1. Quality Assurance Orientation Program Quality Assurance Cell, State Health Society, Bihar Quality Assurance Cell, State Health Society, Bihar

2. Quality Ability of service to satisfy the needs & expectation of users & to meet the purpose for which it is designed. Appraisal of healthcare facility & services in terms of – core healthcare services. safety & hygiene. comfortable atmosphere. facilitation when a healthcare seeker visits. Ambience.

3. Perception of Quality Quality may mean different things to different people. For poor people - Quality in health services means accessibility and availability of services when in need at minimum cost. For services provider - Quality means timely availability of services with minimum infection rate. For community as whole- Quality means availability, accessibility, affordability with positive impact in the environment. For state - Quality means ensuring health care services which is based on the concept of equity, which makes services available, accessible, affordable, and high level of infection control.

4. Quality Management System It is an approach which encourages health facilities to analyze the requirement of service user, define the processes and keep the processes under control for consistency. Identify the gaps in service delivery, trace its root causes & then suggests solution to close this gaps so that its effect is sustainable. Corrective & preventive measures - Regular review of actions taken & result so that the problem doesn’t occurs again & again, it plans & implement system so that whenever gap emerges it gets resolve at the point of emergence.

5. ANY SUSTAINABLE CHANGE IN TERMS OF INSTITUTIONALISATION OF QUALITY ASSURANCE (QA) WILL COME FROM WITHIN THE SYSTEM & NOT FROM OUTSIDE. “ITS WE WHO CAN IMPROVE THE QUALITY TO OUR SYSTEM”

6. Why is quality needed in healthcare system Quality in healthcare is not a matter of choice, it is mandatory, as it can cost life. Benefit users by ensuring quality of service provision. Ensure efficient utilization of resources. Provide for transparency and accountability in the functioning of the healthcare system. Generate a sense of pride and achievement for the health care providers.

7. Quality: Is a continuous process that has to be sustained for continual improvement.

8. State’s focus Area in Quality Assurance Formation, orientation & regular (monthly) meetings of QA committee. (For FY 2012-13 FMR code :- B.15.2) Hospital level quality improvement as per standards. (For FY 2012-13 FMR code :- B.15.2+ RKS, Hospital maintenance grant,untied fund, MCH/FP funds,etc.) Quality certification of hospitals Qualitative operationalization of Facility Based Newborn Care Units (NBCC/NBSU/SCNU) {For FY 2012-13 FMR code :- A.2.2.2}; labour rooms,, Family Planning Corner (FP Corner) Death review – Especially maternal deaths

9. QUALITY ASSURANCE COMMITEE -COMPOSITION, ROLES & RESPONSIBILITIES

10. Formation & strengthening of Quality Assurance Committees State Quality Assurance Committee (Chairperson - Principle secretary – Health, Co- chairperson – Executive Director, SHSB) Regional Quality Assurance Committee (Chairperson – Regional Deputy Director) District Quality Assurance Committee (Chairperson – Civil Surgeon) Facility level Quality Improvement Group State Quality Assurance Cell:- 1.QA Nodal Officer 2.Consultant –MCH – QA 3.Consultant –FP – QA 4.Quality Assurance Manager Nodal Person - Regional Program Manager. Supported by R (M&E) Nodal Person - District Program Manager. Supported by DPC Nodal Person - Dy. Superintendent /MOIC. Supported by Hospital Manager / Health Manager

11. Regional Quality Assurance Committee Functions of RQAC :- Monitoring of health facilities & guiding the District level teams on development of processing for ensuring quality health care services from that facility. Ensuring adherence of treatment protocols on public health management and to ensure delivery of quality health care services focusing more on the medical colleges, district Hospital and FRUs. Planning, controlling, management of the medical staff, demography and bio-statistic, management of research in health care, epidemiology and community health and strategic management. Ensuring proper functioning of the Hospital Management information system and will also ensures and monitor the maintenance of the medical records, as prescribed. Management of health and related services within the medical colleges/hospital premises to achieve optimal care by providing staff with managerial leadership, experts advice and opinion to aid diagnosis, management and treatment of patients To provide quality of care through the monitoring and evaluation of services, development of protocols, supervision of staff and continuing education Review the cases of maternal & infant deaths and report from cases of adverse outcomes/complications in maternal, neonatal health & child health. To provide technical inputs to the medical colleges/District Hospital/FRUs within the division for improving their functioning.

12. {ks=h; xq.koÙkk ;dhu uksMy vkWfQlj ds dk;Z,oa ftEesnkfj;kW %& fu;fer RQAC dk cSBd le; ls lqfuf’pr djuk@djokukA cSBd dh dk;Zokgh lss izeaMy ds lHkh ftyksa vkSj jkT; LokLF; lfefr dks voxr djuk@djokukA {ks=h; xq.koÙkk ;dhu lfefr dh xfrfof/k;k¡ ;kstuk ds vuqlkj lle; fu"iknu djuk@djokukA blds vfrfjDr fdlh Hkh izdkj ds QA need based activity dks djokukA ftyk xq.koÙkk ;dhu lfefr (DQAC) dh ekfld cSBd fu;fer djokus gsrq vko’;d dne mBkukA ftyk xq.koÙkk ;dhu lfefr (DQAC) dks vko’;drkuqlkj rduhdh lg;ksx iznku djukA izeaMy varxZr lHkh ftyksa esa py jgs xq.koÙkk ;dhu dk;ZØeksa dh izxfr dk i;Zos{k.k fujh{k.k djuk@djokuk rFkk lle; vuqikyu lqfuf’pr djokukA vLirkyksa dks FFHI, ISO, bR;kfn izek.khdj.k ds fy, fuf’pr le; lhek ds vanj rS;kj djokukA xq.koÙkk lq/kkj dk;ZØeksa dh izxfr gsrq jkT; o ftyk Lrj ds lkFk liasioning djrs gq, HkkSfrd,oa foÙkh; izxfr dks lqfuf’pr djokukA izxfr izfrosnu dks ¼izk:i esa½ fu;fer :Ik ls jkT; LokLF; lfefr dks HkstukA jkT; ds }kjk le;≤ ij ekaxh xbZ tkudkfj;ksa ;k funsZ’kks dk lle; vuqikyu djuk@djokukA {ks=h; xq.koÙkk ;dhu uksMy vkWfQlj & {ks=h; dk;ZØe izca/kdA dk;ksZ ds lle; fu"iknu esa {ks=h; M & E Hkh mÙkjnk;h gksaxsA

13. District Quality Assurance Committee Functions of DQAC:- Meet once every month. Develop half yearly action plan of district for quality assurance intervention in the facilities (Based on facility wise planning for infrastructure strengthening and strengthening of services at the facility). Provide technical and managerial guidance to blocks on the implementation of action plan for improving the quality of services in the facilities disease control programme service delivery in the state. Monitor the Quality Improvement of programme and track progress based on identified quality indicators at each level e.g. Sub Centres, PHCs, SDHs, District Hospitals and Medical College. Also keep a check whether the facilities are providing the essential service package as per standards and protocols being adhered to. Review the cases of maternal & infant deaths at facility level and report cases of adverse outcomes/complications. Collecting information on all hospitalization cases related to complications following sterilization as well as sterilization failure. Processing all cases of failure, complications requiring hospitalization, and deaths following sterilization for payment of compensation. Reviewing all static institutions, i.e. government and accredited private / NGOs and selected camps providing sterilization services and safe abortion services, for quality of care as per the standards laid down, and recommending remedial action for institutions not adhering to the standards.

14. Conducting medical audits from time to time of all maternal & infant deaths and deaths related to sterilization and sending reports to the State QAC office. Review & monitor the quality of trainings under RHC II/National disease control programmes organized at state & district level and undertake follow-up of selected sample of trainees during field visits. Review of different community based interventions, implementation of schemes under MNCH. Plans QAC visits and make necessary preparations for visit to facilities and use the standardized QA Checklists to conduct assessment and debriefs the Medical Officer In-charge of the facility with guidance on what actions needs to be taken. Compiles findings during the visits at the district level and distributes the District Summary Report and discusses these at the monthly meeting with medical officers. Forward the minutes of the monthly QAC meeting and actions to be taken to the concerned officials; regional and state QAC. Shares the district visit reports with State Committee on monthly basis and initiates actions based on recommendations from state committee. To address the state level actions, the district has to take the initiation and pursue the state authorities and follow-up. Keeps a record of follow-up and actions taken so that these can be reviewed on subsequent visits to the facility. Ensure empanelment of doctors at district level performing sterilization operations & maintain / update their databases. Cont….

15. ftyk xq.koÙkk ;dhu uksMy vkWfQlj ds dk;Z,oa ftEesnkfj;k¡ %& ftyk xq.koÙkk ;dhu lfefr ds cSBd dks flfoy ltZu dh v/;{krk esa izR;sd ekg djokuk( cSBd esa vLirkyksa ds xq.koÙkk ;dhu ls lacaf/kr fy;s x;s fu.kZ;ksa ls lHkh vLirkyksa ds DS/MOIC dks voxr djokukA ftyk xq.koÙkk ;dhu lfefr dh xfrfof/k;ksa ds ;kstukuqlkj lle; fu"iknu lqfuf’pr djokukA blds vfrfjDr fdlh Hkh izdkj ds QA need based activity dks djokukA ftyk varxZr lHkh p;fur vLirkyksa ¼ ISO, FFHI, bR;kfn½ esa py jgs dk;ksZa dh izxfr dk i;Zos{k.k fujh{k.k djuk@djokuk rFkk lle; vuqikyu lqfuf’pr djokukA buds vfrfjDr ftys ds vU; lHkh vLirkyksa (PHC, SDH, RM, DM) esa xq.koÙkk lq/kkj dk;ZØe dks ykxw djus ds fy, ;kstukc} rjhds ls visioning cum gap analysis exercise djokuk] action plan cuokuk rFkk mlds vuq:Ik dk;Z djokuk A vLirkyksa dks FFHI, ISO, bR;kfn izek.khdj.k ds fy, fuf’pr le; lhek ds vanj rS;kj djokukA le;≤ ij Vhe xBu dj vLirkyksa ds xq.koÙkk izxfr dk ewY;kadu djkukA xq.koÙkk lq/kkj dk;ZØeksa dh izxfr gsrq jkT; o {ks=h; Lrj ds lkFk liasioning djrs gq, HkkSfrd,oa foÙkh; izxfr dks lqfuf’pr djokukA lHkh vLirkyksa ls izkIr izxfr izfrosnu dks layXu dj ftyk Lrj ds izxfr izfrosnu ds lkFk jkT; dks rFkk mldh izfrfyfi {ks=h; Lrj ij miyC/k djkukA lkFk gh vLirkyksa ds xq.koÙkk lq/kkj lacaf/kr QksVks] documentary, testimonial bR;kfn le;≤ ij jkT; dks miyC/k djokukA jkT; ds }kjk le;≤ ij ekaxh xbZ tkudkfj;ksa ;k funsZ’kks dk lle; vuqikyu djuk@djokukA ftyk xq.koÙkk ;dhu uksMy vkWfQlj & ftyk dk;ZØe izca/kdA dk;ksZ ds lle; fu"iknu esa DPC Hkh mÙkjnk;h gksaxsA

16. ftyk xq.koÙkk ;dhu uksMy vkWfQlj ds dk;Z,oa ftEesnkfj;k¡ %& ftyk xq.koÙkk ;dhu lfefr ds cSBd dks flfoy ltZu dh v/;{krk esa izR;sd ekg djokuk( cSBd esa vLirkyksa ds xq.koÙkk ;dhu ls lacaf/kr fy;s x;s fu.kZ;ksa ls lHkh vLirkyksa ds DS/MOIC dks voxr djokukA ftyk xq.koÙkk ;dhu lfefr dh xfrfof/k;ksa ds ;kstukuqlkj lle; fu"iknu lqfuf’pr djokukA blds vfrfjDr fdlh Hkh izdkj ds QA need based activity dks djokukA ftyk varxZr lHkh p;fur vLirkyksa ¼ ISO, FFHI, bR;kfn½ esa py jgs dk;ksZa dh izxfr dk i;Zos{k.k fujh{k.k djuk@djokuk rFkk lle; vuqikyu lqfuf’pr djokukA buds vfrfjDr ftys ds vU; lHkh vLirkyksa (PHC, SDH, RM, DM) esa xq.koÙkk lq/kkj dk;ZØe dks ykxw djus ds fy, ;kstukc} rjhds ls visioning cum gap analysis exercise djokuk] action plan cuokuk rFkk mlds vuq:Ik dk;Z djokuk A vLirkyksa dks FFHI, ISO, bR;kfn izek.khdj.k ds fy, fuf’pr le; lhek ds vanj rS;kj djokukA le;≤ ij Vhe xBu dj vLirkyksa ds xq.koÙkk izxfr dk ewY;kadu djkukA xq.koÙkk lq/kkj dk;ZØeksa dh izxfr gsrq jkT; o {ks=h; Lrj ds lkFk liasioning djrs gq, HkkSfrd,oa foÙkh; izxfr dks lqfuf’pr djokukA lHkh vLirkyksa ls izkIr izxfr izfrosnu dks layXu dj ftyk Lrj ds izxfr izfrosnu ds lkFk jkT; dks rFkk mldh izfrfyfi {ks=h; Lrj ij miyC/k djkukA lkFk gh vLirkyksa ds xq.koÙkk lq/kkj lacaf/kr QksVks] documentary, testimonial bR;kfn le;≤ ij jkT; dks miyC/k djokukA jkT; ds }kjk le;≤ ij ekaxh xbZ tkudkfj;ksa ;k funsZ’kks dk lle; vuqikyu djuk@djokukA ftyk xq.koÙkk ;dhu uksMy vkWfQlj & ftyk dk;ZØe izca/kdA dk;ksZ ds lle; fu"iknu esa DPC Hkh mÙkjnk;h gksaxsA

17. vLirky xq.koÙkk ;dhu uksMy vkWfQlj & vLirky v/kh{kd@izHkkjh fpfdRlk inkf/kdkjhA dk;ksZ ds lle; fu"iknu esa vLirky izca/kd@LokLF; izca/kd Hkh mÙkjnk;h gksaxsA vLirky xq.koÙkk ;dhu uksMy vkWfQlj ds dk;Z,oa ftEesnkfj;kW %& vLirky Lrj ij,d xq.koÙkk lq/kkj lfefr dk xBu DS/MOIC dh v/;{krk esa djuk@djokuk ftlesa vLirky ds inkf/kdkjh@dfeZ;kas (MO/HM/ANM/Nurses/BAM/LT/VI grade Staff representative bR;kfn ) dh Hkh Hkkxhnkjh gksA xq.koÙkk lq/kkj lfefr dh cSBd izR;sd ekg djuk@djokuk rFkk fy, x, fu.kZ;ksa ls ftyksa dks voxr djkukA vLirky lq/kkj gsrq xfrfof/k;ksa ds ;kstukuqlkj dk;ksZa dk lle; fu"iknu djuk@djokuk rFkk vuqikyu izfrosnu layXu izk:Ik esa izR;sd ekg ftyksa dks miyC/k djkukA izR;sd =Sekl Gap Analysis Report dh leh{kk djuk rFkk mldks v|ru djuk@djokukA vLirky dks FFHI/ISO, bR;kfn ds fy, rS;kj djokukA

18. HOSPITAL QUALITY IMPROVEMENT & CERTIFICATION

19. Approaches for Establishment of QMS in Hospital PLANDO ACTCHECK Quality service & better Environment for patient Visioning, Gap Analysis, Action Plan Development, SOPs, availability of standard documents & guidelines Implementation, Training/capacity building, Report compilation & timely reporting Corrective & preventive action; redesigning of plans & system etc Progress monitoring, review of developed action plan, Lags & lacunas in implementation of affecting final outcome Quality certificate to hospital

20. Process of FFHI In Facility Team building -Formation of Hospital Quality Improvement Group Visioning Exercise & Problem Bank creation. Vision statement of health facility / Quality statement. Gap analysis Action Plan Development with Time frame (Prioritizing the gaps, level at which gaps would be addressed, resources/FMR source, responsible person,etc) Monthly Hospital Quality Improvement Group and RKS meetings for approval of work and associate line department. Implementation of Plan according to activity plan. Indicator development. Monitoring & check. Apprise District QAC on the processes & progress. Once facility is ready it may apply to DQAC for certification. Meeting by Hospital Quality Improvement Group Independent assessment and certification Hospital staff

21. Process of certification Diagrammatic representation for facility assessment and certification process State Certification Body Public Health Facility District Quality Assurance Committee (DQAC) State Quality Assurance Committee (SQAC) Check readiness of facility and request for assessment Forward request to - conduct assessment Check readiness of facility and request for assessment Regional level Assessment team (RQAC + any nominated member) Submit report with recommendation or non-recommendation for certification visit Submit final reports for - conducting certification visits Apply for certification Conduct certification Visit & award quality certificate

22. PHOTO GALLERY- QUALITY ASSURANCE

23. SDH, Sherghati

24. PHC, Uchkagaon, Gopalganj

25. SDH, Danapur

26. Sadar Hospital, Aurangabad

27. Quality PoiicyDoctor list Duty roaster; sitting arrangement at OPD OT