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Transcript of Quality
(HEALTH DEPARTMENT)
MUNICIPAL CORPORATION OF DELHIMUNICIPAL CORPORATION OF DELHI
“QUALITY IMPROVEMENT
IN
HEALTH SERVICES ”
DR.P.P.SINGHDR.P.P.SINGH
Ex Medical Superintendent HRH & Ex Medical Superintendent HRH & SDN Hospital DelhiSDN Hospital Delhi
Ex. DIRECTOR PROJECT Ex. DIRECTOR PROJECT
IPPVIII- DELHIIPPVIII- DELHI
MEANNING OF QUALITYMEANNING OF QUALITY
•QUALITY IS A SET OF ATTRIBUTE OF SERVICES.
•TOTALITY OF FEATURES AND CHARACTRESTICS OF SERVICES THAT BEAR ON ITS ABILITY TO SATISFY GIVEN NEEDS.
•PROPER PERFORMANCE OF INTERVENTIONS THAT ARE KNOWN TO BE SAFE, AFFORDABLE TO SOCIETY AND HAVE ABILITY TO PRODUCE IMPACT ON MORBIDITY ,MORTALITY, DISABILITY AND MALNUTRITION.
WHY QUALITY.?
TO ENHANCE UTILISATION OF HEALTH SERVICES TO THE OPTIMUM.
•SUSTAINABILITY OF SERVICES.
THUS FOR QUALITY , REPRODUCTIVE HEALTH SERVICES HAS TO BE:-
1 . EFFECTIVE.
2. EFFIECENT.
3. OPTIMUM.
4. IN PROPER FRAMEWORK.
5.CLIENT SATISFACTION. OUTCOME.
INTER PERSONNNAL BEHAVIOUR
MODEL OF QUALITY FRAMEWORKMODEL OF QUALITY FRAMEWORK
THERE ARE A NUMBER OF FRAMEWORKS:-
1 .DONABADIAN.
2 .ZUDITH.
3 .I I P F FRAME WORK.
4. I C O M FRAME WORK.
5. U N F P A FRAME WORK.
EDUCATION ,SOCIOECONMIC
ENVIORNMENT SOCIAL,
POLITICAL,LEGAL.
TECHNOLOGICAL
FACTOR.
SYSTEM ORGANSATION SIDE EFFECT/
SUFFICIENT POLICIES SAFETY.
TRAINING
EDUCATION ,SOCIOECONMIC
ENVIORNMENT SOCIAL,
POLITICAL,LEGAL.
TECHNOLOGICAL
FACTOR.
SYSTEM ORGANSATION SIDE EFFECT/
SUFFICIENT POLICIES SAFETY.
TRAINING
CLIENT
MANAGEMENT
SERVICESDELIVERY
TECHNOLOGICAL
1 . DONABEDIAN FRAME WORK. STRUCTURE PROCESS. OUT COME.
2. I I PF FRAME WORK A. CLIENTS RIGHT– Information
----RIGHT OF INFORMATION
-- RIGHT OF ACCESS.
--Safe Services
--Privacy & confidentiality.
Dignity, Comfort,& expression of Opinion.
B. PROVIDERS NEEDS.-Facilitative supervision & Management
--- Informative Training & development
--- Supplies, Equipment & Infrastructure..
FOR F.P. METHODS (QUALITY AT EACH STEP)
. Choice of methods. . Information
.Technical competence .Client Provider Relation ship
.continuity of care. .Appropriate Services.
World of
mouth
Personnel
needPost exposure
expected
Perceived
services
Dimension of
services quality
reliability
responsive
ASSURNCE
EMPATHY
TANGIBLE
PERCEIVED QUALITY
SERVICES.
ES<PS(QUALITY)
ES=PS(SATISFACTORY)
ES>PS(UNACCEPTABLE)
CUTOMER SERVICES EXPECTATIOINMODEL
ADEQUATE DESIRED
ZONE OF TOLERANCE
LOW HIGH
LEVEL OF
EXPECTATION
LEVELS OF QUALITY1.QUALITY ASSURANCE(QA) BY MANAGEMENT LEVEL.
2. SYSTEM IMPROVEMENT
3.QUALITY IMPROVEMENT(Qi) BOTH EMPLOYER&EMPLOYEE
INVOLVED
4.TOTAL QUALITY MANAGEMENT (TQM)
CORPORATE THINKING.
Death Review and CPC.
S Q C – in X RAY & LAB.
Hospital Based Gross Death Rate,
Institutional Death Rates
Anesthetic Death Rates.
Postoperative Mortality Rate.
M M R & I M R in hospital.
Caesarian Rate
Post-operative Infection Rate.
H A I rate.
Bed Occupancy, Average of Stay., Re-admission rate
Recurrence Rate, Autopsy Rate.
MEDICAL AUDITS, EQUIPMENT AUDIT
HOW TO UNDERSTAND THE CLIENTS NEED/PERCEPTION
1.LISTENING,LIFE SITUATION, PREFERANCES, CHOICES
2 SURVEY&FOCUS GROUP DISCUSSIONS WITH COMMUNITY
3.OBSERVATION OF CLIENTS &FEEDBACK ABOUT SERVICES.
4 .STUDY METHODS/PROCEDURES
5 .STUDY CAUSE OF DISCONTINUATION/NON ACCEPTANCE OF SERVICES.
6 .BEING CLOSE TO CLIENTS(BEFRIEND)
QUALITY ASSURANCE PROCESS
NOT ACCEPTABLE
ACCEPTABLE
IDENTIFICATION OF REMEDIAL ACTION
IMPLEMENTATION OFREMEDIAL ACTION
PROBLEM ANALYSIS
INVESTIGATION
IDENTIFICATION OF PROBLEM AREA
PRIORITIZATION OFPROBLEM
ASSESSMENT OFQUALITY CARE
QUALITY IMPROVEMENT TOOLS
1.COMPARISION WITH STANDARD AVAILABLE.
2CLIENTS FEEDBACK BY SURVEY,EXIT INTERVIEWS
3.GROUP DISCUSSION
4.FOCUS
5.OPEN DISCUSIONS ON TOPIC PLANNED
6.MYSTERY CLIENT STUDIES.
OPERATION RESEARCH
PLANS FOR IMPROVEMENTS
ELEMENTS OBSERVATIONCHARACTRESTICS
STADERAD
A INPUTB. PROCESSC .OUTCOME
1.BY FLOW CHART ANALYSIS
2.BY CAUSE & EFFECT CHARTS
3. SYSTEM MODEL
(DONABADIAN FRAMEWORK)
DATA COLLECTION
INDICATOR SOURCE METHOD OF SAMPLE FREQUENCY PERSON
COLLECTION RESPONSIBLE
INPUT
PROCESS
OUTCOME
INTERVENTIONS TO IMPROVE THE QUALITY
A.TRAINING----I INDUCTION
IIREFENCE/PERIODIC
TYPE--INTER PERSONNAL
--SKILL
--MANAGEMENT
B,PROPER REFERALS--TIMELY
--SPECEFIC
C.SUPERVISON----FACILITATIVE / SUPPORTIVE
-CHECK LIST.
D.MODEST INVOLVENT OF CLIENTS--VOICE
---CHOICE
C O P E METHOD(CLIENT ORIENTED PROVIDERS EFFECTIVE SERVICES)
A.FORMATION OF COMMITTEE/TEAMS
(AFTER CLIENTS ASSESSMENT)
I.SELF ASSESSMENT.
II.CLIENT INTERVIEWS
IIICLIENT FLOW ANALYSIS
IV.MEDICAL RECORD REVIEW
V. ACTION PLAN.
B. ACTION PLAN STATUS
I.THE PROBLEMS
II.THE CAUSES
III.THE RECOMMENDATIONS
IV. BY WHOM
V.BY WHEN.
KEY SUCCESS FACTORS FOR RCH PROGRAMME
1.HEALTH WORKERS
2.TIMELY SUPPLY OF DRUGS,CONTTRACEPTIVES,VACCINE
3,TRAINING
4.SUPERVISION
5.METHOD MIX
.
6.ACCESSIBILITY.
KEY INDICATORS
1. TIMELY SUBMISSION OF REPROTS.
2.ADEQUACY OF MONITORING IN THE FIELD.
3ORGANISING I. E.C ACTIVITIES.
PROBLEM SOLVING &MOTIVATION SKILL.
Developing a Customer’s or Focus.
Creating Staff involvement and ownership in QI
Emphasis on Improving process and system rather than blaming individuals.( Environment )
Cost Consciousness and efficiency.
Continuous quality improvement.
Staff development and Capacity building.
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THANK YOU VERY MUCH