1. How Can We Improve Quality of Care? Dr Bounthanh Family Medicine CME Conference, Champasack Provincial Hospital, Pakse October 2012

2. Case Study 1 A doctor at the District Hospital heard that there were several children in school who had been sick for about a week. The mothers said the children had stopped eating and drinking and were very tired. The doctor examined one of the children and noticed that the child was jaundiced.

3. The doctor learned from the teachers that children are often missing school. When they came to school they seem tired. They do not run and play actively, and they do not seem interested in the lessons.

4. Should the doctor ask the parents to let him examine these children even if they did not come to the hospital? In what ways can the doctor evaluate the health of these children? How could the doctor develop a plan to treat the children if he finds some health problems?

5. The doctor noticed that the school had no place for children to wash their hands. He also noticed that they did not use the latrine. Most of them were not drinking safe water. Are these problems that the Family Doctor should try to improve in the school, or should he wait till patients come to the hospital or health center?

6. How can a doctor at the District Hospital begin to improve these problems for an entire community? ▫Education of teachers and families – what aspects? ▫Funding for latrines or clean water – how to discuss and find funds

7. When should the Provincial Health Office be notified of community health problems? Should the doctor manage things differently if he suspects an ongoing problem or an acute epidemic?

8. Case Study 2 The doctor knows that 2 women have died at the hospital in the last month on the maternity ward. He had provided care of one of these patients. One woman died of sepsis following a Caesarean section and one woman died of post- partum hemorrhage.

9. What should the doctor do with this information? a)Not discuss it with anyone b)Discuss it with the hospital director c)Discuss it with the provincial health officer d)Discuss it with other doctors at the hospital e)Discuss it with nurses on the maternity ward

10. Should hospital staff try to identify the reasons why these two women died? If yes… Who should do this? How should this be done? How can this information be useful in trying to prevent such deaths in the future?

11. What is the responsibility of the Family Medicine doctor in trying to improve the quality of care given to his patients or other patients on the maternity ward?

12. How can the doctor have discussions to improve quality of care without making hospital staff feel like they are being judged or severely criticized?