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The Role of Clinicians in
Quality Transformation
Dato Abd Jamil Abdullah
Head of Surgical ServicesMinistry of Health
Consultant Surgeon, HSNZ, Kuala Terengganu
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Traditional roles
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Traditionally
Doctors
Nurses Allied Health
PATIENT CARE
Administrators
Finance Engineers
ORGANISATIONALCARE
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Clinician participation
CEOs in highest-performing organisations
engage clinicians in dialogue and in jointproblem-solving efforts
Enhancing Engagement in Clinical Leadership, Acdemy of
Royal Medical Colleges and NHS Institute, 2007
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Clinician power
Hospitals with greatest clinician
participation in management scored 50%higher on drivers of performance than
hospitals with low levels of clinical
leadership
Pedro J Castro et al, A Healthier health care systemfor
the United Kingdom Mckinseyquarterly.com, Feb 2008
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Clinicians & Quality
Quality not in Medical School syllabus
Clinicians not formally taught leadership &
transformation skills
Doing better and process management
usually self-taught
Gold standardDouble blind controlled
trials & evidence-based medicine
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My QA journey in
KKM
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QA Workshops - 1991
QA WORKSHOP FOR MEDICAL
SUPERINTENDENTS &
COORDINATORSPort Dickson
25.02.91- 02.03.91 7 days
06.05.91- 08.05.91 5 days
NIA, H.S.A, Problem-Solving Approach
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Achievable
Benefit
Not
Achieved
(ABNA)
Avedis Donabedien
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Problem
Prioritisation
QualityAssurance
Cycle
Problem
Analysis
Quality
Assurance
Study
Identification of
Remedial
Actions
Implementation of
Remedial Actions
Re-evaluation of
the Problem
Problem
identification
Problem solv ing
approach cycle
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QA Study Tour, USA
18.10.93 - 08.12.93 2 months
New York, Baltimore, Kansas City,
Chicago, Salt Lake City, Los Angeles
Different QA approaches
No part time QA clinicians
Good non-clinical support
QA Cycle, Incident reporting, process
control
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1stNational QA Conference
Kuala Lumpur
13.12.94 - 15.12.94
Awareness of Quality Assurance
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Qa Management &
Methodology Course
27.11.95 - 30.11.95, Kuala Lumpur
Exposure to other methodologies Benchmarking, risk management
Report cards
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Other Quality Initiatives
POMR
Credentialling
TQM
ISO
Accreditation
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Quality Related Exposures
QA
Courses/Workshops
QA Conferences QA Conventions
ISQua Conferences
Travelling Fellow
ISO
Safe Surgery
TQM Accreditation
Infection Control
Strategic Planning 5S
TGP
P5VS
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Other Courses
MANAGEMENT FOR CLINICIANS,
18.03.96 - 22.03.96, Genting
MANAGEMENT FOR CLINICIANS ,
16.10.96 - 17.10.96 , Air Keroh
KKM & Manchester University
HEALTH TECHNOLOGY ASSESSMENT,
25.03.96 - 26.03.96
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CLINICAL PRACTICE GUIDELINES WORKSHOP
08.12.96 - 10.12.96
K.Lumpur
STRATEGIC MANAGEMENT by INTAN Kijal
CREDENTIALLING WORKSHOP, Kuala Lumpur
KKM, Academy of Medicine Malaysia
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MSQH Accreditation
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QA Convention
KONVESYEN QA, Kuala Terengganu
28.08.0029.08.00
Every 2 years
2013in Kota Bharu.
A result of many echo workshops
Showcase of QA efforts
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Patient Safety
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THE WHITE BOARD
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Intra-op Communications
Check-In
Intermittent report
`Shout it Out
Pre Closure
disclosure
Can westart
now?
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Intra op. communication
Shout out
One pack in !Stable,
B/P 100/60
Intermittentcommunication
Photo Credit : SSSL, H Ipoh
Hows he doing?
One pack
IN
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Pre-Closure DisclosureClosing now
Preparation of
Final swab
count
Closing sutures
Prepare reversal
Plan for the next
case
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Communication with Relatives
Informing of progress
Showing of specimen
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The operating surgeon should do
pre- & post operative visits.
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my 14March201130
Launching of
MOH Save Surgery Saves Lives Initiative
in Langkawi , 15thNov 2009
Officiated by Director of
Medical Development Division, MOH
Y.Bhg. Dato Dr Azmi Shapie
THE MALAYSIAN THEMESaferSurgery
Through Better Communication
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Safe Surgery Workshops
Involved all category
of OT staff
Clinician driven Can only minimise
errors
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PROBLEMS
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Surgical Error
Prevention
Capt. Stephen W. HardenBetter Teamwork. Better Systems. Better Care.
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Thoughts + Act ions +
Hab its + Charac ter =
Culture
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The Formula for Changing Culture
Thoughts w i th training
Act ions w i th system tools
Habi ts w i th leadersh ip act ions
Character
Culture
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Getting clinicians on
board
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Why Clinicians need to be in
Process owners
Role models
Natural leaders
Knowledgeable
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Advantages
People of Influence
When they know & understand quality
Understand standards
Support quality initiatives
Lead & give input
Innovate and change for the better
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Why few clinicians involved
Not sure if time is well spent
Assumption that a long learning period isrequired
More interested in scientific, clinical-relatedimprovements
No incentivesemployment, promotion,financial
Lack of opportunities for trainingin-house, abroad
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What will interest clinicians?
Work related quality
They give the input
Support to collect and analyse data
Platform to share
Incentives to go on
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SURGICAL OUTCOME AUDIT
REPORT
Standard: 3%16%
Problems with Audit:
Reporting, reliability of data collection
CLINICAL AUDIT
YEAR TOTAL CASES
COMPLICATION
RATEEL EM EL EM
2010 804 1110 3.50% 5.10%
2011 827 913 2.50% 7.30%
2012 597 1013 7.70%) 5.40%
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Reasons for failed surgery
TOTAL FAILED 2010 2011 20129
TOTAL SURGERY 4753 5267 3458
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Dr. C, Normal Vs Abnormal Finding, Apr-Jul 05
0
10
20
30
40
50
60
Apr May Jun Jul
Month
C
ases
TOTAL OGDS OGDS AB-OGDS AB-SIGM
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What role
Leader
Role model
Teacher
Enforcer
Champions
Whistleblower
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Levels of Clinical
Leadership
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Institutional Leader
CEO, DG
Clinician & Leader for organisation
Little patient contact
Able to communicate vision
Skilled in strategic thinking, succession
planning, political-savvy,
Strong negotiation skills and influence
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Service leader
Head of Specialties and services
Advocate of own service
Well connected to centres of excellence
Innovative
People and service development skills
Champion of evidence-based medicine
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Frontline leader
Outstanding clinicians
Passionate about work, respected by
collegues Can see opportunities for improvement
Understands quality improvement
techniques & tools
Team worker
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To transform
Clinicians cannot just do ONLY clinical
work day-in & day-out
Grab any opportunity to learn extra skills
Fit into whatever comfortable level of
leadership role
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Understand and involved with
Management Systems
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Clinicians must be willing to be
part of the organisations tinktank
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Involve in non-clinical training
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Getting to quality
- aware
- educate
- practice
- internalise
- incentives
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Conclusion
Clinicians MUST be involved with Quality
Initiatives
Exposure & training essential Champions will emerge to keep the flag
flying
Incentives sustain the momentum
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Quality is a
journey ,
not a destination
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Thank you
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