1. Thuy Trang Nguyen Thi
Hloliphani Juta
Jasmine Paul
Lara Kesteloo
Quality Improvement:
Treatment of Post Disaster
Diseases in Viet Nam

2. Health Issue: Treatment of
diarrhea post disaster

3. What is diarrhea?
• Occurrence of loose, watery, and frequent stools. Stool
and vomit are highly contagious
• Common causes: viral gastroenteritis (stomach
flu), medical conditions, or by eating or drinking
contaminated food or water (in Viet Nam during floods)
• Treatment:
– Fluids such as water and Pedialyte
– Oral rehydration therapy
– Intravenous fluid
– Monitoring

4. How do nurses in Viet Nam treat diarrhea after a
disaster?
• Hanoi, Vietnam: 1 in 10 paediatric • Shortage of nursing staff and
patients are hospitalised due to hospital beds due to inadequate
complications of diarrhea and funding → diarrheal patients are
during natural disasters the treated as outpatient and only a
number increases few can be hospitalised.
• Use of buckets under beds to
catch stool. Buckets are then
washed and disinfected with
chlorine

5. Post disaster issue: Diarrhea
• Despite strong improvements in key social
indicators, water and sanitation and related
diseases remain a major health problem following
disasters in Vietnam. Polluted drinking water and
swampy conditions substantially increase the risk of
cholera, diarrhea, dengue fever, and malaria
outbreaks. More than 70 percent of Vietnam’s 85
million people live in rural areas. While a large
majority of rural communities have access to
improved water sources, great disparities remain in
access to clean water

6. Why focus on diarrhea as a health issue
following a disaster?
• “Although symptoms may be
mild, approximately 5%-10% of previously
healthy people will develop a copious diarrhea
within about one to five days after ingesting
bacteria from contaminated sources such as
water and food”

7. QUALITY IMPROVEMENT THEORIES:
FADE Model
Microsystems Model

8. FADE model
• → Focus
• → Analyze
• → Develop
• → Execute/Evaluate

9. Relevance of the FADE model
• The FADE model allows the nurse to focus on a
concrete issue (diarrhea post disaster) and use
baseline data (how many cases of cholera →
diarrhea/ what are the rates of morbidity and
mortality) to either:
– Improve care/implement care
– Reduce errors that are leading to high rates or
morbidity or mortality
– For example...

10. Microsystems model
• Provides practical steps for designing/redesigning
components of the microsystem to perform optimally in
alignment with guidelines and policies
• Use of four “P’s” to guide patient-centered care:
- Patients
- People
- Processes
- Patterns

11. Relevance of the microsystems model
• Places the patient at the forefront
E.g. Not placing patients with diarrhea beside
those who are being treated for an open
wound because doing so→ further spread of
disease (based on evidence-based practice)

12. Drawback of the microsystems model
• “Excellent planned care requires that the microsystem have
services that match what really matters to a patient and
family and protected time to reflect and plan. Patient self-
management support, clinical decision support, delivery
system design, and clinical information systems must be
planned to be effective, timely, and efficient for each
individual patient and for all patients”
• Yes this is possible in a microsystem, but is it possible to
achieve in one whose main concern is disaster
management/care?

13. Six Sigma Model
TQM Model

14. Discarded theories
• Six Sigma • TQM Model
Customer
Define Focus
Total Planning
Control Measure Participation Process
Results
Process Process
Improvement Management
Improve Analyze

15. References
A.D.A.M. Medical Encyclopaedia. (2012). Diseases and conditions: Diarrhea. Retrieved April 18, 2012, from
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0003613/
De Koning, H., Verver, J. P., Van den Heuvel, J., Bisgaard, S., & Does, R. J. (2006). Lean six sigma in healthcare. Journal for Healthcare
Quality, 28(2), 4-11. doi:10.1111/j.1945-1474.2006.tb00596.x
Duke Medical Center Department of Community and Family Medicine. (2005). Patient safety: Quality improvement. Retrieved April
19, 2012, from http://patientsafetyed.duhs.duke.edu/module_a/methods/fade.html
George, M. L. (2003). Learn six sigma for service: How to use lean speed and six sigma quality to improve services and transactions. NY, NY:
McGraw-Hill.
Medicine Net. (2012). Disease & conditions: diarrhea. Retrieved April 19, 2011, from http://www.medicinenet.com/cholera/article.htm
Nelson, E. C., Batalden, P. B., & Lazar, J. S. (2007). Practice-based learning and improvement: A clinical improvement action guide (2nd ed.).
Oakbrook Terrace, Illinois: Joint Commission Resources.
Nguyen, H.N., Trung, K.V., & Niem, N.V. (2007). Fighting climate change: Human solidarity in a divided work. Flooding in Mekong River
Delta, human development report 2007/2008
Ovretviet, J. (2000). Total quality management in European healthcare. International Journal of Health Care Quality Assurance, 13(2), 74-
80. doi:10.1108/09526860010319523
Patel, G. (Biomedical Engineer). (2012). Total quality management in health care [PDF]. Retrieved from
http://www.biomedicalprojects.com/files/TQM%20in%20Healthcare.pdf
Path. (2010). Keeping a focus on diarrheal disease control in Viet Nam. Retrieved April 18, 2012, from
http://healthmarketinnovations.org/sites/healthmarketinnovations.org/files/VAC_ddc_vietnam_fs[1].pdf
Raisinghani, M. S., Ette, H., Pierce, R., Cannon, D., & Daripaly, P. (2005). Six sigma: Concepts, tools, and applications. Industrial
Management & Data Systems, 105(4), 491-505. doi:10.1108/02635570510592389
Wasson, J.H., Godfrey, M.M., Nelson, E.C., M, J.J., & Batalden, P.B. (2003). Microsystems in healthcare: Part 4. Planning patient-centered
care. Joint Commission Journal on Quality and Safety, 29(5), 227-237

16. • We started by looking at our first presentation, which was a broad topic of
disaster preparedness in Viet Nam, and individually researched specific issues that
occur both in the acute phase, and the long term phase
•Choosing the acute phase and attempting to find an issue in which nurses were
the focal point proved to be difficult; we then strategized and researched common
health issues post disaster that nurses encounter in Viet Nam
•From here we found that Cholera was a common and specific health
issue, occurring both in rural and highly populated cities after disasters.
However, we refined this to treatment of diarrhea, as this seemed to be a more
concrete and specific health issue to link to the theories we chose
• We used scholarly databases such as CINAHL, Pub Med, The World Health
Organization, and other scholarly work from American and European accredited
journals
Search process

17. Collaboration
• We initially collaborated as a group to research
and decide which topic would be appropriate. We
each brainstormed one specific topic and came back
to the group to discuss why we thought it would be
a relevant topic. To choose one, we went back to the
research to support each topic, which led to our
final decision
•From here we worked individually but contacted
each other through e-mail and Facebook to gain
new ideas and knowledge
•Each member of the group had the choice to
decided which topic she wanted to focus on. One
group member was in charge of creating the Power
Point after each member was done her slide(s)
•Another member of the group read over the power
point for spelling errors and to ensure the
references were scholarly and appropriately cited