GOALS OF PRESENTATION HEALTHCARE QUALITY AND 1.To Know Malaysia and the healthcare System. PATIENT SAFETY: 2.Why Quality and Safety THE MALAYSIAN EXPERIENCE 3.Approaches to improve Quality and Patient Safety 3 Approaches to improve Quality and Patient Safety 4.Foster comparative discussions of strategies for BY quality of care & safety Assoc.Prof.Dr.Kadar Marikar CEO,MSQH 5 Feb.2009 • Population of over 26 million people. Malaysia • Multi-cultural and multi-racial population consists • The country is made up of two of Malays, Chinese, regions, Peninsula Malaysia Indians and and East Malaysia (Borneo) across the South China Sea. numerous natives. Peninsula Malaysia • Ethnic Groups: • The Peninsula Malaysia is 59% Malay and divided into the 'east coast' other indigenous, other indigenous and the 'west coast' by the East Malaysia (Borneo) 32% Chinese Main Range in the middle. and 9% Indian. • East Malaysia is geographically rugged, with a series of mountain ranges running through the interiors of both Sabah and Sarawak. The Crocker Range in Sabah is the site of Mt Kinabalu, the highest peak in South East Asia. • Malay is the official language but English is widely • Malaysia is generally warm spoken, especially in business. throughout the year with • Official religion is Islam, but its people are free to observe temperatures ranging from 21° to any religion of their choice. It is common to see temples, 32° C in the lowlands. This can mosques and churches located in close proximity. however be as low as 16° C in • Languages: the hills and highlands . Malay, English, Chinese, Tamil and other tribal languages. • Annual rainfall is heavy at • Religion: 2,500mm (100 inches). On a rainy day, thunder and lightning Muslim (primarily Malays), Buddhism (Chinese), Hindu often accompany the heavy often accompany the heavy (Indian) Christianity (Indian), Christianity. downpour which normally lasts for less than two hours. The humidity level is high at 80% throughout the year. • Generally, Malaysia has two seasons. The dry season is from May to September and the rainy season is from November to March. 1
• Malaysia has 12 MALAYSIAN HEALTH SECTOR: states and 3 Federal Territories. MINISTRY OF HEALTH • The Capital City is Inpatient care services Kuala Lumpur -Total 138 hospitals -Primary -Secondary -Secondary -Tertiary -Specialized services (Range of beds 40-2000) Public Health Services Out-patient services: -Health Centre (10,000 centre) Private Sectors -Community Clinics (2,000 Clinics) - Private Hospitals: 328 ( Range of beds 2-350 beds) (Estimated every 5 kilometers radius -> 1CC) - Private Medical clinics: 6000 -In remote areas: Flying Doctors Services. - Maternity Centres : (Especially for Sabah & Sarawak) - Hemodialysis centers : - Day care centers : Preventive and Health Promotion services - Nursing Homes: Medical Training Institutions-University Hospitals: 3 Corporatised Hospital : National Heart Institute (IJN) 262 beds Ministry Of Defence: 3 + 1 Reasons for Supporting Quality of Care VISION FOR HEALTH Agenda REDUCE COSTS OF WASTES & ERRORS THROUGH CLINICAL QUALITY Malaysia is to be a nation of healthy Purchasers: individuals, families and communities, 1) Control costs + assess quality = VALUE through the health system that is equitable, (cost-effectiveness for money spent) affordable, efficient, technologically 2) Ensure access to care (government) appropriate, environmentally adaptable and pp p , y p S Suppliers / hospitals / doctors: li / h it l / d t consumer friendly, with emphasis on 1) Demonstrate quality and value to purchasers quality, innovation, health promotion and 2) Improve safety and reduce medical errors respect for human dignity and which 3) Attract patients to maintain revenue promote individual responsibility and community participation towards an Patients / consumers: enhanced quality of life. 1) Get high-quality, affordable care when needed 2) Maintain choice of doctors and hospitals 2
Why Measure Quality of Care? Stakeholders for Quality of Care Purchasers: Quality & effectiveness of health care essential to: • National & state governments � Improve health • Private health insurers � Improve abnormal risk factors & prognosis Suppliers: • Health Industry (high blood pressure or high glucose) (high blood pressure or high glucose) • Drug and device companies � Lower morbidity Providers: • Doctors and professional societies � Lower mortality • Hospitals, Clinics etc.. Patients / consumers US National Library of Medicine QUALITY FRAMEWORK OPERATIONAL MODEL LEADERSHIP ORGANISATIONAL CULTURE & VALUES MEDICAL STAFF FOCUS PROCESS FOCUS STRUCTURE OUTCOME ON ON SAFETY ACCESSIBILITY PATIENT PROCESS COMPETENCY COMPETENCY QUALITY EFFICIENCY (What is the (What are the things (What do you do PEOPLE FOCUS result of what that you have) EFFECTIVENESS With these things ) APPROPRIATENESS you do with these things that you have) CONTINUOUS QUALITY IMPROVEMENT ENHANCED QUALITY OF LIFE MSQH ORGANISATIONAL QUALITY ASSURANCE PROGRAMME QUALITY ASSURANCE PROGRAMME IN MINISTRY OF HEALTH IN MINISTRY OF HEALTH STRUCTURE – Launched in 1985 (with implementation of Launched in 1985 (with implementation of Patient Care Services QA Programme) Patient Care Services QA Programme) – QAP expanded to QAP expanded to 1. National level � Public Health Services Public Health Services (1990) (1990) � Pharmaceutical Services Pharmaceutical Services (1990) (1990) 2. Programme level � Dental Services Dental Services (1992) (1992) 3. State level � Engineering Services Engineering Services (1992) (1992) � 4. Hospital/Institutional level Laboratory Services Laboratory Services (1992) (1992) � Training & Manpower Training & Manpower Services Services (1996) (1996) � Planning Division Planning Division (1997) (1997) 3
Quality Improvement Activities ACTS AND REGULATIONS • PRIVATE HEALTHCARE FACILITIES AND SERVICES ACT 1998 AND SERVICES ACT 1998 Hospital based • REGULATIONS 2006 QUALITY IMPROVEMENT ACTIVITIES QUALITY IMPROVEMENT ACTIVITIES Strategic Plan For Quality IN THE MOH MALAYSIA IN THE MOH MALAYSIA • NATIONAL INDICATOR APPROACH (NIA) NATIONAL INDICATOR APPROACH (NIA) • HOSPITAL SPECIFIC APPROACH (HSA)/ HOSPITAL SPECIFIC APPROACH (HSA)/ • DISTRICT SPECIFIC APPROACH (DSA) DISTRICT SPECIFIC APPROACH (DSA) • MATERNAL MORTALITY REVIEW/ MATERNAL MORTALITY REVIEW/ • Late 1996 & 1997: Evaluation of 17 Quality • PERINATAL MORTALITY REVIEW PERINATAL MORTALITY REVIEW • PERIOPERATIVE MORTALITY REVIEW (POMR) PERIOPERATIVE MORTALITY REVIEW (POMR) Initiatives in MOH was carried out at • MEDICAL AUDIT MEDICAL AUDIT National Level. • TOTAL QUALITY MANAGEMENT TOTAL QUALITY MANAGEMENT • • QUALITY CONTROL CIRLCE QUALITY CONTROL CIRLCE QUALITY CONTROL CIRLCE QUALITY CONTROL CIRLCE • QUALITY CONTROL QUALITY CONTROL • INFECTION CONTROL INFECTION CONTROL • Outcome of the evaluation was deliberated in • CLINICAL PRACTICE GUIDELINES (CPG) CLINICAL PRACTICE GUIDELINES (CPG) • INCIDENT REPORTING INCIDENT REPORTING the 1998 National Conference on Quality in • CORPORATE CULTURE CORPORATE CULTURE • CLIENT’S CHARTER CLIENT’S CHARTER Health Care held in March 1998. • INNOVATIONS INNOVATIONS • RENAL REGISTRY RENAL REGISTRY • Credentialing and Privileging Credentialing and Privileging • Accreditation of Healthcare Facilities and Services Accreditation of Healthcare Facilities and Services The National Indicator Approach The National Indicator Approach • Strategic Plan for Quality in Health – Implementation Plan of the Strategic Plan for Quality in • • Use of common indicators to assess the quality of Use of common indicators to assess the quality of Health – 14 Manuals: care care • Corporate Culture � PKPA • NIA � MMR • • For each indicator a standard is set, against which For each indicator a standard is set, against which • Incident Reporting � CPG the performance is compared the performance is compared • POMR � Renal Registry • Nosocomial Infection Nosocomial Infection � Innovations Innovations • • If do not meet standards carry out investigations • • If do not meet standards, carry out investigations If do not meet standards carry out investigations If do not meet standards, carry out investigations • Quality Control � Client Charter to identify contributing factors or reason for to identify contributing factors or reason for • Quality Control Circle � MS ISO 9000 shortfalls in quality shortfalls in quality • • Remedial measures are identified so as to Remedial measures are identified so as to Report on a decade of NIA Performance by Programmes overcome these shortfalls overcome these shortfalls • • The cycle is then repeated The cycle is then repeated These document have also been distributed for use by the Private Health Care providers - to assist them towards compliance of the Private Healthcare Facilities and Services Act 1998. 4
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