QUALITY IMPROVEMENT IN HEALTH CARE SERVICE DELIVERY

DURING 29TH ANNUAL KENYA THEATRE NURSES SCIENTIFIC

CONFERENCE AT KISUMU

QUALITY IMPROVEMENT OF HEALTH CARE SERVICES

DEFINITION: • Is the making of a service better than before.

Objectives:

Broad Objective • Assess main factors that hinder quality

improvement in the health care delivery.

continuation

Specific Objectives• Assess how best quality can be improved. • How to aim at improving the quality of health

care services.• Identification of opportunities for improvement.• Hindrances to attaining standards to improve

quality.• Assess improvement in quality of service.• Importance of quality improvement.

FACTORS THAT AFFECT QUALITY AND ITS IMPROVEMENT

Infrastructure/buildings in which care is provided.• Do not meet the required standards \specifications i.e.

ventilation, spacing to patient ratio.• State of repair i.e. lack maintenance of regular face lifts.• Arrangement and /or absence of all the required duty

stations for proper and easy patient flow.

Continuation

• Waste management in the surrounding.• Social amenities .• Security.

Medical equipment and logistical supplies for use in provision of quality and timely service.

Lack of modern diagnostic equipment (laboratory, radiology and imaging ),irregular servicing of these equipment and irregular supply of related consumables leading to clinical diagnosis and hence:

• PharmacyPoly pharmacy (Misuse and Stock outs)Under use (Expiries and overstocks)

• AdmissionsUnnecessary admissionDelayed admissionDenied admission

Continuation

• DischargeDelayed dischargeUntimely discharge

• ReferralsDelayed referralUnnecessary referralMis directed referral

ContinuationLack of most operating theatre (surgical, anaesthesia) ICU and ward equipment.

• Most equipment is improvised or completely missing• Are not the correct/ right specification • Are too few to meet the patient numbers

Maintenance and servicing of the available equipment is not done regularly and/ or not done at all.

Continuation

Poor Medical supplies management• Poor supply of essential/basic medications

and other logistical consumables.• supply of unspecified/not requested for items

by the end user.• Failure of supply of specified/requested items

by the end user.• Inadequate and untimely supplies

Continuation

• Corruption involved at all levels i.e. from tender awards, procurement until delivery of the items.

Human resource/personnel

• Absolute numbers not there.• Health worker to patient ratio categories.• Lack of Training (CPD/CME, in-service , up

grading).• Poor licensing, promotion, appointment,

recruitment and retirement methods.

Continuation

• Brain drain.• Lack of Competent, Skilled, Knowledgeable

and experienced staff.• Geographical/rural/urban distribution ratios.• Absentism and unavailability at the work

station.• Lack of Courtesy and poor public

relations/customer care.

Process of patient care and management

• Diagnostic accuracy.• Length of stay in the hospital.• Re hospitalization.• Noso- comial infections.• Mis adventures.• Evidence based practice. (scientifically proven)

How to aim at improving the quality of service

• Setting up of standards of care in all departments.

• Identifying problems at all levels.• Documentation and assignment of

responsibilities.• Elimination of errors in the system especially

those taken for granted.• Implementation of guidelines to prevent

reoccurrences of mistakes.

Continuation

• Paying special attention to unwanted outcomes.

• Guarantying presence of personnel at all times when on duty.

• Need to take collective responsibility instead of blaming one another/pointing fingers.

Identification of opportunities for improvement

• Regular brain storming and management meetings.

• Morbidity and mortality meetings.• Event identification, measurement and

ultimately there documentation.• Analysis of processes leading to most

occurring problems.• Proper communication and coordination.

Continuation

• If change leads to improvement then its implemented.

• Changing of duty roles and continuous duty relief.• Compulsory attendance to inservice

updates/CME CPD.• Displinary actions in case of grave avoidable

errors.• Reassessing the status of work after an

appropriate period/given time frame to determine whether improvement really occurred

Hindrances to attaining standards to improve quality

• Costs involved in the input before there is change.• Not having well qualified and adequate personnel

who know what to do.• Poor conduct and discipline of personnel.• Lack of disciplinary actions for those with poor

professional conduct.• Absence of established guidelines and SOPs. • Failure of some personnel to attend meetings and

inservice updates/CME CPD.

How to assess improvement in quality

It is very difficult to measure a change in quality of an out come in a service, but there are other collateral variables that are good indicators and therefore offer adequate information:

• Satisfaction from the recipient of the service.• Satisfaction from the service provider with the

out come.• Decrease in the rate of adverse outcomes.

Continuation

• Increase in quality of outcome from the service.• Improved performance by comparison.• Focus on the chronology of mishaps and there

identification.• The use of statistical analysis with other data

sources.• Retrospective record review.• Setting up of standards that must be met.• Self reporting by the service provider of health care.

Importance of quality improvement

• Enhances the value of services provided and therefore its out come.

• Measures the value of an item/service in a relative form.

• It’s a concept whose attention to, improves patient safety and satisfaction.

• It is a continuous process guided by requirements and programmes of the health delivery system.

Conclusion

A health unit/Hospital that has adopted asystem of assessing, improving the input offunctions and methods of care on a regular basiswill definitely show quality improvement.

Finally quality improvement should be a mustfor all health service delivery departments.

References

• Donaldson SM,1999, measuring quality in health care, Washington, National Academic Press.

• Evan RJ, 2005, total quality management organization and strategy, Ohio. South western publishers.

• URL WWW.progressivepractices.com/articles/system- thinking pdf accessed 02/05/10.

• CURE Children's’ Hospital of Uganda policy manual in-service update 2010

THANK YOU FOR LISTENING

QuestionsCommentsAdditions Subtractions.