙkk izxfr dk ewY;kadu djkukA

xq.koÙkk lq/kkj dk;ZØeksa dh izxfr gsrq jkT; o {ks=h; Lrj ds lkFk liasioning djrs gq,

HkkSfrd ,oa foÙkh; izxfr dks lqfuf’pr djokukA

lHkh vLirkyksa ls izkIr izxfr izfrosnu dks layXu dj ftyk Lrj ds izxfr izfrosnu ds lkFk jkT; dks

rFkk mldh izfrfyfi {ks=h; Lrj ij miyC/k djkukA lkFk gh vLirkyksa ds xq.koÙkk lq/kkj lacaf/kr

QksVks] documentary, testimonial bR;kfn le;≤ ij jkT; dks miyC/k djokukA

jkT; ds }kjk le;≤ ij ekaxh xbZ tkudkfj;ksa ;k funsZ’kks dk lle; vuqikyu djuk@djokukA

ftyk xq.koÙkk ;dhu uksMy vkWfQlj & ftyk dk;ZØe izca/kdA dk;ksZ ds lle; fu"iknu esa DPC Hkh mÙkjnk;h gksaxsA

vLirky xq.koÙkk ;dhu uksMy vkWfQlj & vLirky v/kh{kd@izHkkjh fpfdRlk inkf/kdkjhA dk;ksZ ds lle; fu"iknu esa vLirky izca/kd@LokLF; izca/kd Hkh mÙkjnk;h gksaxsA

vLirky xq.koÙkk ;dhu uksMy vkWfQlj ds dk;Z ,oa ftEesnkfj;kW %&

• vLirky Lrj ij ,d xq.koÙkk lq/kkj lfefr dk xBu DS/MOIC dh v/;{krk esa djuk@djokuk ftlesa

vLirky ds inkf/kdkjh@dfeZ;kas (MO/HM/ANM/Nurses/BAM/LT/VI grade Staff representative bR;kfn)

dh Hkh Hkkxhnkjh gksA

• xq.koÙkk lq/kkj lfefr dh cSBd izR;sd ekg djuk@djokuk rFkk fy, x, fu.kZ;ksa ls ftyksa dks

voxr djkukA

• vLirky lq/kkj gsrq xfrfof/k;ksa ds ;kstukuqlkj dk;ksZa dk lle; fu"iknu djuk@djokuk rFkk

vuqikyu izfrosnu layXu izk:Ik esa izR;sd ekg ftyksa dks miyC/k djkukA

• izR;sd =Sekl Gap Analysis Report dh leh{kk djuk rFkk mldks v|ru djuk@djokukA

• vLirky dks FFHI/ISO, bR;kfn ds fy, rS;kj djokukA

HOSPITAL QUALITY IMPROVEMENT &

CERTIFICATION

Approaches for Establishment of QMS in Hospital

PLAN DO

ACT CHECK

Quality service & better

Environment for patient

Visioning, Gap Analysis,Action Plan Development, SOPs, availability of standard documents & guidelines

Implementation,Training/capacity building, Report compilation & timely reporting

Corrective & preventive action; redesigning of plans & system etc

Progress monitoring, review of developed action plan,Lags & lacunas in implementation of affecting final outcome

Quality certificate to hospital

Process of FFHI In Facility Team building -Formation of Hospital Quality

Improvement Group

Visioning Exercise & Problem Bank creation.

Vision statement of health facility / Quality

statement.

Gap analysis

Action Plan Development with Time frame

(Prioritizing the gaps, level at which gaps

would be addressed, resources/FMR source,

responsible person,etc)

Monthly Hospital Quality Improvement Group

and RKS meetings for approval of work and

associate line department.

Implementation of Plan according to activity

plan.

Indicator development.

Monitoring & check.

Apprise District QAC on the processes &

progress.

Once facility is ready it may apply to DQAC for

certification.

Self-Assessmen

t

Gap Analy

sis

Action

Plan

Corrective steps

Follow

up / Monitoring

Meeting by Hospital Quality

Improvement Group

Independent assessment

and certification

RKS

Hospital QI group

District QA Team

Hospital staff

Process of certificationDiagrammatic representation for facility assessment and certification process

State Certification Body

Public Health Facility

District Quality Assurance Committee

(DQAC)

State Quality Assurance Committee

(SQAC)

Check readiness of facility and request for assessment

Fo

rwar

d r

equ

est

to

-co

nd

uct

ass

essm

ent

Check readiness of facility and request for assessment

Regional level Assessment team

(RQAC + any nominated member)

Submit report with recommendation or non-recommendation for certification visit

Submit final reports for -conducting certification visits

Apply for certification

Co

nd

uc

t c

ert

ific

ati

on

Vis

it &

aw

ard

qu

ali

ty c

ert

ific

ate

PHOTO GALLERY- QUALITY ASSURANCE

SDH, Sherghati

PHC, Uchkagaon, Gopalganj

SDH, Danapur

Sadar Hospital, Aurangabad

Quality Poiicy Doctor list

Duty roaster; sitting arrangement at OPD

OT

Thanks.