Lcif and sf dr pararajasegram

04/07/23 LIONS SF Conclave.Kolkata Oct. 2013

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SightFirst History

LCIF SIGHTFIRST

HISTORY AND BACKGROUND

AIMS AND OBJECTIVES

ACHIEVEMENTS

FUTURE TRENDS AND DIRECTIONS

Meeting the Challenges at Lion Eye Hospital Level


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WHAT WAS THE IMPETUS FOR LIONS

BECOMING INVOLVED IN SIGHT-RELATED WORK?


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Helen Keller’s speech

Occasion:

1925 Lions International Convention

Venue:

Cedar Point, Ohio, USA.

Date:

June 30, 1925


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What Helen Keller said:• “Will you not help me hasten the day when

there will be no preventable blindness; no little deaf, blind child untaught; no blind man or woman unaided?

• It is the caring that we want more than the money. The gift without the sympathy and interest of the giver is empty.


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Helen Keller’s appeal to the Lions.

“I appeal to you Lions , you who have your sight, your hearing, you who are strong and kind,

Will you not constitute yourselves

KNIGHTS of the BLIND,

in this crusade against darkness?


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Throughout its History

• Lions have had an enduring interest in prevention of blindness and its alleviation.

• Projects include Cataract Surgical Camps,

Cataract Free zones, Distribution of used spectacles, Eye Banks, Training projects, Low Vision care, Lions Eye Clinics and Hospitals, Academic Chairs in Ophthalmology, Eye health education, Rehabilitation, etc.

The importance of our EYES

Perhaps the most important of our five senses.

Sight Loss of Sight is the most feared event.

HearingTouchSmellTaste04/07/23 LIONS SF Conclave.Kolkata Oct.

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The role of Sight

Development and growthEducation and LearningMobilityDoing TasksEmploymentRecreationQuality of Life04/07/23 LIONS SF Conclave.Kolkata Oct.

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BUT we take our sight for granted

No one appreciates Sight more than one who has had good sight and lost it.

No one cherishes Sight more than one who has lost it and regained it


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Lions “Seminar for Sight” in Singapore 1988

International President: Lion Austin Jennings

The Seminar made the delegates aware of the

- magnitude of the problem of global blindness,

- the feasibility and cost effectiveness of intervention

- the great potential for Lions everywhere to participate and help those who were blind or in imminent danger of going blind.


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LCIF decided to launch SightFirst "Lions Conquering Blindness”

• The first step was to mobilize resources through a SightFirst Campaign.

• Chair: Past International PresidentJudge Brian Stevenson.

• Lions worldwide responded with their hearts and their purses.

• Over US$140 million was raised


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Setting up of a Structure• Global LevelSightFirst Advisory (Review) CommitteeWHO as Technical advisors to SFSightFirst Department in Oakbrook

• Country levelLionistic SightFirst CommitteesTechnical Advisors for different regions


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Projects launched under SightFirst• Cataract Surgeries- camps, cataract free zone• Training Institutions and training• New Eye Hospitals and upgradations• Eye Health Education - Diabetes, Glaucoma• Onchocerciasis and Trachoma Control• Childhood Blindness

• EVALUATIONS CARRIED OUT

• Findings resulted in the need for re-thinking priorities and new needs.


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SightFirst Mission Statement• “The Lions Clubs International Foundation

SightFirst program, funds the efforts of Lions, Non Governmental Organizations, government agencies, and others to fight the major causes of preventable and reversible blindness through the support of eye health care delivery systems, training and infrastructure development.”• Wherever possible the local LIONS should be

involved. It is in their Benefit to do so. • Visibility that this was a LIONS project was

important


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"From LIONS Conquering blindness"Partnerships and Collaborationswere encouraged and developedEnhanced Partnerships for improving

impact of SF.Reinforce existing and forge new

partnerships as stated in mission statement.Seek joint project development where it is

not inimical to Lions SF


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New developments"Top-Down Projects"

Projects targeted for Action by the International leadership based on an

identified need which go beyond even multiple districts.

A small technical committee should pursue the identification and development of such

project(s) eg. Childhood Blindness

Child friendly Eye Care Centers04/07/23 18LIONS SF Conclave.Kolkata Oct.

2013


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NEED FOR COMMITMENT OF LIONS LEADERSHIP AT ALL LEVELS

Lions Leadership to become very familiar with SF goals, criteria, projects and outcomes

Formal training of new International Directors on SF

Include SF information Seminar in Regional Forum and have staff on hand

Training of MD SF Chairmen Include SF information in DG-Elect Training


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PUBLIC RELATIONS regarding SIGHTFIRST

Highlight SF achievements in LCI PRin-house to Lions and externally to general

publicUse opportunity of World Sight Day to

emphasize activities and achievements of Lions SF.

Keep Lions Web site updated on SightFirst


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• Some new principles and criteria• The general moratorium on Capital

Construction projects to be maintained• Upgradation of facilities be entertained based on

established criteria• Management

• Prior MOU/ Letter of intent, with partners be established before proposal submission

• Management training for Project staff including Lions

• Standardized Management (Technical) monitoring system be introduced


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MONITORING, REPORTING AND EVALUATION

SHOULD BE AN INTEGRAL PART OF THE PROPOSAL

OPERATIONAL RESEARCH AND POPULATION BASED SURVEYS TO BE

CONSIDERED WHERE NECESSARY.


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PRIORITY AREAS FOR SIGHTFIRST

Disease perspective Blinding Cataract – an unfinished agenda (phasing

out) Blinding Trachoma (S A F and E ). “ Diabetic Retinopathy, Glaucoma, URE LV care in

areas where adequate infrastructure exists. The Lions Eye Health Program (LEHP) Areas not included could be supported by other LCIF

grants or local clubs


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TRAINING

Technical training/skills developmentManagement skillsCommunity Eye CareEstablishing partnerships with existing

centres of excellenceComprehensive Eye Care


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DEVELOP ALTERNATIVE PROJECTS

• Comprehensive eye care

• Sustainable projects

• Develop model projects in poor areas

• TRAINING IN MANAGEMENT AND CEH

• Identify Centres for training

• Develop capability in Region


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TECHNICAL COOPERATION BETWEEN “LIONISTIC” AND “NON LIONISTIC” COUNTRIES

• The Committee accepted this in principle and would like to promote this idea especially between

geographically proximal countries, with active local participation in needs assessment, planning and implementation, monitoring and evaluation,

with special emphasis on training and local capacity building.


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PAST AND PRESENT• The SightFirst Programme has been a DYNAMIC

one with periodic evaluation, reviews and long range planning. These Long range plans have served as dynamic guidelines to assist Lions and TA’s, out in the field, and SF staff and the SAC.

• They have been flexible enough to deal with unforeseen or emerging situations.

MUCH HAS BEEN ACHIEVED

MUCH MORE REMAINS TO BE DONE


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Future directions for the Lions SightFirst Programme.

• The second Lions Seminar for Sight, in Seoul, S Korea,held in 2004, 16 years

since the first one, brought in the promise of new dimensions, with a

galaxy of experts in fields, representing a broad spectrum of Vision related eye care and activities including research


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DETERMINING THE BEST INVESTMENT

How can the Lions, individually and collectively, through their philanthropy and volunteerism, do the greatest good, to the largest number, in greatest need, in the shortest possible time, at the lowest cost?


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Sight Preservation, Restoration and Enhancement

Helping to apply the knowledge and skills that we already possess, to prevent and treat blindness and visual impairment and enhance functional vision, is perhaps the

first priority.


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ENHANCING VISION AND IMPROVING Function

Uncorrected Refractive errors

Low Vision careOrientation and Mobility

Training


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Vision loss

from Diabetes Mellitus

( A Chronic Multi- System Disease)

Diabetic RetinopathyControl of systemic

disorder important


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• Preventing Blindness from GLAUCOMA

Aging relatedChronic Disease – Long follow up.Care expensive and labour intensiveAdherence to treatment poorBest case detection through

Comprehensive eye examination

Measuring the Results of our labours

To measure is to know.If we do not measure (EVALUATE)

we will never know whether we achieved what we set out to achieve.Publish and truthfully share our

results.It will help reaping rich dividends


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HOSPITAL LEADERSHIP/

MANAGEMENT

• PATIENT CENTRED COMPREHENSIVE EYE CARE

• EFFECTIVENESS AND EFFICIENCY• HUMAN RESOURCES

• QUALITY OF CARE• SUSTAINABILITY• SELF RELIANCE


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• “See the Person in the Patient”

• PATIENT CENTRED CARE

that is COMPREHENSIVE


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EFFECTIVENESS

and

EFFICIENCY


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HUMAN RESOURCES


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SUSTAINABILITY


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• QUALITY OF CARE


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Quality Assurance inEye Care


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The Role of Lions Eye Hospitals in the context of implementing

SightFirst Projects


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• HOSPITAL

• LEADERSHIP and MANAGEMENT

• SUSTAINABILITY

• and

• SELF RELIANCE


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The SightFirst Programme• The SightFirst Programme was conceived

as a Sight preserving and sight restoration project

• Of the LIONS• By the LIONS• For the PEOPLE – the poorest of the Poor.• The rewards for the LIONS would come from

the gratitude of the PEOPLE who are helped


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The provision of health, including Eye Health is already a “service business”.

Patients (customers) must come first. They should not be treated with needless technology for diagnosis or treatment.

They must be the recipients of a product (VISION) that is good, is affordable and is delivered with compassion and in a timely manner.


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The key to Quality in Health Care Service Delivery is patient satisfaction

Patient satisfaction means fulfilling the expectations of patients.


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The Deming Philosophy

Three basic precepts

• Customer orientation

• Continuous sustained improvement

• Recognising that Quality is determined by the system


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.If you or your parents went as a patientwhat factors would make you feel confident and satisfied with the doctor you are consulting?


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Behaviours and service quality perceptions of customers

• Reliability• Responsiveness• Competence• Access• Courtesy• Communication• Credibility• Security• Understanding• Empathy

Inspiring confidence


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QUALITY ASSURANCE

The Concept of Quality assurance comes from the Manufacturing Industry

It has not been used in Health Care Delivery till recently


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In What way has this happened?


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ADAPTING QUALITY PRINCIPLES• Adapting quality principles used in manufacturing

to health care services is a means to achieve both productivity improvement (quantity) and along with it, product improvement (quality).

• However quality improvement is not something that you do once and then sit back to enjoy the results.

• QUALITY is associated with an attribute of a product at a discrete time.

• RELIABILITY relates to performance over a period• of time - consistent quality.


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ENSURING QUALITY

• With a product, the manufacturer (provider) ensures that the product is of acceptable standards through various forms of quality control

• The Customer (user) is the final judge.


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IN EYE HEALTH CARETHIS IS SADLY LACKING

• There is generally hardly any mechanism for ensuring quality control in the production of the product, which

is FUNCTIONAL VISION.

• The PATIENT (customer) is seldom consulted on, or an opinion sought on the quality of the product (outcome).


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Lessons from Manufacturing Industry

• Much of our quality practice comes from the

manufacturing industry but fundamental differences exist


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MANUFACTURE OF A PRODUCT

>STRUCTURE

>PROCESS

>PRODUCT (OUTPUT and OUTCOME)


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STRUCTURE(In manufacturing)

• Factory building

• Machinery

• Trained Personnel

• Components

• Stores etc.


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PROCESS(In manufacturing)

COMPONENTS PRODUCT

INPUTS OUTPUTS

• Checking parts and product

• Discarding faulty items

• Assembling

• Checking final product for quality


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OUTPUT(In manufacturing)

The Product

In productivity terms this refers to quantity

• the Number of a products manufactured


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OUTCOME(in manufacturing)

• Finished Product of assured Quality

• Determined by the consumer in terms of the “value” and enjoyment of the use of the product (customer satisfaction).


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EYE HEALTH CARESTRUCTURE

• Outpatient Department• Wards• Operating Theatre• PERSONNEL • Equipment• General facilities – lobby, waiting rooms,

toilets• Dining rooms


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PROCESS(In Health Care)

NON CLINICAL ACTIVITIES• Appointment system• Registration• Counseling• Billing• CLINICAL ACTIVITIES• Patient care – Doctor/patient relationship• Pre Op/ Operative/Post Op care


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PRODUCT(In health care)

OUTPUT- Number of surgeriesOUTCOME - quality of surgery

• VISION - VA

• Return of Functional activity

• Activities of Daily Living (ADL)

• Quality of Life

• Patient Satisfaction


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Measures of OUTCOME

• ORGAN LEVEL Function of eye» Visual acuity» Field of vision» Contrast sensitivity» Colour vision

• PERSON LEVEL Function of person» ADL - QOL

• SOCIETAL LEVEL» Patient satisfaction


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Methods of Measurement• ORGAN LEVEL - Clinical audit

• PERSON LEVEL - extended clinical audit - community based study

RACSS• PATIENT SATISFACTION - part of clinical audit - follow-up study


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“CLINICAL AUDIT”SELF ASSESSMENT

• Measure outcome - VA• Analyse outcomes - good and poor results• Identify reasons for suboptimal outcome, if any.• Retrain as necessary - individual or team

THIS SHOULD BE A RECURRING PROCESS.

CONTINUOUS SELF ASSESSMENT and SELF

IMPROVEMENT IS THE KEY TO SUCCESS


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Learning and Progress“To measure is to know”

Learning and Progress accrue only when there is something to learn from, and the something, is any completed action.

DO NOT FALL INTO THE TRAP OF THE

“SYNDROME OF ASSUMED MERIT “SAM”


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There is a major difference between the

manufacturing industry and health care


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A MAJOR DIFFERENCE IN MANUFACTURING AND HEALTH

CARE

• The interface between the producer

( health care provider ) and the customer ( patient )


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INTERFACE• Customers never interact with

workers in manufacturing organizations, whereas in service organizations, interactions between provider and patient (consumer) is high.

• INTERACTIONS AFFECT PERCEPTIONS OF QUALITY

• STAFF BEHAVIOUR HAS A CRITICAL IMPACT UPON PERCEPTIONS OF QUALITY


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PRODUCER/CUSTOMER INTERFACE IN

MANUFACTURING

FFAACCTTOORRYY

RREETTAAIILLEERR

STORESTORE

CustomerCustomer


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HEALTH FACILITY/ PATIENTINTERFACE

OOTT

OOPPDD

STRUCTURE PROCESS OUTCOMESTRUCTURE PROCESS OUTCOME

WWAARRDD

WWAARRDD


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HEALTH FACILITY/ PATIENTINTERFACE

OOTT

OOPPDD

STRUCTURE PROCESS OUTCOMESTRUCTURE PROCESS OUTCOME

SatisfactionSatisfaction

WWAARRDD

WWAARRDD


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Service Organizations

• Must recognize that QUALITY is a product of the SYSTEM, and in service organizations, particularly, PEOPLE are the system.

• Sustained excellence has to be developed in a systematic and well directed fashion.

• Pre-experience training Skills Training

• “On the job” guidance Re- training


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Team WorkA number of personnel with different job descriptions and training are involved in these

three phases. However the Team Leader has to ensure the

highest quality of performance in each one of the personnel. Being a good role model is critical.

This cannot be enforced. The value of quality must be a shared culture.

Motivation is a key factor in developing a quality culture. Job satisfaction is a key element.


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Training needs

• Training is necessary in order to enable personnel to acquire the skills, knowledge

and attitude necessary to perform the task to an acceptable standard.

• Training is essentially a learning process , and in order that progress can be

successfully monitored there should be a system of constructive performance

assessment.


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Details of Training

• The training needs of both the individual and the organization must be identified and

analyzed.

• Targets and standards must be set for the trainee which are within their capabilities.

• There must be active involvement on the part of the learner, not just passive

acceptance of information.


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Training

• A variety of methods and techniques should be used to provide stimulus variation and maintain interest.

• The pace of the training programme should reflect the trainee’s ability to maintain progress.

• The trainee should have regular feedback of results. Any problem areas should be highlighted/ discussed/resolved as soon as possible.


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Shared value of Quality• Quality control should not be construed as an

extra burden incorporated in, or added to, a process.

• It should be the concern of all personnel, since the production of high quality services enhances the reputation of the institution.

• Thus all employees should be encouraged to contribute ideas for increasing efficiency of the processes and the quality of the product.


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QUALITY ASSURANCE(In health care )

ENSURE QUALITY OF• STRUCTURE

• PROCESS

• PRODUCT/ (OUTCOME)

IF PATIENT SATISFACTION IS DESIRED


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ENSURING QUALITY

• Mission for Quality in top management

• Shared Vision of Quality

• Development of a Quality Culture


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Ensuring Quality (Contd)Adopting Norms/Preferred Practice

GuidelinesContinuous Measurement &

MonitoringSelf assessment

Continuing Professional Development


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Quality Aspects of Cataract Surgery

Each year cataract surgery enables millions of people to improve their vision - it is one of the most frequently performed and successful surgical operations in the world.

Although it has been performed from ancient times, the last half century has seen remarkable refinements of the procedure

We need to ensure that the benefits are passed on to all patients

Use of Quality (Visual Outcome)

The primary purpose is for the surgeon to assess his or her own results of Surgery.

Analysis of these results would indicate how well or badly they are helping the patient.

It is a clue to improving the outcome.


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Stages in Cataract Surgery

• Preoperative Assessment

• Surgical procedure

• Post Operative care

• A POOR result may be due to one or more of these stages


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Elimination of Avoidable Blindness

• We now say 38 million people are blind and 3 times that number have "low vision".

• ."• We need to address the issue of blindness on an

individual basis, whether it is cataract surgery, or prescription and supply of glasses, or glaucoma etc.


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Extreme sub-specialization

With increasing sub-specialisation professionals begin to focus on the tissue rather than on the person and beyond.

Some overlook that the cornea is part of the eye, leave alone part of a person, a family, a community.

Adopt a holistic view of eye care, not a narrow tissue oriented focus.


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Benefits of Quality Assurance(In health care)

• Patients perspective

• Surgical team’s perspective

• Institutions perspective


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Patients’ perspective

• Patients expectations achieved - Patient satisfaction

• Better functioning

• Better productivity

• Better Quality of life

• Removes barrier to service utilization by patients


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Surgical Teams Perspective• Self esteem and professionalism

• Identification of weaknesses

• Needs assessment for training

• Improvement in teamwork and practice

• Sense of achievement

• Gratitude of patient


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INSTITUTIONAL PERSPECTIVE

• Gaining in Popularity

• Increased patient load and income

• Sustainability

• Sense of achievement

• Sense of gratitude of community

• Recognition as a centre of excellence


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REWARDS OF QUALITY

• PERSONAL LEVEL

• Self Esteem working in a Quality Facility

• Seeing happy, Satisfied Patients

• Professional satisfaction

• Enhanced practice and incomes


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QUALITYQUALITY

> willingness> willingnessto payto pay

QualityQualityreputationreputation

PatientPatientsatisfactionsatisfaction

Provider Provider satisfactionsatisfaction

QAQAQUALITY QUALITY

REPUTATIONREPUTATION

Cost effectiveCost effectiveStandardsStandards

Loyalty toLoyalty toFacilityFacility > REVENUE> REVENUE

> NET REVENUES> NET REVENUES

Doing itDoing itRight the first timeRight the first time < COSTS< COSTS

SUSTAINABILITYSUSTAINABILITY

> > CUSTOMER BASECUSTOMER BASE

ReducedReducedAttritionAttrition


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Quality Assurance inEye Care Delivery

• Take Home Messages A WORTHWHILE INVESTMENT IT REMOVES AN IMPORTANT BARRIER TO UPTAKE OF

SERVICES IT ENHANCES PATIENT COMPLIANCE and LOYALTY IT ENSURES SUCCESS IN ACHIEVING VISION 2020 GOALS


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Take Home Messages (contd)

CLEAR VISION AND GOALS ABOUT QUALITY MUST BE COMMUNICATED TO ALL

TOTAL TEAM MEMBER EMPOWERMENT AND INVOLVEMENT IS NECESSARY

CUSTOMERS( patients ) AS THE KEY DRIVERS FOR CHANGE FOCUS ON PROCESS: THE HOW OF DOING WORK:PEOPLE THE KEY

ELEMENT MEASURES FOR CONTINUING PERFORMANCE ASSESSMENT and

IMPROVEMENT


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Thank you

Date post:	14-Sep-2014
Category:	Health & Medicine
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Lcif and sf dr pararajasegram

Health & Medicine