Transcript Introducing Quality Management in District Hospitals in

Introducing Quality Management
in District Hospitals
in Tanga Region
First Experiences
from Korogwe District Hospital
Improving Patient Care – a strategic
framework for Tanzanian Hospitals
Goal:
To improve the health and well-being of all
Tanzanians with a focus on those most at risk and to
encourage the health system to be more responsive
to the needs of the people
Purpose:
To provide access for all Tanzanians to good quality,
equitable and affordable hospital services
Why?
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Public dissatisfied with services
Efficiency and effectiveness of services low
Poor value for money
Low motivation and morale amongst health
workers
• Weaknesses in management
• Inadequate quality control
Some objectives in the framework
• Strengthen management systems and
capability in the Ministry and Hospitals
• Improving quality and effectiveness of
clinical care, e.g.:
– Introduction of peer hospital appraisal
– Establishment of evidence-based protocols,
standards, guidelines and benchmarks
– Introduction of internal and external clinical
audits of patient care
• Ensure financial sustainability of hospital
services
Quality Assurance Guidelines
for health workers
Introduces HWs to:
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concept of quality and quality assurance
Quality control
Professional standards
Package of minimum essential health
interventions
Team work
Management skills
Communication skills
Data collection and use
Activities in Tanga Region
• QM activities established aimed at
Dispensaries and Health Centres:
– Supervision checklist
– Ranking and scoring of HFs
– Public awarding of best performing HFs
• Next step: inclusion of Hospitals in QM
activities
5 important Principles of QM
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Client orientation - satisfaction
Focus on improving systems and processes
Decisions based on (good) data
All staff members are involved and
responsible for quality of services
= TEAM WORK important
• Commitment to continuous improvement
Quality Management Triangle
Defining
Quality
Improving
Quality
Measuring
Quality
3 key conditions required to succeed with
quality improvement activities
• Management is committed to meet staff
needs
• Empowerment and support of staff to initiate
and implement changes in terms of
– Decision-making
– Access to resources
• Adequate infrastructure for service delivery
Adequate infrastructure
• Adequate buildings and working space
• Necessary equipments always available and
functioning
• Necessary medications and medical supplies
always available
Situation at District Hospital
• Availability of equipments:
– Basic equipments available but not always in sufficient
number
– Some essential equipments missing
• Availability of drugs and medical supplies:
– Stock- outs still occurred from time to time for various
reasons
• State of buildings etc:
– old electrical and water system
– old buildings
– Some wards overcrowded
• Inadequate staffing levels and staff mix
Getting ready…1
• Strengthening the Hospital Committees
Getting ready …2
• Raise availability of drugs and medical supplies:
– Support of pharmacy
– Review logistics system
• Purchase of equipments as planned in CCHP 2003
Introduction to QM - 1
• Initial 2 day seminar for clinical and nursing
in-charges of the hospital:
– Meaning of quality
– Basic principles of quality management
– Introduction to quality improvement cycle using a
practical example
Introduction to QM – 2
• 5 day workshop organised by Ministry of
Health
• Participants: Hospital Matron and 1 Nurse
• Topics:
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COPE Methodology
Quality Measuring Tool
Cost Analysis
Clinical Monitoring
Supervision
Quality Circles
Definitions:
• A group of health workers who form a group
to identify and solve specific quality
problems at their workplace
• Peer Review: a group of health
professionals, e.g clinical officers who review
case management together in order to
improve / maintain quality of services
Kamati ya ubora wa huduma
• Appointed by the hospital management team
• Multi-disciplinary
• Members:
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MO I/c
Matron
1 Clinical Officer
1 Health Officer
1 Nurse / Midwife
1 Medical Attendant
Tasks of the Hospital Quality Committee
• Establish a Comprehensive quality plan for the
Hospital in close cooperation with departments
• Initiate, coordinate and support Quality Groups in
the various hospital departments
• To give advice to Quality Groups for developing their
action plans
• Support implementation of action plans of the
Quality Groups
• Motivation and appraisal of Quality Groups
• Feedback to Hospital Management Team
First Activities of HQC
• All departments of the hospital were asked
to compile a list of quality problems
• Review of the list by the Hospital Quality
Committee
• Provide feedback to the departments and
support departments for the analysis of
problems and design of solutions
Planned activities
• Establish quality circles in all departments
• Train more staff with QM skills
• Work on the problems with each department
Results
• Quality is a topic in the hospital
Quality Activities initiated by
staff of Maternity ward
• Improvement of dispensing of medications:
– Problem identified in recording
– Development of a dispensing sheet
• Prevention of prolonged labour of Prime
Gravida:
– Problem identified in interpreting partograph and
initiating appropriate action
– Development of a flow chart
3 pillars of Quality Management
Defining
Quality
Improving
Quality
Measuring
Quality
Data management
• Data collection:
– Patient records
– Financial records
– Inventories etc.
• Data analysis
• Feedback and use of data
Patient records
• Information about:
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Patient
Symptoms and diagnosis
Investigations
Treatment given
gives information about quality of care