1. Promoting Quality Care Dr. Gwen Hollaar

2. Introduction We all want quality in health care –Communities –Patients –Health Care Workers –Managers –MOH / Provincial Health Office

3. Introduction Most evaluations of health service focus on: –Service coverage (how many receive treatment) –Mortality rates Few evaluations focus on quality

4. Introduction “Quality health care costs too much money” or “Not having quality care costs too much money” Examples: –Measles immunization campaign meets target rate BUT vaccine not effective because poor maintenance of cold chain Immunization done but poor quality Resources wasted –Patient has ultrasound, but poor quality Wrong diagnosis / Wrong treatment Resources wasted

5. Introduction Primary Health Care Operations Research (WHO) –Evaluated essential activities for 7 child survival interventions Immunizations - ORS - Growth Monitoring Prenatal care - Family planning ARI treatment - Malaria treatment –Observation of health care worker - patient encounters –Poor quality observed Diagnosis Treatment Patient education Supervision

6. Quality Assurance Ongoing activities to SET STANDARDS and MONITOR & IMPROVE PERFORMANCE for Effective Health Care and Patient Safety

7. Guiding Principles 1.Meets needs of patients / communities 2.Focuses on activities and processes 3.Based on events or data 4.Encourages team approach Build commitment at all levels (managers, health care providers, support staff)

8. Quality of What? Technical competence Knowledge, skill, and performance of health care providers Are health care providers accurate and consistent? Are managers supervising staff? Access to service Are services affordable? Are services acceptable within local culture? Can patients understand language at hosp?

9. Quality of What? Effectiveness Does the procedure or treatment lead to good result? Is the recommended treatment the most technologically appropriate for this place? Interpersonal relations Do health care staff communicate well and respectful to patients? Do health care staff communicate well with each other? Do managers communicate well with health care providers?

10. Quality of What? Efficiency Are patients receiving optimal care for this setting --- the most benefit for the resources available? Continuity Do patients receive health service easily between health centers without repetition of tests? Is there good communication between health centers for good patient care?

11. Quality of What? Safety Have risks to patients been minimized? Have risks to health care workers been minimized? Health Center Environment Is the health center clean? Do patients have privacy when examined? Do patients have access to clean toilets?

12. Method to Promote Quality Care Identify Opportunities for Improvement Define Problem Choose Team Analyze Problem to Identify Causes Develop Solution and Action Implement and Evaluate Changes Made

13. Method to Promote Quality Care Identify Opportunity for Improvement Based on Observation of health workers Patient outcomes Patient / Community feedback or complaints Brainstorming by health workers Better participation if health workers are involved in identifying problems After identifying problems, as a team choose 1 or 2 Choose something that is manageable

14. Method to Promote Quality Care Define Problem Problem needs to relate to Better outcome for patients Better quality of service Be clear about problem May see large problem, but identify one piece Find one process or activity that you can change Example “Patients don’t do what we tell them” - problem is too vague Be more specific…. “About 50% of diabetics do not continue their medication after leaving hospital” Select one activity or process that could improve this problem

15. Method to Promote Quality Care Choose Team Make team of those who understand the problem and local situation You will have better participation and success if multiple people are involved Analyze Problem and Identify Causes Analyze reasons for problem (ie. problem tree) Develop Solution and Action May be simple Remind staff about guidelines through staff meeting or supervision Develop wall chart Make checklist

16. Method to Promote Quality Care Implement and Evaluate Changes Made Develop timeline Identify how you will evaluate success (ie. indicator) Let directors know what you are doing If success, continue / If no success, change strategy If Success… let others know Announce at staff meeting Storytelling bulletin board at health center for other staff and patients to see Present at conference

17. Promoting Quality Care Examples : Mortality / Morbidity Discussion Set regular time to discuss patients who had poor outcome Present patient case Team discussion to identify causes why patient did not do well Brainstorm what you could change that may have resulted in better outcome This is NOT ABOUT BLAMING someone… this is about improving things for next time

18. Promoting Quality Care Examples: Identify health problem where health service can improve Create treatment guideline Mushroom Poisoning Dengue Fever Monitor compliance / Monitor success

19. Promoting Quality Care Examples: Identify area of poor communication with patients Create simple information sheet / Diagram Designate process of patient education Supervise to ensure happening and clear teaching

20. Promoting Quality Care Examples: Use checklist or forms to ensure patient safety Count sponges before and after every OR Equipment checks are done at regular intervals and form signed Nurses sign physician order forms before finishing work to make sure all patient orders has been done Lab requisition forms have place for results to be written to save time and reduce error

21. Summary Our work is about patients and improving their experience and outcome in the health care system Improving quality of care is responsibility of ALL staff at health care center Improving quality of care does not need to be expensive or complicated

22. Summary Improving quality must be a team approach Improving quality requires monitoring Let others know what improvements you have made