Promoting Quality Care

Dr. Gwen Hollaar

Introduction

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

Introduction

• Most evaluations of health service focus on:– Service coverage (how many receive treatment)

– Mortality rates

• Few evaluations focus on quality

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

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

Quality Assurance

Ongoing activities to

SET STANDARDSand

MONITOR & IMPROVE PERFORMANCE

for

Effective Health Careand

Patient Safety

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)

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?

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?

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?

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?

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

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

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

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

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

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

Promoting Quality Care Examples:

• Identify health problem where health service can improve

• Create treatment guideline• Mushroom Poisoning• Dengue Fever

• Monitor compliance / Monitor success

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

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

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

Summary

• Improving quality must be a team approach

• Improving quality requires monitoring

• Let others know what improvements you have made