quality in health care delivery vikram anand hosmac india pvt.ltd
Post on 21-Dec-2015
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QUALITY IN HEALTH CARE DELIVERY
VIKRAM ANAND
HOSMAC INDIA PVT.LTD
Contents :Quality in Health Care Delivery
Quality in Health Care Sector-Key Principles Infrastructure for Quality Assurance in Health
Care Decision Making in Health Care Improvement Audit –Key Tool in Q.A Conclusion
Quality in Health Care Sector :
Key Principles
HEALTH CARE
The system that a Nation has built up and continuously maintains in order to combat (unnecessary) Death,Disease,Disability,Dissatisfaction and (social) Disruption
A collection of curative,preventive,rehabilitative and promotive services
Health care is a social and economical endeavor encompassing activities by providers,consumers,financiers and government within their respective value systems
What’s wrong in today’s Health Care?
Avoidable errors Underutilization of services Overuse of services Variation in services Communication problems Lack of Evidence Dissatisfied clients
What can we do about it?
Do nothing Better education and training Policing,Inspection,Punishment Change,Improve,Reward Comprehensive Approach:Quality Assurance
Definition of Quality
Why define quality of care? Reach consensus among employees Avoid confusion and in-house fighting Allow for sound evaluation Allow consumers to make a choice
From the beginning there was
chaos quality assessment quality assurance quality improvement continuous quality improvement Information technology values
Quality :Terminology
Quality Assurance: the overall philosophy on Quality and its Assurance
Total Quality Management:one of the newest organizational and managerial approaches to Quality Assurance in the (not) for profit industry
Continuous Quality Improvement:an important organizational and managerial mechanism for quality assurance in the health sector
Continuous Quality Improvement
Important elements: External and internal customer satisfaction Management leadership Involves all personnel Uses statistical methods Focuses on improvements
Definition of healthcare quality
Quality is working according to specifications Quality is providing effective services with a
minimum of unnecessary use of resources Quality is to satisfy customers
The Core Principles
The essentials are: Assuring(I.e assessing and improving) quality
is the responsibility of the provider Quality assurance is an evaluation and
improvement process Of all the necessary
attributes(knowledge,skills,attitudes,values) values and attitudes are the most important
TOTAL QUALITY
The end point of a development in phases: Focus on professional quality Focus on client satisfaction Focus on system effectiveness Focus on interconnections Organizational and societal unification
Why improve my quality
Because I know it is needed because I am told to do so because I must survive Because I need to follow the rules
Today’s choice:SURVIVAL
Mission Statement
Rationale:programmeRationale:programme SURVIVAL
My programme is dedicated to Provide high-quality service to the members of
the community Employ well-trained professionals Maintain a high safety record Provide a customer –friendly environment
Plan high –quality services
Identify priorities,goals and customers Set up working groups Describe service according to:
-consumer and client needs
- structure,process,outcome Make plans for evaluation
Quality Planning
Establish Quality project: goals and team Identify customers Determine client needs Design services to be provided Design delivery process Determine information need Use and evaluate
Train professionals
Select key professionals Design appropriate training Organize continuous training sessions Evaluate results of training including
satisfaction Reward participants Repeat training regularly
Evaluation
Includes assessment and improvement Orientation:what are the possibilities? Selection:What is most appropriate? Implement: who is doing what? Collect and discuss the results Disseminate the results inside and outside Prepare for the next round
Improvement of care
Focus:Structure,Process and Outcome Structure:better equipment Process:doing the right things better! Outcome:obtain better results in
- effective services
-costs
- client and employee satisfaction
Improvement of structure
Includes building,equipment,personnel,manuals,
information systems,rules and regulations Includes new provisions,and updating and
refurbishing of old provisions Need to include recording of inputs and costs
Improvement of Process
Principle:Doing the right things better! Doing the right things more effective! Doing the right things more efficient!
Includes: Appropriate use of technology Appropriate use of personnel Client/provider relationship
Improvement of outcome
Focus: Programme effectiveness Programme efficiency Consumer and employee satisfaction Consumer and employee education Building and technology safety Community relations Information and communication needs
Tools for Improvement
Motivation Insight Evaluation methods Communication tools Dedicated personnel Dedicated Management Money
That implies:
Quality improvement is essential for survival
Customer satisfaction is important for survival
Monetary support will come only after well-executed quality assurance studies
Infrastructure for Quality
Assurance in Health Care
Quality Assurance Universe – Big including small
Small
Concepts
Methods Application Effectiveness Efficiency Criteria for good care Improvement activities
Big•Patients•Providers•Organization•Technology•Information•Costs•Risks•Innovation
Infrastructural Needs
Assessment of actual situation: Structural analysis Rapid need assessment SWOT analysis Programme evaluation Part of certification
Essentials
A Policy Document for Quality Assurance
A Blue Print for Quality Assurance
Quality Assurance Policy Document
Directed to Quality Assurance,not to quality
Based on National Needs for Improvement of health services
Items:definitions,principles,locus,focus,actors,
costs,strategies
Contd…..
Size:less than 32 pages Production Time: less than 9 months Easy to understand ,no jargon Support by main parties(participants) Distributed widely Updated once in five years
Listing the Infrastructure
The Body The Engine The Petrol Assembly line and Maintenance The Route Map The Driver
And then ……On the road!
The Engine
Policies Planning Mechanisms Implementation strategies Organization Resources Knowledge,skills,attitudes Value systems
The Body
The system for quality assurance Information systems Conformity between healthcare system and QA
system
The Driver
Roles and Functions Education and Training License Rewards Remuneration Accountability Value Systems
The Petrol
Epidemiology of Health and disease Epidemiology of quality(ABNA) Willingness to evaluate/be evaluated Willingness to Change and Improve Legislation Value Systems
Epidemiology of Quality
Rumours and Hearsay Surveys:Opinions,Dissatisfaction Registration of Facts:Incidents Registration of Facts: Trends ABNA:Achievable Benefit Not Achieved
Maintenance
Support mechanisms Research and Development Internal Quality Assurance System Value Systems
Assembling Quality Assurance
A Laboratory (be in control) Real Life situations(hope the best) Value Systems
Whatever you do , you still need a Manual and a Road Map!
Decision Making in Healthcare
Improvement
Key Concerns:
To find the decision makers:
Who decides about quality?
Who decides about quality improvement? To identify the client in health care quality
improvement
Roles and Functions in Decision making in Quality Improvement
The Consumers
The Professionals
The Managers
The Government,Policy Makers
The Seven Roles of the Consumer
Definers of Quality Evaluators of Quality Informants of Care Co-producers of care Targets of Quality Assurance Controllers of Practitioner Behavior Reformers of Health Services
The Seven Roles of the Provider
To be accountable To provide quality care(plan,implement) To safeguard the quality of care services To be evaluated by colleagues To evaluate his colleagues To continue learning To collaborate with colleagues and
management
Seven Roles and Functions of Management
Do their job(Quality Management) Exert leadership Participate in Quality Management Communicate on Quality matters Be accountable re: quality Evaluation of Quality Management Provide resources
Role of Government
Still open: Active role with responsibilities Support role with limited responsibilities No role at all
AUDIT
Key Tool for QA Implementation
History of Audit
Global Development: Until 1980s : the only mechanism available since 1985: superseded by CQI Since 1995: rebirth of audit as tool for professionals in
CQI programmes
Historical definition: audit is retrospective review of medical care as laid down in the medical record
Audit: a modern definition
Is a criterion –referenced review of health care delivery to establish quality followed by, if necessary, specific activities to improve care delivery
The method is used by professionals to assess and, if needed, improve the quality of their work
Audit :Applied with little more discipline
Practical Solutions: Focusing on relevant health care delivery Focusing on multidisciplinary professional work Retrospective and concurrent in orientation Focus on assessment and improvement Based on reliable and valid data Not more time consuming than others
Audits’ Building Stones
A well selected topic A limited number of relevant criteria Well selected reliable and valid data A functioning judgment procedure A will to change when needed Relevant changes leading to improvements
What are benefits in health care?
Improvement in health status Increase in satisfaction Elimination of impairment Elimination of disability Elimination of risks Elimination of malfunctioning
all due to present health care
What is ABNA?
ABNA
Maximum conceivable benefit
Achievable benefit Benefit not achievable
Achievable benefit achieved Achievable benefit not achieved
Errors of commission Errors of omission
Well –chosen priorities
Priorities for Quality Improvement: Are formulated in a clear <problem> mode Identify targets with high ABNA Identify all players in the field including patients Provide insight into attainable improvements Put the responsibility for quality improvement
where it should be
Conclusion
We should: Focus on generalities,later on specifics!
Focus on gaps and weaknesses!
Each country gets the quality assurance
system it deserves!
Thank You