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healthcare quality and safety

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Ahamed Masooth mohamed
Ahamed Masooth mohamed

Fully meeting the needs of those who need the service most, at the lowest cost to the organization, within limits and directives set by higher authority

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Healthcare Quality & Safety
Managing Healthcare – Global Trend Challenges Faced by Many Governments Need to provide healthcare for the even if they are unable pay Provide healthcare, public good, with limited resources and competing needs
Managing Healthcare – Global Trend Challenges Faced by Many Governments Providing Quality Healthcare Expectations of better healthcare from people. Accountability: Clinical Effectiveness & Financial Accountability Success of a government can sometimes depend on how well they meet peoples’ demands for healthcare
Man Trend Challe ments Incr Health - Incre aging Healthcare – Global nges Faced by Many Govern easing Expenditure on care ase in the cost of healthcare
Stakeholders Perspective…. Patient • Needs of the client • Expectations • Outcomes • Relief from the ailment • Service & Treatment with compassion • Services at affordable cost/on nonpaying basis Provider (Public Hospital) • Able to meet the needs of the masses • Medically Safe • Professionally ethical • Accessible • Acceptable • State of the art-technical care • Outcome comparable to known standards Management (Government /Funding Agencies) • Quality Improvement and impact utilization • Investment and Return on Public Funds • Relevant to Community • Relevant to national demands • SUSTAINABLE
Quality of Care Quality of Care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. (IOM 1990)
Quality in Public Care Fully meeting the needs of those who need the service most, at the lowest cost to the organization, within limits and directives set by higher authority (Ovretveit)
13 Total Quality Management A comprehensive & fundamental rule or belief for Leading & operating an organization aimed at, Continuous improving performance over a long term by focusing on Customers while addressing the needs of all stakeholders
Effectiveness And Efficiency Optimum Utilization of Resources Uniformity In Processes Community confidence Waste Reduction Safety and risk reduction Improved Health Outcomes Reduced Cost of Healthcare
Patient-Driven Quality according to Importance (US survey) Source: The Quality Connection in Health Care by Lynne Cunningham 1. Immediate attention and triage 81 2. Care first and then paperwork 67 3. Knowledgeable personnel 62 4. Explanation in terms we can understand 60 5. Appropriate waits/explanations if you have to wait 57 6. Friendly staff and bedside manner 56 7. Enough staff 48 8. Clean facility 34 9. Ancillary support readily available 33 10. Accessibility/easy to find/physical facility 31 11. State of the art equipment 22
Description Implications for Patients Implications for Staff Cost Implication Inadequate clinical details given to Pathology Department Delays to Patients Risks of incorrect tests Extra work for pathology staff Extra conversations with clinical outcomes Extra pathology costs Increased length of stay More complaints Some appointments cancelled Patients kept waiting over an hour for pre- booked appointments Stress and frustration Can’t park as car parks over-full Ambulances held up Staff on the defensive Extra staff time on explaining and mollifying Need for larger waiting rooms and car parks
• Improve patient care • Patient centred approach • Reduce Risk • Learn from mistakes • Be accountable Engage and inform staff :Clinical engagement Promote an open culture: What is wrong? not who is wrong?
Roots – 5S Kaizen, Team Work BPR Leadership Total Quality ManagemeMnedtia Reports Attitudes Seeds Fertilizer
KAIZEN LEADERSHIP Water Trunk Root
Total Business Policy Toyota Way Lean MX Six Sigma TQM ISO 900O BPR 5S . Succession Plan in an Organization
C4C3C2C1 C7C6C5 B4B1 B2 B3 B5 B6 B7 A4 A5 A6 A7A1 A2 A3 A4 A5 A6 A7A1 A2 A3 B4B1 B2 B3 B5 B6 B7 C4C3C2C1 C7C6C5 •Reserved seats •Matching names SEITON
Dichlophanic Sodium Dilantin Sodium D. Sodium Di. Sodium SALA Concept
Dichlophanic Sodium Dilantin Sodium
Visual Control 11/26/2018
D HQSMINISTRYOF HEALTH,SRI LANKA Sensitize Institutionalize Formalize Standardize Professional Colleges
D / HQS MINISTRYOF HEALTH,SRI LANKA Sensitize Institutionalize Formalize Standardize Professional Colleges
34
We can develop beautiful tools and mechanisms but people are still the key for success
Time Technology Development Risk Gap Technology Development and Risk in Healthcare Training Development c1950 c2001c1980 Source: Chris Quinn, Newcastle Hospitals NHS Trust,England
39 Professionally (and humanely) agreed level of performance for a particular setting which is Desirable Achievable Measurable Standard
• Dignity • Basic human needs • Prompt attention in care and treatment • Confidentiality • Communication • Autonomy Humanely Namely,
QualityHigh Specification 1 = Bad Q – Not accepted Specification 2 = improved Q – Not accepted Specification 3 = accepted Q – Accepted Standard is a measuring yard of Quality Standard is the minimum level of goodness Standard stipulates the acceptable Quality level Standard is the demarcation between Good and Bad
Waiting time <45 min Waiting time 60 min Standards Vs. Performances Waiting time 50 min Waiting time 55 min
Waiting time <30 min Waiting time 35 min Waiting time 40 min Waiting time 45 min Continuous Quality Improvement
Comments 1. Structure, process and outcome – not attributes to quality. Provides kinds of information, based on which one can infer whether quality is good or bad 2. Predetermined relationship between three approaches: Structure Process Outcome (Linear relation – simplified version. But much complex in reality)
In Diagnosis and Treatment Structure OutcomeProcess Characteristics of the diagnosis laboratory Physician’s Characteristics Test performed by the laboratory Test ordered by the physician Results of tests interpreted by the physician Treatment chosen and executed by physician, other personnel and patient Results of tests Diagnosis: the illness and its characteristics Change in the patient’shealth
Private Public Preventive Curative Technical Quality Management & System Quality Functional Quality Quality & Safety
But it comes to patient safety, the numbers are startling …..1 in 10 patients will be harmed during a hospital stay WHO, 2014
The risk of a hospital-associated infection is significant In the USA, if you are admitted to a hospital, you have a 5% chance of contracting an HAI People per year get an HAI during a hospital stay 2 million Of these > 99,000 People die annually from HAIs US$ 28 – 33 billion per year in healthcare costs30% Of Intensive care Unit patients developHAI
Not just a problem for Hospitals Of 8.8 million Outpatient adverse drug events, more than 3 million are estimated to be preventable James 2013
In Sri Lanka……………… Illegible Hand writing – 65%
Patient Safety Definition • The avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of healthcare. These events include ‘errors’, deviations’, and ‘accidents.’
QualityofCare High QualityImprovement Raising the Ceiling Patient Safety Raising theFloor
The Arrow Regulators Government Hospital Management Operational Staff Work Actions Adverse Event Latent Failures Active Failures
Patient Safety is not a law or regulation It is a culture
The Evolution of Safety Culture Pathological Who cares as long as we are not caught Calculative Safety is driven by Mx systems with collection & analysis of data. Primarily driven by top Mx. rather than looked by the workforce Reactive Org. Start to take safety seriously but there is only action after incidents Proactive Workforce involvement starts. We work on the problems that we still find Generative Safety is how we do business round here – safety is inherent part of the business
QualityofCare High Quality Improvement Raising the Ceiling Patient Safety Raising the Floor
Safety Culture Informed Culture Those who manage and operate the systems have current knowledge about the factors that determine the safety of the system Reporting Culture Prepared to report their errors and near misses Just Culture Encouraged and even rewarded for providing safety-related information, but must be clear about what is acceptable and unacceptable behavior Learning Culture Willingness and know-how to drawthe right conclusion from a safety information system and to implement reforms Open Culture Staff feel comfortable discussing patient safety incidents and raising safety issues with both colleagues and senior managers
An eye towards improvement………….. ALL EVENTS Repor t Event s Analyze Events Learn from Events Culture Chang e Reality Understandi ng Data Not quite enough Feedback to Reporter
An eye towards improvement………….. ALL EVENTS Repor t Event s Analyze Events Learn from Events Fix Systems Culture Chang e Reality Understandi ng Data Feedback to Reporter Patient Safety
Same-handed single patient room With evidence-based design (EBD) safety features Large bathroom door Direct path with hand assist to toilet Handwashing sink with sight line Dublin Methodist Hospital, Dublin Ohio Design: Karlsberger with Cama Sound-absorbing ceiling tile
Surfaces commonly contaminated by MRSA Methicillin-resistant staphylococcus aureus) R.S. Ulrich with P.A.Wilson
Centrally Driven, Locally Lead, Clinically Oriented, Patient centered CQI Programme
Implementation Expanding Sustaining Quality Introduction Phase 1 Preparation Phase 2 Phase 3 Phase 4 Phase 5 Road Map for Quality Improvement
Measuring Performance of Hospitals Hospital Performance Hospital 1 Outstandingly Achieved (OA) Hospital 2 Exceptionally Achieved (EA) Hospital 3 Markedly Achieved (MA) Hospital 4 Markedly Achieved (MA) Hospital 5 Somewhat Achieved (SA) Hospital 6 Exceptionally Achieved Hospital 7 Less Achieved (LA)
Start with what is important; then do what is possible; suddenly you realize that you will be doing what you thought was impossible. St. Francis of Assisi
11/26/2018
11/26/2018
11/26/2018
11/26/2018
Teamwork rather than Individual Heroes creates Safety
Elder Toyoda to encourage his son. that is Sakichi told to Kiichiro • Everyone should tackle some great project at least once in their life. I devoted most of my life to inventing new kinds of looms. Now it is your turn. You should make an effort to complete something that will benefit society.
‘Mantra’ of Quality Improvement

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organizing care and services to achieve best outcome
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improving quality and safety in patient care delivery .
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kaizen IN Health sectors
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healthcare quality and safety

  • 2. Managing Healthcare – Global Trend Challenges Faced by Many Governments Need to provide healthcare for the even if they are unable pay Provide healthcare, public good, with limited resources and competing needs
  • 3. Managing Healthcare – Global Trend Challenges Faced by Many Governments Providing Quality Healthcare Expectations of better healthcare from people. Accountability: Clinical Effectiveness & Financial Accountability Success of a government can sometimes depend on how well they meet peoples’ demands for healthcare
  • 4. Man Trend Challe ments Incr Health - Incre aging Healthcare – Global nges Faced by Many Govern easing Expenditure on care ase in the cost of healthcare
  • 5.
  • 6. Stakeholders Perspective…. Patient • Needs of the client • Expectations • Outcomes • Relief from the ailment • Service & Treatment with compassion • Services at affordable cost/on nonpaying basis Provider (Public Hospital) • Able to meet the needs of the masses • Medically Safe • Professionally ethical • Accessible • Acceptable • State of the art-technical care • Outcome comparable to known standards Management (Government /Funding Agencies) • Quality Improvement and impact utilization • Investment and Return on Public Funds • Relevant to Community • Relevant to national demands • SUSTAINABLE
  • 7. Quality of Care Quality of Care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. (IOM 1990)
  • 8. Quality in Public Care Fully meeting the needs of those who need the service most, at the lowest cost to the organization, within limits and directives set by higher authority (Ovretveit)
  • 9.
  • 10. 13 Total Quality Management A comprehensive & fundamental rule or belief for Leading & operating an organization aimed at, Continuous improving performance over a long term by focusing on Customers while addressing the needs of all stakeholders
  • 12. Patient-Driven Quality according to Importance (US survey) Source: The Quality Connection in Health Care by Lynne Cunningham 1. Immediate attention and triage 81 2. Care first and then paperwork 67 3. Knowledgeable personnel 62 4. Explanation in terms we can understand 60 5. Appropriate waits/explanations if you have to wait 57 6. Friendly staff and bedside manner 56 7. Enough staff 48 8. Clean facility 34 9. Ancillary support readily available 33 10. Accessibility/easy to find/physical facility 31 11. State of the art equipment 22
  • 13.
  • 14. Description Implications for Patients Implications for Staff Cost Implication Inadequate clinical details given to Pathology Department Delays to Patients Risks of incorrect tests Extra work for pathology staff Extra conversations with clinical outcomes Extra pathology costs Increased length of stay More complaints Some appointments cancelled Patients kept waiting over an hour for pre- booked appointments Stress and frustration Can’t park as car parks over-full Ambulances held up Staff on the defensive Extra staff time on explaining and mollifying Need for larger waiting rooms and car parks
  • 15. • Improve patient care • Patient centred approach • Reduce Risk • Learn from mistakes • Be accountable Engage and inform staff :Clinical engagement Promote an open culture: What is wrong? not who is wrong?
  • 16. Roots – 5S Kaizen, Team Work BPR Leadership Total Quality ManagemeMnedtia Reports Attitudes Seeds Fertilizer
  • 19.
  • 20. C4C3C2C1 C7C6C5 B4B1 B2 B3 B5 B6 B7 A4 A5 A6 A7A1 A2 A3 A4 A5 A6 A7A1 A2 A3 B4B1 B2 B3 B5 B6 B7 C4C3C2C1 C7C6C5 •Reserved seats •Matching names SEITON
  • 24. D HQSMINISTRYOF HEALTH,SRI LANKA Sensitize Institutionalize Formalize Standardize Professional Colleges
  • 25. D / HQS MINISTRYOF HEALTH,SRI LANKA Sensitize Institutionalize Formalize Standardize Professional Colleges
  • 26. 34
  • 27. We can develop beautiful tools and mechanisms but people are still the key for success
  • 28. Time Technology Development Risk Gap Technology Development and Risk in Healthcare Training Development c1950 c2001c1980 Source: Chris Quinn, Newcastle Hospitals NHS Trust,England
  • 29. 39 Professionally (and humanely) agreed level of performance for a particular setting which is Desirable Achievable Measurable Standard
  • 30. • Dignity • Basic human needs • Prompt attention in care and treatment • Confidentiality • Communication • Autonomy Humanely Namely,
  • 31.
  • 32. QualityHigh Specification 1 = Bad Q – Not accepted Specification 2 = improved Q – Not accepted Specification 3 = accepted Q – Accepted Standard is a measuring yard of Quality Standard is the minimum level of goodness Standard stipulates the acceptable Quality level Standard is the demarcation between Good and Bad
  • 33. Waiting time <45 min Waiting time 60 min Standards Vs. Performances Waiting time 50 min Waiting time 55 min
  • 34. Waiting time <30 min Waiting time 35 min Waiting time 40 min Waiting time 45 min Continuous Quality Improvement
  • 35. Comments 1. Structure, process and outcome – not attributes to quality. Provides kinds of information, based on which one can infer whether quality is good or bad 2. Predetermined relationship between three approaches: Structure Process Outcome (Linear relation – simplified version. But much complex in reality)
  • 36. In Diagnosis and Treatment Structure OutcomeProcess Characteristics of the diagnosis laboratory Physician’s Characteristics Test performed by the laboratory Test ordered by the physician Results of tests interpreted by the physician Treatment chosen and executed by physician, other personnel and patient Results of tests Diagnosis: the illness and its characteristics Change in the patient’shealth
  • 37.
  • 38. Private Public Preventive Curative Technical Quality Management & System Quality Functional Quality Quality & Safety
  • 39.
  • 40.
  • 41. But it comes to patient safety, the numbers are startling …..1 in 10 patients will be harmed during a hospital stay WHO, 2014
  • 42. The risk of a hospital-associated infection is significant In the USA, if you are admitted to a hospital, you have a 5% chance of contracting an HAI People per year get an HAI during a hospital stay 2 million Of these > 99,000 People die annually from HAIs US$ 28 – 33 billion per year in healthcare costs30% Of Intensive care Unit patients developHAI
  • 43. Not just a problem for Hospitals Of 8.8 million Outpatient adverse drug events, more than 3 million are estimated to be preventable James 2013
  • 45.
  • 46.
  • 47. Patient Safety Definition • The avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of healthcare. These events include ‘errors’, deviations’, and ‘accidents.’
  • 50. Patient Safety is not a law or regulation It is a culture
  • 51. The Evolution of Safety Culture Pathological Who cares as long as we are not caught Calculative Safety is driven by Mx systems with collection & analysis of data. Primarily driven by top Mx. rather than looked by the workforce Reactive Org. Start to take safety seriously but there is only action after incidents Proactive Workforce involvement starts. We work on the problems that we still find Generative Safety is how we do business round here – safety is inherent part of the business
  • 52. QualityofCare High Quality Improvement Raising the Ceiling Patient Safety Raising the Floor
  • 53. Safety Culture Informed Culture Those who manage and operate the systems have current knowledge about the factors that determine the safety of the system Reporting Culture Prepared to report their errors and near misses Just Culture Encouraged and even rewarded for providing safety-related information, but must be clear about what is acceptable and unacceptable behavior Learning Culture Willingness and know-how to drawthe right conclusion from a safety information system and to implement reforms Open Culture Staff feel comfortable discussing patient safety incidents and raising safety issues with both colleagues and senior managers
  • 54. An eye towards improvement………….. ALL EVENTS Repor t Event s Analyze Events Learn from Events Culture Chang e Reality Understandi ng Data Not quite enough Feedback to Reporter
  • 55. An eye towards improvement………….. ALL EVENTS Repor t Event s Analyze Events Learn from Events Fix Systems Culture Chang e Reality Understandi ng Data Feedback to Reporter Patient Safety
  • 56. Same-handed single patient room With evidence-based design (EBD) safety features Large bathroom door Direct path with hand assist to toilet Handwashing sink with sight line Dublin Methodist Hospital, Dublin Ohio Design: Karlsberger with Cama Sound-absorbing ceiling tile
  • 57. Surfaces commonly contaminated by MRSA Methicillin-resistant staphylococcus aureus) R.S. Ulrich with P.A.Wilson
  • 58. Centrally Driven, Locally Lead, Clinically Oriented, Patient centered CQI Programme
  • 60. Measuring Performance of Hospitals Hospital Performance Hospital 1 Outstandingly Achieved (OA) Hospital 2 Exceptionally Achieved (EA) Hospital 3 Markedly Achieved (MA) Hospital 4 Markedly Achieved (MA) Hospital 5 Somewhat Achieved (SA) Hospital 6 Exceptionally Achieved Hospital 7 Less Achieved (LA)
  • 61. Start with what is important; then do what is possible; suddenly you realize that you will be doing what you thought was impossible. St. Francis of Assisi
  • 67.
  • 68.
  • 69. Elder Toyoda to encourage his son. that is Sakichi told to Kiichiro • Everyone should tackle some great project at least once in their life. I devoted most of my life to inventing new kinds of looms. Now it is your turn. You should make an effort to complete something that will benefit society.
  • 70.
  • 71.
  • 72. ‘Mantra’ of Quality Improvement