QUALITY ASSURANCE IN PRIMARY HEALTH CARE ASIF IMAM, M.D. MARCH, 2011 SINA HEALTH EDUCATION AND WELFARE TRUST

THE ORIGINS OF SINA HEALTHCARE SYSTEMS STARTED AS A PROTOTYPE PRIMARY HEALTH FACILITY IN BALDIA TOWN, KARACHI IN 1998 OBJECTIVES : To evaluate the existing primary healthcare systems in Pakistan To develop an indigenous, practical, evidence-based, quality-managed, auditable primary healthcare system for developing countries

Vision Quality primary healthcare should be accessible to everyone in our society Increase font size SINA HEALTH EDUCATION AND WELFARE TRUST

Our quality mission TO DEVELOP A STANDARDIZED, QUALITY-MANAGED, INDIGENOUSLY COMPATABLE PRIMARY HEALTHCARE SYSTEM FOR WIDESPREAD APPLICATION IN PAKISTAN SINA HEALTH EDUCATION AND WELFARE TRUST

SINA Healthcare System And Quality Assurance SINA HEALTH EDUCATION AND WELFARE TRUST

DEVELOPMENT OF QUALITY MANAGEMENT COMPONENTS STANDARD OPERATING PROCEDURES QUALITY MANAGEMENT DOCUMENTS AND PROCEDURES TRAINING OF STAFF IN THE STANDARDIZED SYSTEM QUALITY AUDITING PROCEDURES AND TOOLS REMEDIAL AND REPRIMANDING POLICIES ON AUDIT RESULTS

SINA HEALTHCARE QUALITY-MANAGEMENT COMPONENTS DOCTOR TO PATIENT HEALTHCARE DELIVERY QUALITY PARAMEDIC TO PATIENT HEALTHCARE DELIVERY QUALITY PHARMACY TO PATIENT SERVICE QUALITY LABORATORY SERVICES QUALITY INFECTIOUS DISEASE CONTROL / FACILITY HYGIENE QUALITY MEDICAL INSTRUMENTS CALIBERATION / MAINTENANCE FACILITY ADMINISTRATION / PATIENT SATISFACTION QUALITY

Recordkeeping System: Registration Card Patient Files SINA HEALTH EDUCATION AND WELFARE TRUST

DOCTOR TO PATIENT HEALTHCARE DELIVERY QUALITY DOCTOR RECRUITMENT CRITERIA PRE-EMPLOYMENT ( INDUCTION) SYSTEM TRAINING DOCUMENTING OF PATIENT CARE ON QUALITY MONITORING TOOLS AUDIT OF DOCUMENTED PATIENT HEALTHCARE ON-GOING ON JOB RE-TRAINING (CME) REMEDIAL MEASURES OR REPRIMAND ON QUALITY AUDIT RESULTS

Employment System: Doctors Selection Criteria: Family Medicine experience FCPS / MRCGP, prefered Entrance Test Pre-employment ( Induction) Training To be system trained before doing clinics SINA HEALTH EDUCATION AND WELFARE TRUST

Candidate Evaluation Form

SINA CME SINA HEALTH EDUCATION AND WELFARE TRUST

Half yearly 1-to-1 review Feedback on MCQ and SMS performance Monthly audit and 1-to1 teaching CME SMS Service X3/ week CME Half yearly 1-to-1 review and PDP development Monthly ½ day group teaching Pre-reading materials Learner-led sections Pre and post Session MCQs

Patient Registration Cards 14 Algorithmic Protocols Recordkeeping System Patient Files Patient Registration Cards 14 Algorithmic Protocols Compromise On Quality SINA HEALTH EDUCATION AND WELFARE TRUST

FEVER PROTOCOL Don’t get too carried away by the wizzy graphics – if you use too many types of movement of the text people start focusing on what’s going to happen next rather than the content of the slides themselves

SINA Audit System SINA HEALTH EDUCATION AND WELFARE TRUST

Monthly Doctors’ Audit: Protocol based audits Clinic based audits Proper one to one feedback to every doctor Review for improvement every month Proper record keeping Font size/line spacing SINA HEALTH EDUCATION AND WELFARE TRUST

Protocol Based Audit

Clinic Based Audit

Half Yearly Evaluation Of Doctors Every six months Record of the last 6 months performance One to one feedback Discuss about the weaknesses and solutions for improvement Personal development planning forms SINA HEALTH EDUCATION AND WELFARE TRUST

Half Yearly Evaluation Form

PDP form

SINA Paramedics Evaluation SINA HEALTH EDUCATION AND WELFARE TRUST

SINA Health Manpower Training Program : Internal Lack of quality human resource Training upon employment Continuous education Periodic exams & evaluation Performance feedback

SINA Paramedics OSCE SINA HEALTH EDUCATION AND WELFARE TRUST

OSCE CHECKLIST

TPR Station:

Dressing station:

Dispensing station:

SINA Pharmacy System SINA HEALTH EDUCATION AND WELFARE TRUST

SINA Pharmacy Services Standard Formulary GMP Certified Medicines Central Purchasing FIFO Inventory Control Hygienic Practices Trained Staff Quality Control SINA HEALTH EDUCATION AND WELFARE TRUST

SINA Laboratory Services SINA HEALTH EDUCATION AND WELFARE TRUST

LABORATORY QUALITY CONTROL Internal Assessment Continuous quality improvement External Assessment Monthly comparative testing with AKUH lab Adherence to SOP manuals Quarterly audits

SINA Infrastructure Maintenance SINA HEALTH EDUCATION AND WELFARE TRUST

Medical Centre Audit: Monthly audit by head office staff Follow proper checklist All registers and written documentations are checked Medical equipments checking Corrective actions taken SINA HEALTH EDUCATION AND WELFARE TRUST

MEDICAL CENTRE AUDIT CHECKLIST

SINA Infectious Disease Control System SINA HEALTH EDUCATION AND WELFARE TRUST

Standard Operating Procedures Instrument Sterilization  Clean the dirty instruments with cotton swabs. Wash with tap water. Dip the instruments in antiseptic solution for 5-10 min. Wrap the instrument in cotton and keep in the instrument tray Keep the tray in sterilizer at 150 F for 20 min.   SINA HEALTH EDUCATION AND WELFARE TRUST

Clinical Waste Segregation SINA Waste Management Service Clinical Waste Segregation Red Bags Hazardous Waste Danger Box Sharps & Needles Green Bags General Waste SINA HEALTH EDUCATION AND WELFARE TRUST

SINA Waste Management Service 78 km twice a week BALDIACLINIC MACHAAR CLINIC CDGK INCINERATOR SABZIMANDI CLINIC HIJRAT CLINIC SINA HEALTH EDUCATION AND WELFARE TRUST

SINA Management System SINA HEALTH EDUCATION AND WELFARE TRUST

SINA Management System Monthly Meeting of Clinical Coordinator and Clinic Manager Solutions Provided To Clinic Manager Minutes By Clinic Managers Clinical Coordinator Trustees and Operation Manager SINA HEALTH EDUCATION AND WELFARE TRUST

Thankyou For Listening Just ‘thank you for listening’ is enough I think SINA HEALTH EDUCATION AND WELFARE TRUST