Transcript Document

Dr. Vivienne Mitchell
MBBS, DM, MPH
IMPROVING QUALITY OF HEALTH
CARE IN GUYANA
Learning Objectives
 Define quality
 Understand the concept of Total Quality
Management (TQM)
 Critical incident analysis
 Identify quality gaps in our healthcare
delivery
 Recognise that quality is everybody’s
business
Definition
 Quality is the degree to which health
services for individuals increase the
likelihood of desired health outcomes and
are consistent with current professional
knowledge
IOM, Medicare. A strategy for Quality Assurance, 1990, p21
Definition cont’d
Doing the right thing for the right
person at the right time in the right way
Eisenberg. Testimony to Congress, 1999
Components
 A high quality health care system is one
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which is reliably STEEP
Safe
Timely
Effective, Efficient
Equitable and
Patient-Centered
IOM. Crossing the Quality Chasm, 2001
Components
Quality Management System
 Plan :
Train; establish policies & procedures;
provide resources; infrastructure; environment
 Do :
Implement
 Check: Monitor SMART (specific, measurable,
achievable, relevant, time-bound) indicators,
data analysis, audits, customer satisfaction
 Act :
Corrective & Preventive action
Total Quality Management
Continuously meeting and exceeding
agreed customer requirements at
minimal cost, by releasing the potential
of all employees
Principles of TQM - Customer
Identify customer needs :
Patient’s charter
Customer – supplier process flow :
Process mapping
Cost
 Total quality is about
 Building quality into our products and
services
 Preventing failures from occurring
 Eliminating the enormous financial waste
caused by poor quality
Principles of TQM - Cost
 Do the right things - Avoid wrong things done
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well – blame game; complaints department;
unread reports & memos; surveillance &
inspection without action
Manage by proactive prevention, not correction
Measure for success
Prevention & Appraisal costs vs Internal &
External costs
Goal – continuous improvement
Employees
The planned involvement of the
enormous resource of employees is
really the key to Total Quality success.
Principles of TQM - Employees
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Management must lead by example
Never compromise quality
Training is essential
Ignorance is expensive!
Communicate more effectively – top down,
bottom up and across
 Recognize successful involvement – News
articles, gifts, “Thank You” for a job well done
 Work as a TEAM
(Together Each Achieve More)
Input
 Staff – quantity, quality; match skill mix to
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patient needs
Physical resources - ?basket to hold water
Accreditation of learning institutions :
NAC, CAMC
Accreditation of health facilities: CAAMHP
Licensure – Medical Council, MOH, NAC
Credentialing
Input
 Patient charter
 Staff sensitive to cultural issues, changing
demography; who will develop rapport
and empathize with patients.
 Healthy work environment – no abuse,
exercise, recreational facilities
Process - Internal
 Clinical practice guidelines
 Regular staff appraisals - Feedback
 Eliminate abusive or bullying culture
 Encourage engaged, empowered staff
 Line of sight
 Risk management
Process - Internal
 Audit – stocks, records, cases, staffing
 Monitoring & Evaluation of indicators
 Morbidity/ Mortality Meetings
 Process mapping – used to identify quality
gaps
 Critical incident analysis - investigate the
REASON for the error.
Critical Incident Analysis
Machines
Manpower
Environment
Methods
Materials
Money
Resources
Root cause analysis – 5 Whys
 Why did the motor burn out?
 Lack of lubrication on the bearings.
Lubricate
 Why were the bearings not lubricated?
 The operator hadn’t done his job
Discipline him
 Why hadn’t he done his job?
 He hadn’t realised the need to lubricate the
bearings
Tell him
 Why didn’t he recognise this need?
 He hadn’t been properly trained
Train him
 Why hadn’t he been properly trained?
 There was no system for training operators
 Develop effective training systems for
all operators
PROCESS - External
 International best practices.
 Internationl Organization for
Standardization (ISO) - habit of excellence
 Audit
 Inspections
 Risk management
Risk Management
 “Clinical and administrative activities undertaken to
identify, evaluate, and reduce the risk of injury to
patients, staff, and visitors and the risk of loss to the
organization itself.”
 It is proactive (avoiding/preventing risk) or reactive
(minimizing loss or damage after an adverse event).
JHACO
 Considers patient safety, quality assurance and
patients’ rights. The potential for risk permeates all
aspects of health care, including medical mistakes,
electronic record keeping, provider organizations and
facility management.
Insurance Bureau of Canada
Outcome
 Health Indicators
 Complaints
 Litigation
 Patient satisfaction surveys
 Staff exit interviews
Medical Tourism
 Local care must first be of good quality.
 Health care must be as good as at home.
 Security, safety, political stability and
follow-up care are also important factors.
 Do not build a new facility for medical
tourism.
Change Process
 Easier to change situation than
behaviour
 Easier to change behaviour than
attitude
 Easier to change attitude than person
Quality Blocks
Reflective Questions
 Are we reacting to problems or preventing
them?
 Are our decisions made for the sake of
expediency or for the sake of quality?
 Are we tackling sporadic problems or
looking for root causes of chronic
problems?
Quality Responsibility
 Around 80% of problems are caused by
 Failures in systems
 Absence of tools
 Lack of training
 Inadequate procedures
 Poor documentation
 Unclear requirements
Staff needs
 In order to do a job properly, staff need
 To know what to do
Requirements
 To know how to do it
Training
 To have the means to do it Skills, tools
 To measure performance
How they are
doing
 To take corrective action
Ability to respond
Manager’s Responsibility
 It is every manager’s responsibility to
ensure that their staff have ALL the
requirements they need to do their
job effectively.
 Only then can staff be held truly
responsible if things go wrong.
Success factors for change
 Respected opinion leaders’ support
 Ownership by participants
 Participants recognize need for change
 Focus on QI rather than on reducing costs
 Combined approaches
 Change methods to ensure sustained change
Recommendations
 Include quality in the budget, curriculum and
accreditation of medical schools of health facilities
 Do process mapping
 Standardize data collection, analysis and
presentation
 Identify data gaps, e.g. complaints, medical errors,
near misses, litigation, investigation, treatment
and prescribing errors
 Proactive risk management
Dr. Vivienne Mitchell
MBBS, DM, MPH
IMPROVING QUALITY OF HEALTH
CARE IN GUYANA