IMPROVING QUALITY OF HEALTH CARE IN GUYANA

Dr. Vivienne MitchellMBBS, DM, MPH

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 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 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 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 patient needs Physical resources - ?basket to hold

water Accreditation of learning institutions :

NAC, CAMC Accreditation of health facilities:

CAAM-HP 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

Methods

Materials

Environment

Machines Manpow

er

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

IMPROVING QUALITY OF HEALTH CARE IN GUYANA

Dr. Vivienne MitchellMBBS, DM, MPH