1. Case Example Management for Quality Services Dr. ENKHTUR Shonkhuuz Director General of the N.Gendenjamts’s Memorial National Center for Maternal and Child Health

2. 2 Policy and planning Department of Quality Assurance of Medical Aid and Service (DQAMAS):  Control quality of health care and patient safety  Prevention and reducing risk  Consultation and professional advices  Recommendation DQAMAS follows quality assurance rules and regulations.  5 full - time quality managers and a reference staff  41 quality teams (at every department and unit)  Each team has 3 – 5 members Quality assurance Current Situation

3. 3 Policy and planning 1. Implementation of the diagnostic and treatment protocols, standards, guidelines.  297 MNS standards  475 guidelines and 120 common activity protocols  255 original MNS standards are situated to the internal web site of the hospital 2. Internal control (everyday).  Respectful and effective communication  Giving friendly advice to correct mistakes and errors  Discussion and talking in micro groups 3. External control from Professional Inspection Agency Quality assurance Current Situation

4. 4 Policy and planning 3. Conducting quality research and analysis. Example 1: 109 cases of misdiagnosis. Period of 2008 – 2012.  As a result of retrospective analysis most common reasons were lack of doctor’s knowledge in differential diagnosis and inconsistent peer and senior doctors’ review. Example 2: Newborn death cases within 24 hours of hospital admission in 2013.  Delivery hospitals need to improve diagnostic capacity of fetus defect and management of complicated delivery, neonatal resuscitation in delivery rooms.  District general hospitals need to have experienced pediatric surgeons, reduce numbers of repeated surgical intervention. Quality assurance Main activities and tools

5. 5 Policy and planning 4. Review of medical records and charts.  Periodic, planned, and case-based  All death cases, ICU and intra-surgical mortality cases, deaths within 24 hours of hospital admission 5. Registration of medical errors and mistakes.  Doesn’t include the name of health care providers  Do not aim to blame  Inform on their own  Use collected information to prevent make similar mistakes or “Learning by someone’s mistakes” Quality assurance Main activities and tools

6. 6 Policy and planning 6. Registration of good information.  Collecting good information, good idea and the best experiences  Distributing to others  In 2013 there were registered 81 good information 7. Discussion.  Team meeting, department discussion, hospital wide conference  In case of a serious error, complicated and/or rare cases it is debated in a very detailed way  Evidence-based theoretical information Quality assurance Main activities and tools

7. 7 Policy and planning 8. Peer review checkup  Good way of quality control at every level of hospital hierarchy 9. Conducting customer’s satisfaction surveys  DQAMAS, hospital administration and HR, government agency, NGOs  Not only external but also internal customer’s satisfaction!  Each department and unit has request notebook, request box, online  Approved questionnaire  Planned, periodic Quality assurance Main activities and tools

8. 8 Policy and planning Improving not only external but also internal customer's satisfaction, reducing customer’s complaints Reducing risk of health care Reducing hospital waiting list and time Building a patient and family centered hospital environment Quality assurance Challenges

9. 9 Policy and planning 1.Middle (until 2016) and long-term (until 2020, 2024) strategic development plan 2.Building a high performance medical organization (HPMO) 3.Meeting criteria of the JCI and creating a family – centered environment Quality assurance Future Plans

10. 10 Policy and planning Key messages Quality assurance is a daily activity by everyone. Ensure top level management support and commitment. To ensure that risk management will be embedded in the culture of the health program, all stakeholders should be ready to learn and evolve as they go through the process.

11. Thank you for your attention Монгол улс, 16060 Улаанбаатар, Баянгол дүүрэг, 11-р хороо, Хувьсгалчдын гудамж, Эх Хүүхдийн Эрүүл Мэндийн Үндэсний Төв Утас: 362633, 362205 Факс: 976-11-362633 E-mail: ehemut@moh.mnehemut@moh.mn Вэб сайт: www.ehemut.mnwww.ehemut.mn