PROBLEM AREAS LACK OF ORGANISATION HOW HOW TO TO ACHIEVE ACHIEVE - PDF document

����������������������� ����������������������� ������������������������ ����������������������� � � � ������������ ������������ ������������ ������������ �������� �������� �������� �������� • Quality improvement is an important goal in all clinical practice • Basic ingredients are Dr. Rajiv Mohan Dr. Rajiv Mohan Dr. Rajiv Mohan Dr. Rajiv Mohan • M.S, F.R.C.S. M.S, F.R.C.S. M.S, F.R.C.S. M.S, F.R.C.S. Commitment of clinicians Mohan Eye Institute ,New Delhi Mohan Eye Institute ,New Delhi Mohan Eye Institute ,New Delhi Mohan Eye Institute ,New Delhi • Monitoring of data on processes and patient care • Active support of management. • Evaluation of trends in the practice patterns However many practicing group do not routinely identify or, examine their quality problem 1 2 Objectives of Managing Quality Objectives of Managing Quality Managing Managing Quality Quality serves serves mainly mainly to to achieve achieve two two goals goals : : Managing Quality Managing Quality serves serves mainly mainly to to achieve achieve two two goals goals : : Managing Managing Quality Quality serves serves mainly mainly to to achieve achieve two two goals goals : : Managing Managing Quality Quality serves serves mainly mainly to to achieve achieve two two goals goals : : Efficient and Effective Performance Efficient and Effective Performance Improving Patient Improving Patient Care Care Efficient and Effective Performance Efficient and Effective Performance Improving Improving Patient Patient Care Care An improvement in the quality of the care provided also results in cost savings. In many instances, the hospital staff is not aware of the quality of its own services In order to ensure efficient (economical) and effective (operative) patient care, because they receive no feedback. there must be interaction between the medical, nursing and infra-structural measures . Quality assurance is intended to provide them with information on the quality of their performance. In cases of inefficiency, the reasons for the deficiencies must be sought. The next step is to initiate measures to improve the situation. 3 4 PROBLEM AREAS • LACK OF ORGANISATION HOW HOW TO TO ACHIEVE ACHIEVE QUALITY QUALITY HOW HOW TO TO ACHIEVE ACHIEVE QUALITY QUALITY Every evaluation requires yardsticks for reference. • LACK OF STRUCTURE Quality can only be measured once specific perceptions of the targets have been defined. Quality is therefore the rate of compliance with pre-defined • LACK OF INFORMATION targets. Efforts are made to strive for the best possible quality, which can be obtained with the available resources. • LACK OF PROCESS This is what is executed and evaluated in the course of managing quality. 5 6 1

thus……. Quality Assurance Approaches • We can find many other such quality deficits in hospitals. Measuring quality • Often they go completely unnoticed and therefore not dealt with. • Systematic quality assurance work will Defining quality Improving quality contribute towards removing quality deficits . Although the QA Triangle highlights the three core quality assurance activities in its vertices, there is actually a range of 7 8 sub-activities related to each core QA activity Quality Assurance Approaches Determinants of quality in healthcare Improvement of health service is a long drawn relentless process. It can be achieved by implementing a carefully planned program of quality management. The triangle shape appropriately suggests that there is no "correct" or even optimal sequence to initiate QA activities. The program has to be – Precisely planned & meticulously executed. It should be a continuous ongoing process. Staffs at all levels has to be trained, involved & committed. There are no shortcuts. The order will depend on the capacity of the healthcare system or facility and the interest of the providers. It involves a major change in the organizational culture. Hiring an outside consultant can be advantageous. Board of management has a crucial role to play. Programme has to have a precise time schedule. 9 10 Steps of implementing quality in a hospital Identification and mapping of the organization’s process : Development of hospital information system There should be commitment from the top Formulation of criteria and standards Implementing the program Educating the management and staff Internal audit Formation of quality management team Mock survey Awareness campaign and development of quality culture Detection of non conformities Defining key improvement objectives Implementing of corrective measures External certification & accreditation Development of quality policy and quality manual for the organization Training of top management Training of lower staff 11 12 2

Quality of Inpatient Services Managing Quality in Inpatient Services – In General Some of the Quality attributes of a patient friendly hospital are as below It is recommended that the overall quality be divided into quality : components. Approach and entrance Diagnostics, therapy and care of an adequate quality Display of important information accompanied by planned and adjusted time schedules and Parking and traffic control sufficient documentation to improve monitoring and the tracing Help and guidance of documents, analysis of the duration and result of the individual steps, specific competence of physicians, nurses, physiotherapists, etc. 13 14 Managing Quality Managing Quality Technical performance Technical Technical Technical performance performance performance Out patient and emergency services Waiting area Access Access to Access Access to services to to services services services In patient areas Discharge process Effectiveness Effectiveness of Effectiveness Effectiveness of care of of care care care Patient’s participation in decision making Cost of treatment Efficiency of Efficiency of service service delivery delivery Efficiency Efficiency of of service service delivery delivery Ethical consideration Interpersonal relations Interpersonal relations Interpersonal Interpersonal relations relations Respect for privacy and dignity of patients Psychosocial support Continuity Continuity of Continuity Continuity of services of of services services services Healthy environment Safety Safety Safety Safety Convenience of relatives Dietary and canteen services Physical Physical infrastructure Physical Physical infrastructure and infrastructure infrastructure and and and comfort comfort comfort comfort Information/education of patients / public Image of the hospital Choice Choice Choice Choice 15 16 Quality Provided by Doctors, Nurses and Medical-Technical Staff Managing Quality Quality assurance measures should aim to identify existing Structurally oriented quality assurance takes into account the quality deficits and initiate a process of change. doctors who are treating the patients, the nurses and the providers of medical-technical services, their qualifications Hospital staff members should not resign themselves to accepting and other information relevant to their person or specific existing deficiencies. tasks, as well as the administrative and financial aspects which They should neither put up with nor be satisfied with an influence the treatment process. unsatisfactory situation, as this would prevent them from the These facts are known to have a strong impact on the treatment proper discharge of their duties. process and the treatment results. The management, in particular, must be aware that it is their task In view of this, a hypothesis has been formulated according to to provide good quality. which a sufficient number of well-qualified staff, supported by Everyone working in a hospital should therefore view the high-quality and efficient technical equipment and the proper Guidelines as an invitation and incentive to start introducing organization, are in a position to provide high-quality services quality assurance measures as quickly as possible. and thus achieve the desired quality of treatment results. 17 18 3