SINA HEALTH EDUCATION AND WELFARE TRUST ASIF IMAM, M.D. MARCH, 2011.

SINA HEALTH EDUCATION AND WELFARE TRUST

ASIF IMAM, M.D.

MARCH, 2011

THE ORIGINS OFSINA HEALTHCARE SYSTEMSSTARTED AS A PROTOTYPE PRIMARY HEALTH

FACILITY

IN BALDIA TOWN, KARACHI IN 1998

OBJECTIVES :

1. To evaluate the existing primary healthcare

systems in Pakistan

2. To develop an indigenous, practical, evidence-

based, quality-managed, auditable primary

healthcare system for developing countries

Vision

Quality primary healthcare should be

accessible to everyone in our society


Our quality mission

TO DEVELOP A STANDARDIZED, QUALITY-MANAGED,

INDIGENOUSLY COMPATABLE PRIMARY HEALTHCARE

SYSTEM FOR WIDESPREAD APPLICATION IN PAKISTAN


DEVELOPMENT OF QUALITY MANAGEMENT COMPONENTS

STANDARD OPERATING PROCEDURES

QUALITY MANAGEMENT DOCUMENTS AND PROCEDURES

TRAINING OF STAFF IN THE STANDARDIZED SYSTEM

QUALITY AUDITING PROCEDURES AND TOOLS

REMEDIAL AND REPRIMANDING POLICIES ON AUDIT RESULTS

SINA HEALTHCARE QUALITY-MANAGEMENT COMPONENTS

1. DOCTOR TO PATIENT HEALTHCARE DELIVERY QUALITY

2. PARAMEDIC TO PATIENT HEALTHCARE DELIVERY QUALITY

3. PHARMACY TO PATIENT SERVICE QUALITY

4. LABORATORY SERVICES QUALITY

5. INFECTIOUS DISEASE CONTROL / FACILITY HYGIENE QUALITY

6. MEDICAL INSTRUMENTS CALIBERATION / MAINTENANCE

7. FACILITY ADMINISTRATION / PATIENT SATISFACTION QUALITY

Recordkeeping System:Registration Card Patient Files


DOCTOR TO PATIENT HEALTHCARE DELIVERY QUALITY

1. DOCTOR RECRUITMENT CRITERIA

2. PRE-EMPLOYMENT ( INDUCTION) SYSTEM TRAINING

3. DOCUMENTING OF PATIENT CARE ON QUALITY MONITORING TOOLS

4. AUDIT OF DOCUMENTED PATIENT HEALTHCARE

5. ON-GOING ON JOB RE-TRAINING (CME)

6. REMEDIAL MEASURES OR REPRIMAND ON QUALITY AUDIT RESULTS

Employment System:Doctors Selection Criteria:

Family Medicine experienceFCPS / MRCGP, preferedEntrance Test

Pre-employment ( Induction) TrainingTo be system trained before doing

clinics


Candidate Evaluation Form

Place of Interview:

Screened by: Designation: Date:

1st Interview Date: Panelists 1 2 3

2nd Final Interview Date: Panelists 1 2 3

Required Position Profile of the Candidates: Instructions Please select one box per area. Selection should be based on:

1. Similarity to requirements as specified in the Position Profile 2. Interviewer’s understanding of candidate’s acquired level, skill or experience

Use the “Point Assessment” to rate the candidate level

1 Pre-Interview

Position Profile Candidate Exceeds Exact match Acceptable May be

considered

Required Actual 8-10 5-7 2-4 0-1

Age

Education/ Qualification

Industry Experience

Function Experience

Computer Skills

Required Competencies

Total

Total Score

Exceeds Exact match Acceptable May be

considered Score

50-60 39-49 28-38 17-27

HR Requisition Received:

Full Name (in block letters): First Name Middle Name Last name

Position Title: Grade:

Date of Birth:

Department: Division:

SINA HEALTH, EDUCATION & WELFARE TRUST Candidate Evaluation Form HRM-RS/4/003

Issue 1

CME CME SMS ServiceX3/ week

Monthly½ day

group teaching

Feedback onMCQ and SMSperformance

Learner-ledsections

Pre-readingmaterials

Pre and postSession MCQs

Half yearly 1-to-1 reviewand PDP development

Monthlyaudit and

1-to1 teaching

Recordkeeping SystemPatient FilesPatient Registration

Cards14 Algorithmic

Protocols


Compromise On

Quality

Sina Protoc ol FEVER

DATE: W / S / D of:

REG NO: TEL: ADDRESS:

AGE: HABITS: CIG. / NASW. / PAAN / GUTKA

CLINIC:

TEMP PULSE PAIN SCORE CURR MED:

BP Si/L/St RR

Ht Wt N . A NAME & SIGN:

C HIEF C OMPLAINT

Fever Nasal Cong. Earache Other Symptoms

HI / LO

SORETHROAT HOARSENESS

WT. LOSS

BODYACHE RASH

FOC USED EXAM Other Findings

Eye Nose Abdomen

Ears Neuro

Lungs Joints

Throat Heart Skin INVESTIGATION Red Flags

CP / ESR MP UDR SDR ALT/ LFT CXR US ABDOMEN Fits

BLOOD C/S URINE C/S Shortness of breath

DIAGNOSIS TREATMENT Altered consciousness

Viral More than 10 days

Wt loss

Neck stif fness

Bacterial: Hyperpyrexia

Pharyngitis Complicated P.falc. Malaria

Tonsillitis Sinusitis Pneumonia

Otitis Media Heat stroke

Bronchitis Other

Pneumonia

UTI

Enteric Fever

Liver abscess REFER

Malaria

Meningitis

Encephalitis

T.B T MYPF RIF3/RIF4 ETHA

Heat Stroke COOLING MEASURES

I / V FLUIDS REFER

Drug Reaction

Other

Diagnosis

PATIENT EDUC ATION / ADVIIC E

T / C AMOX / AUGM / AZIT

Rx / Days FUP REF : Yes / No ZF Pnemonic& Sign:

T/ C NITR / CIPR / CEFI

SINA HEALTH, EDUCATION & WELFARE TRUST

NAME:

OCCUP:

Rash

ALLERGIES:

T / I CEFI / CIPR / CEFT

Sorethroat

Lymph Nodes

DIFF. BREATH. NIGHT SWEATS

CHEST CONG. / WHEEZE

CHILLS / RIGORS MENTAL CONFUSION

ABOVE +

T / C AMOX / CEPR / AUGM / AZIT

EAR PAIN L / R / B

CONT / INTER.

COUGH DRY / CLR / YEL. / BLOOD

T CHL / PROM / LORAT

S DEXT / DXCP

DIFF. SWALLOWING

COOLING MEASURES / STEAM INHALATION / GARGLES

Neck/ Tender Thyroid

CH. DIS: DM / HTN / ASTHMA / TB

JOINT PAIN / SWELLING

ABD. PAIN / DIARRH.

URINE BURN. / FREQ. / YEL.RUNNY NOSE CLR / YEL / NASAL CONG.

FEVER ×

NAUSEA / VOMT.

HEADACHE

T/I METO/ CEFU/CEFT

NAD-√ Not Done-— Abnormal- Description

STOP Rx, CHL / PROM / LORA / PRED

T PYRA PYRI

REFER

T CHLQ / ARTS + T PRIM (FOR VIVAX)

C DOXY / CLIND

INJ CEFT / CEFO / AMPI

INJ CEFT / AUGM / LEVO

T PC / IBU

FEVER PROTOCOL

Monthly Doctors’ Audit:Protocol based audits

Clinic based audits

Proper one to one feedback to every

doctor

Review for improvement every month

Proper record keepingSINA HEALTH EDUCATION AND WELFARE TRUST

Doctors name_________________ Clinic___________________ Month of Audit______________

Well Done=2 Adequate=1 Inadequate=Below 0

Fever respsys backpain chestpain GIT headache skin dizziness gynae injury other Comments

Protocol history

Physical exam

Diagnosis

Investigation

Treatment plan

Patients advice

Appropriate=1 Inappropriate= 0

Antibiotic usage

Followup

Referral

Sign documentation

Red FlagsMarks Obtained

Total score __________________ out of 16No of patients seen __________________

Receivers comments_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Providers comment_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_______________Discussed:Yes_______ No:________ Receiver's Signature

Next audit:______________________Provider's Signature

Doctor Audit Form

Description

Clinic Based Audit CONTINUITY OF CARE AUDIT FORM

Doctor: _____________________________ Clinic: _______________________________

Medical Record No: ____________________ Patient Visit Dates:_____________________

Date Of Audit: ______________ Patient: Initial: ____ FUP: ____ Protocol: _____________

0 = Inadequate 1 = Adequate 2 = Well done NA = Not aplicable 0 1 2 NA

Protocol history

Physial examination

Patient education / advice

Follow up plan

Referral

Sign documentation

0=Inadequate 1= Adequate 2=Welldone NA = Not Applicable0 1 2 NA

Diagnosis consistent with H / PAppropriate diagnostic investigationAppropriate treatment planAntibiotic UseAppropriate Continuity of Care

Overall Score : __________________/ 22

Reviewer's comments:

Recommendations:

Corrective measures taken from previous audit:

Corrective measures not taken from previous audit:

__________________________Discussed: Yes: ____No: _____ Assessee's SignatureNext Audit: _________________ ___________________________

Reviewer's Signature

COMMENTS

COMMENTS

Half Yearly Evaluation Of DoctorsEvery six months

Record of the last 6 months performance

One to one feedback

Discuss about the weaknesses and

solutions for improvement

Personal development planning forms SINA HEALTH EDUCATION AND WELFARE TRUST

Half Yearly Evaluation FormDOCTORS HALF YEARLY EVALUATION FORM Doctor's name_________________________

0 1 2 3Knowledge

Average CME posttest scores <60% 60-69% 70-79% >80%Audit scores <70% 70-74% 75-79% >80%SMS-CME scores <70% 70-74% 75-79% >80%CME attendance <70% 70-79% 80-89% >90%

ProfessionalismPunctuality <85% 85-89% 90-95% >95%Patient volume 10pts/hr InadequateAdequateClinic attendance <80% 80-84% 85-89% >90%Patient satisfaction scores <60% 60-69% 70-79% >80%

Communication SkillsPatient communication skills Poor CompetentGood ExcellentInterpersonal relationship with the health team Poor SatisfactoryGood Excellent

Referral Comprehensive written notes No YesAppropriate referrals No Yes

Over all scores /30Previous Performance /30Unsatisfactory <16 Satisfactory=16-19 Good=20-22 Excellent>22

Suggestions for improvement (to be formed into SMART targets on PDP overleafand reviewed in the next evaluation)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Constraints that are holding up change or progress_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Comments ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Name of evaluator_________________ Name of Doctor________________________Signature of evaluator_____________ Signature of doctor_____________________Date___________-

PDP formPDP FORMDr_____________________

Development needs How to address

Date to achieve the goal

Outcome I plan to see

e.g. gain greater skills in managing common gynae problems

e.g. use MCQs to develop knowledge on management, try 1 or 2 on line learning modules e.g. 1/1/11

e.g. increased scores on gynae protocol audits

SINA Health Manpower Training Program : Internal

Lack of quality human resource

Training upon employment

Continuous education

Periodic exams & evaluation

Performance feedback

PARAMEDIC OSCE CHECKLIST

Name_____________________ Clinic__________________ Date________________Examiner Name__________________ Examiner Sign_________________________

Proper Uniform Y/N Wearing ID card Y/N Watch Y/NNails cut Y/N

BLOOD PRESSUREYes No

Blood Pressure Positioning appropriateCuff Applied ProperlySystolic BP measured properlyCuff deflated slowly

Pulse Approproate pulse used Yes=2Time duration appropriate No=0

Temperature Thermometer cleanedPt asked about place of measurement

Resp Rate Measurement appropriate

Weight Measured appropriately

Total Marks Obtained _______/ 20

INJECTION Yes No

Gloves wornYes=2

Needle filled appropriately No=0

Positioning of needle appropriate (IM inj)

Positioning of needle appropriate (SC inj)

Needle discarded appropriately

Total Marks Obtained________/ 10

PHLEBOTOMYYes No

Gloves worn

Positioning of patient appropriate Yes=2No=1

Appropriate blood vessel used

Needle discarded appropriately

Saniplast applied

Total Marks Obtained________/ 10

DRESSINGYes No

OSCE CHECKLI

ST

TPR Station:

Dressing station:

Dispensing station:

SINA Pharmacy Services

Standard Formulary GMP Certified Medicines Central PurchasingFIFO Inventory ControlHygienic PracticesTrained StaffQuality Control


LABORATORY QUALITY CONTROL

Internal Assessment

Continuous quality improvement

External Assessment

Monthly comparative testing with AKUH lab

Adherence to SOP manuals

Quarterly audits

Medical Centre Audit:Monthly audit by head office staff

Follow proper checklist

All registers and written

documentations are checked

Medical equipments checking

Corrective actions takenSINA HEALTH EDUCATION AND WELFARE TRUST

CLINIC:________________ DATE:_________________

Auditor:_________________ Designation:_____________

Yes No Corrective ActionAttendanceSignatureTime in & Time outAbsent / Late

Reception WindowTimelinessPatients file searchableToken GivenRegister Prepared properly

Financial statusMantainance of manual cash registerCash TallyRegular Cash Deposit Filing of documents

EquipmentsEquipments repairableEquipments RequiredCalibrationEmergency KitSterilization of EquipmentsO2 cylinder status

Laboratory CollectionProper Blood SamplingRegister EntrySlip Book TallyUltra Sound Register MaintaindX- Ray Register Maintaind

Yes No Corrective ActionCleanlinessBed SheetsWallsFloorWash BasinInstrumentsEquipmentsCabinetsWash Room

ComputerWorking properly

Data updated

MEDICAL CENTER AUDIT CHECK LIST MEDICAL CENTRE AUDIT CHECKLIST

Standard Operating ProceduresInstrument Sterilization

Clean the dirty instruments with cotton swabs.Wash with tap water.Dip the instruments in antiseptic solution for

5-10 min.Wrap the instrument in cotton and keep in the

instrument tray Keep the tray in sterilizer at 150 F for 20 min.


Clinical Waste Segregation

Red Bags Hazardous Waste

Danger BoxSharps & Needles

Green Bags General Waste

SINA Waste ManagementSINA Waste Management ServiceService


SINA Waste Management Service

78 km twice a week

BALDIACLINIC MACHAAR CLINIC

HIJRAT CLINICSABZIMANDI CLINIC

CDGK INCINERATOR



SINA Management System

Monthly Meeting of Clinical Coordinator and Clinic

Manager

Minutes By Clinic Managers

Clinical Coordinator Trustees and

Operation Manager

Solutions Provided To

Clinic Manager

SINA HEALTH EDUCATION AND WELFARE TRUST ASIF IMAM, M.D. MARCH, 2011.

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Transcript of SINA HEALTH EDUCATION AND WELFARE TRUST ASIF IMAM, M.D. MARCH, 2011.