Systemic Quality Improvement Approach Quality Concours
MoroccoAssessment of the process and its effects on
maternal and child health services
Dr Nejoua BELKAABResponsible for the Quality Unit
Hospitals Direction and ambulatory cares-MH-Morocco
Royaume du Maroc
Ministère de la Santé
The expert talkEschborn 4th of December 2012
Processus de réalisation
Processus support
Processus de
management
PROCESS APPROACH
Eléments d’entrée
Elements of output
MODEL GENERIC USED
How to assess the quality of health
services?
Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12
THE EXCELLENCE MODEL- EFQM(EUROPEAN FOUNDATION FOR QUALITY
MANAGEMENT)
INNOVATION AND LEARNING
Leader-ship
Staff
Policy & Strategy
Partnership and
Resources
Process
F A C T O R S
Results ofPersonnel
Results of customers
Community results
Key Performa
nce Results
R E S U L T S
Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12
STEPS OF THE SQI
1.Participants preparation
2.Self assessment
3. Analysis of self
assessment
4.Audit +feedback
5. Participatif improvement
plan
6.Result announcement
and price rewards
7.Improvement support
HospitalHealth center
Provincial health dept
Maternity hospital
Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12
GENERAL BENEFITS OF SQI
Creation of a dynamic in the system. Effect system, Annual appointment of all professionals;
A step ahead in the process of governance: accountability, transparency and recognition of efforts;
It became a political instrument which can include the priorities of every strategy of the Ministry of Health;
Better performance after several editions.
STEP 1: PREPARATION OF STRUCTURES
Strengths Challenges The responsible managers are
informed on conduct of CQ, the evaluation criteria;
Awareness raising to reach highest numbers of different structures to join the process and to plan and implement changes according to the criteria of CQ;
Concrete actions to improve; Development of partnerships:
Supporting representatives of the communities
No predetermined schedule that is shared with all structures / lots of hazards, unstable financing .....> difficulty of planning;
No circulation of information following the meetings;
No technical support, to execute changes "If we know or can do it, we had done! Without CQ “
Non harmonized actionsDr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12
Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12
STEP 2: SELF-ASSESSMENT
Strengths Challenges Open questioning of
some processes;
Time for change and search recommendations for it.
Small team that fills the guidebook;
Teams do not have the same level of understanding;
No visibility on the horizons of expectation;
Lack of support during this
phase;
Feels as a burden instead of being an opportunity for change.
Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12
STEP 3: ANALYSIS OF SELF ASSESSMENT
Strengths Challenges Results that reflect the
effort of the structure and level of involvement in the process.
Scoring very subjective, answers and horizons of expectation not detailed;
Questionable since all structures shall be subject to audit.
Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12
STEP 4: AUDIT & FEED-BACK
Strengths Challenges External evaluation;
Preparing the structure for this visit;
Structured diagnostic;
Confirmed areas for improvement in the majority of cases by the team;
Results more credible.
Time: 1 day, not sufficient for some structures;
Warned structures / situation not real;
Assessment according to one process description;
Results remain audit-dependent.
Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12
STEP 5: PARTICIPATORY IMPROVEMENT PLAN
Strengths Challenges Improvement Plan is the
subject of a specific assessment for the next edition;
Improvement actions oriented at the processes;
Realization of training by the central level, following the analysis of Improvement Plan in several domains.
Improvement Plan is not always included in the Annual Action Plan of the structure;
Sometimes implemented to meet the requirements of CQ;
Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12
STEP 6: RESULT ANNOUNCEMENT AND PRICE REWARDS
Strengths Challenges
Diagnostic of the entire system in real time and based on only one tool;
Official ceremony; Recognition and distinction
in presence of the Minister of Health;
Mediatization.
Double classification:◦ Better performance in CQ◦ Better productivity performance
Transverse data bank not available;
No substantial prices;
When they exist (study trip or training ) for managers only;
Teams are not valued sufficiently.
Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12
STEP 7: IMPROVEMENT SUPPORT
Strengths Challenges Duplication of efforts: Lack of
coordination with other structures in the province (delegation, hospital and health centers);
Lack of support in the implementation of Improvement Plan;
The resources are not oriented at implementing corrective actions.
Responsibility of the team to develop its own Improvement Plan;
Research partnership to concretize the Improvement Plan;
Dr Nejoua BELKAAB-The expert talk-Eschborn 4 Dec 12
STEP n: SUSTAINABILITY
Key factors of success Challenges
Enlists in line with the strategy of the Ministry of Health for the reduction of maternal and infant mortality;
Conditionality in the program program of EU support (2011-2014);
To date provided funding for the organization of CQ:
◦ 2006-2010: GTZ- global fund-OMS-MH◦ 2011-2012: MH
Two evaluations stressed improtance of continuity;
Debate on CQ for the first time in Moroccan parliament
Viability fragile, non-institutionalized approach;
Monotony felt by professionals;
Difficulties of measuring the contribution to the impact;
Implementation of other approaches more fashionable (accreditation) or current tools (RAMED)
1. Linking prices of CQ to technical support and / or financial:(Contracts, Assuring tutoring…);
2. CQ-SQI better synchronize with other approaches to quality management;
3. Develop a legal and administrative framework;
4. Promote an overall development framework with interfaces between health, education, economy and environment based on the same tool;
5. Maximize the values of SQI by maintaining a long-term vision.
PERSPECTIVES
SQI an instrument of creation of valueDr Nejoua BELKAAB-The expert
talk-Eschborn 4 Dec 12
