Presentation is loading. Please wait.

Presentation is loading. Please wait.

Int'l Forum HAS wishes you a warm welcome to Paris On the occasion of the International Forum on Quality and Safety in Healthcare.

Similar presentations


Presentation on theme: "Int'l Forum HAS wishes you a warm welcome to Paris On the occasion of the International Forum on Quality and Safety in Healthcare."— Presentation transcript:

1 Int'l Forum HAS wishes you a warm welcome to Paris On the occasion of the International Forum on Quality and Safety in Healthcare

2 2 Int'l Forum Welcome to the International Forum on Quality and Safety in Healthcare HTA Drugs Devices Procedures Guidelines Good practice Patient safety Public health Actions Accreditation HCOs Continuing Professional Development Certification of information Chronic diseases management HAS (Haute Autorité de Santé) Ensuring High-Quality Healthcare for All

3 Int'l Forum Plenary 1: Introduced by: Laurent Degos, HAS Fiona Godlee, BMJ Speaker: Donald M Berwick, President and Chief Executive Officer, Institute for Health Care Improvement

4 Troubles on a Hook: Global Health and Continual Improvement Donald M. Berwick, MD, MPP, FRCP President and CEO Institute for Healthcare Improvement Keynote Address International Forum on Quality and Safety in Health Care Paris, France: April 23, 2008

5 Millennium Development Goals 1.Eradicate extreme poverty and hunger. 2.Achieve universal primary education. 3.Promote gender equality. 4.Reduce child mortality. 5.Improve maternal health. 6.Combat HIV/AIDS, malaria, and other diseases. 7.Ensure environmental sustainability. 8.Develop a global partnership for development. 5

6 MDG Progress Extreme poverty: 1/3 in 1990 to 1/5 in 2004. Extreme poverty in Sub-Saharan Africa: 47% to 41%. Children in primary education: 80% to 88%. More women in parliaments. Under-five mortality in developing countries: 10.6% in 1990 to 8.3% in 2005. Measles deaths in children down by 60% between 1999 and 2005 (873,000 to 345,000). Measles deaths in Africa down by 75% between 2000 and 2005 (506,000 to 126,000). Tuberculosis per 100,000 down from 321 in 2000 to 255 in 2005. 6

7 Progress toward MDG #4 7

8 MDG Gap At current rates of progress, sub-Saharan Africa will not hit its 2015 MDG target for mortality reduction until 2115… ONE CENTURY LATE! 41 million more children will die between now and 2015. 8

9 Support Staff & Faculty United States Andrew Billi Stacey Downey Meredith Kimball Nicholas Leydon Barbara Tobin Joe McCannon Helen Smits 9

10 W. Edwards Deming Trying harder is the worst plan. 10

11 Paul Batalden Every system is perfectly designed to achieve exactly the results it gets. 11

12 System A collection of elements interacting to achieve a common aim. (Interdependency is inescapable.) 12

13 Four Theories of Improvement 1.Just Set the Goals. 2.Create Better Markets. 3.Add Resources to the Current System. 4.Redesign the System for Better Performance. 13

14 Mamphela Ramphele It is the poorest people on earth who can least afford poor quality. 14

15 Bwaila Hospital – Lilongwe, Malawi 15

16 IHI-Supported Sites in Malawi Salima Lilongwe Kasungu 16

17 Causes of Maternal Deaths Countdown to 2015 Core Group. Countdown to 2015 for maternal, newborn, and child survival: The 2008 report on tracking coverage of interventions. Lancet 2008;371:1247-58. 17

18 Reducing Maternal & Neonatal Mortality MALAWI Florence Bwanali Fannie Kachale Uma Kotagal Roger LeCompte Marco Linden Bejoy Nambiar Olive Sambani Eric Tsetekani Karen Zeribi Agnes Makonda-Ridley Charles Makwenda Violet Manjanja Gibson Masache Barbara Nagy 18

19 Likuni Hospital, Malawi 19

20 Likuni Hospital, Malawi 20

21 Nkhoma Hospital Infant Mortality 21

22 to ensure the primary health care-based component of the PMTCT programme (as defined by current local policy) is executed at 95% reliability by 1 st Sept. 2008 95% all pregnant mothers presenting at PHC for 1 st ANC visit are tested for HIV 100% all pregnant mothers with CD4 counts <250 or WHO Stage 4 are referred to & arrive at ARV site for initiation on ARVs within 2 weeks of clinic getting test results/staging >95% all HIV+ ANC clients take PMCTC drugs as indicated prior to or during labour (currently stat. dose Nevirapine (NVP) or HAART) 100% all babies born to HIV+ mothers receive PMTCT drugs as indicated (currently stat. dose Nevirapine within 72 hrs of birth) 95% all HIV+ mothers make feeding choice that presents the lowest risk of serious illness/ death of their child and that they can consistently maintain 95% all babies born to HIV+ mothers or those whose status is unknown receive a PCR test at 6 weeks involvement of all PHC staff in VCT awareness; health education on programme and benefits delivered in waiting room provide transportation; providing escorts; follow up with clinic fast-tracking of ANC patients at ARV site reliable means of communicating mothers HIV status to other health care facilities without it being explicitly stated educate mothers about need to bring in their babies to the clinic within 72 hours of giving birth at home; ensure reliable means of communicating mothers HIV status to other health care facilities use risk assessment tool as part of counsellors script and recording of feeding choice; support groups for HIV+ mothers (e.g. m-2-m) encourage transfer of PMTCT mothers onto pre-ART registers; do routinely at one of immunisation sessions dry blood spot tests introduced; health education to encourage mothers to have babies (and siblings) tested; linking PCRs to first immunisation visit early issuing of NVP 95% all HIV+ mothers with CD4 >250 during pregnancy receive further test within 6 months 22

23 Model for Improvement (Ref: Associates in Process Improvement) ActPlan StudyDo What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? 23

24 24

25 Life Expectancy and AIDS 25

26 Increasing Access to HIV/AIDS Treatment & Care SOUTH AFRICA Pierre Barker Brandon Bennett Cathy Green Wendy Mphatswe Kimesh Naidoo Patty Webster 26

27 27

28 Before and after Initiation of Antiretroviral Therapy 28

29 Before and after Initiation of Antiretroviral Therapy 29

30 PROBLEM: HIV+ Patients not getting CD4 counts Clinic Design Prompts and Care PathsPatient and Family Input No formal way to track Poor record keeping/ history taking Staff lack knowledge and skills Fishbone Diagram No time to stay Feel fine now / misconceptions Long queue / waiting time No supplies available Lack of available staff Denial/attitude Protocol not understood Data Systems 30

31 Mother attends ANC- 1 st visit HIV test pos CD4 test CD4 <200 CD4 >200 Start ART Nevirapine to mother and infant HIV test Potential botlenecks or failures Sample Process Map: PMTCT 31

32 Mhlontlo Subdistrict Progressive Engagement of Primary Care Clinics in Comprehensive HIV/AIDS Care 32

33 Mhlontlo Subdistrict Cumulative ART Initiations in Mhlontlo Sub-District Total No. of Patients Started on ARVs 33

34 Mhlontlo – Resources Matter 34

35 South Africa 35

36 Umkhanyakude District KwaZulu-Natal 36

37 Inner City Johannesburg Project 37

38 Inner City Johannesburg 38

39 Western Cape – Helderberg and Eertse River 39

40 Ghana 40

41 Ghana 41

42 Causes of Deaths under Five Years Countdown to 2015 Core Group. Countdown to 2015 for maternal, newborn, and child survival: The 2008 report on tracking coverage of interventions. Lancet 2008;371:1247-58. 42

43 Saving Lives Under Five Ghana George Dabuo Cleytus Dakura Gilbert Buckle Nii Coleman Enoch Osafo Lloyd Provost Nana Twum-Danso 43

44 Reducing Under-Five Mortality Countdown to 2015 Core Group. Countdown to 2015 for maternal, newborn, and child survival: The 2008 report on tracking coverage of interventions. Lancet 2008;371:1247-58. 44

45 Wave 4: 42 – 60 months Wave 3: 30 – 42 months Wave 2: 12 – 30 months Wave 1: 0 – 12 months Sequential Scale up of Improvement in Ghana

46 Challenges for Improvement in Developing Nations Logistics – Travel, Communications, Infrastructure Information Systems Data Quality Habits of Hierarchy Misaligned Policies Thin Staffing and No Slack Workforce Training in Improvement Skills Despair 46

47 My Hopes Hit the goal of 0.7% of GDP for development assistance. Link new resources to new designs. Involve the workforce in redesign. Incorporate improvement skills into all workforce development. Foster formats, systems, and sponsors to share freely new models and lessons learned. 47

48 A Dream… A Learning World for Global Health and Development 48


Download ppt "Int'l Forum HAS wishes you a warm welcome to Paris On the occasion of the International Forum on Quality and Safety in Healthcare."

Similar presentations


Ads by Google