1. Mongolia Sub-national situation of patient safety D. Doljin, Director, Regional Diagnostic and Treatment Center for Eastern provinces (Dornod, Sukhbaatar and Khentii provinces)

2. Policies to improve patient safety There have been a number of significant policies contributing to quality improvement activities at the local level including: Health Law revised in 2011 Ministerial Orders establishing quality managers in hospitals and defining the work of quality committees – Development of standards for aimag and soum hospitals to guide accreditation processes, 2001 – The program to strengthen the quality management of care services, 2008 – Health Minister’s Order on “Strengthening the internal monitoring of the quality management of medical care delivery and services”, 2010

3. National initiatives to improve patient safety National initiative to improve Supply of Donation and Blood Products – Guideline Safety for Blood Products (Health Minister’s Order #, dated 2010) – WHO surgical safety checklist – introduced in all hospitals – The World Health Organization (WHO) initiative in the selected hospitals to improve hand hygiene practice among health workers in health care facilities 2007- 2008 – Guidelines to strengthen infection control system developed and implemented

4. Initiatives at the Sub-national Regional Hospital WHO surgical safety checklist initiative become a regular practice Quality agent consists of 3 personnel – head of the agent, quality manager, coordinator that manages waiting time of patients (responsible for internal audit) Every department of hospital has quality team Appointment time – appointment can be made 1 month prior to physical examination to reduce unnecessary waiting time Physical examination by one physician lasts 15-20 minutes on average

5. Initiatives at the Sub-national Regional Hospital (2) Welcoming and goodbye services introduced for admission and discharge from hospitals 8 services to ensure patient satisfaction introduced (guidelines approved and implemented since 2013) 1. Welcoming/Greeting 2. Guide to services 3. Physical examination 4. Diagnosis 5. Counseling 6. Treatment 7. Provide services like patient is staying in hotel 8. Goodbye services at the discharge from hospital Patient satisfaction survey at the discharge

6. Activities on Human Factors and Team Training to improve patient safety: Team training of doctors, nurses and general service staff on improving skills and quality assurance once a week (between 8-9 am every Tuesday) Team building exercises to ensure team work (injury and accident team, surgical team and rehabilitation team and etc.) Short-term training of staff in abroad to improve their skills on specialty-related subjects Training of staff on communication and attitude skills

7. Challenges to improve patient safety in Regional Hospital Unhealthy behavior of people Lack of responsibility of individuals and rely on health services Do not follow up recommendations prescribed by doctors Confident for self-treatment (uncontrolled and irrational use of drugs) Health budget allocated to hospitals is limited

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