Performance Based Financing at Hospital - Process of Care Quality Assessment July 11, 2013 James Sorsor, Foday Kanneh Shun Mabuchi.

Performance Based Financing at Hospital- Process of Care Quality Assessment

July 11, 2013

James Sorsor, Foday KannehShun Mabuchi

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HSSP provides a set of management tools for hospital management

2

1Complicated and assisted delivery (including C-section)

Any labor that is made more difficult or complex by a deviation from the normal procedure. Complicated delivery is defined as: assisted vaginal deliveries (vacuum extraction or forceps), C-section, episiotomy and other procedures.

17

2 Normal deliveries of at risk referralsHigh-risk pregnant women referred by health center to the hospital but delivered normally. A high-risk pregnancy is defined as: evidence of edema, mal presentation, increased BP, multi-parity, etc.

17

3Counter referral slips returned to health facilities

Hospital returns counter referrals letter with feedback on the referred patient to the referring health center. The counter referral letter is completed in triplicate, with one also given to the patient, and one retained by the hospital.

2.5

4Newborn referred for emergency neonatal care treatment and treated

Newborns referred for emergency neonatal care due to: perinatal complications, low birth weight, congenital malformation, asphyxia, etc.

5

6Referred infants and under-fives with fever Any surgical procedure that does not involve anesthesia or respiratory assistance. 2.5

7 Minor surgical intervention

Any surgery in which the patient must be put under general spinal/anesthesia and given respiratory assistance. Major surgery in the case of this package of services is defined as any of the following: Herniarraphy, Appendectomy, Myomectomy, Sleenectomy, Salpingectomy, Hysterectomy, Thyrodectomy, Mastectomy.

5

8Major surgery (excluding CS, including major trauma)

Patients transferred from a lower-level facility (health center or health clinic) to the hospital for emergency treatment.

18

9 Patients transported by ambulance 2.5

10

Number of training sessions held by faculty for nurses, midwifes and PA according to in-service curriculum and defined protocols.

These indicators will incentivize the in-service training activities. 50

11Number of nurses, midwifes and PAs that received specialized in-service training, relevant to benchmarks

10

VerifiedTotal EarningsDefinition

Six Hospitals Total

Fee (USD)Indicators Claimed

Quantity Checklist

Actual % Earned Points

1. Obstructed Labor 0.80 3.87 100% 33% 1.292. Hemorrhage 1.00 4.84 100% 71% 3.453. Maternal Sepsis 1.00 4.84 100% 50% 2.424. Eclampsia 0.70 3.39 100% 47% 1.595. Neonatal Asphyxia 1.00 4.84 100% 67% 3.236. Neonatal Sepsis 1.00 4.84 100% 54% 2.617. Prematurity 0.50 2.42 100% 47% 1.148. Maternal Newborn Best Practices 1.00 4.84 100% 54% 2.619. ETAT 1.00 4.84 100% 33% 1.6110. Malaria 1.00 4.84 100% 71% 3.4511. Pneumonia 1.00 4.84 100% 50% 2.4212. Acute Diarrhea 0.80 3.87 100% 47% 1.8213. Severe Acute Malnutrition 0.60 2.90 100% 67% 1.9414. Surgical Safety 1.00 4.84 100% 54% 2.61

100% 60.00 100% 53% 32.20Total/Average

ChecklistsWeight (by

importance)Point

AllocationMax %

Process of Care Quality Checklist

Score 1.GENERAL MANAGEMENT (30pt)

2. HUMAN RESOURCES FOR HEALTH (16pt)3. HYGIENE AND MEDICAL WASTE DISPOSAL (27pt)

4. DRUGS MANAGEMENT (30 pt)5. EQUIPMENT AND SUPPLIES (84pt)

TOTAL %

Date of Verfication

TOTAL (187pt)

REPUBLIC OF LIBERIAMinistry of Health and Social Welfare (MOHSW)

Hospital Quarterly Quality AssessmentName of the Hospital

Name of Team Leader of Quality VerificationVerification Period

Quarterly Quality Verification Score

I. Management

II. Structural

Management and Structural Checklist

Assessment/Monitoring

IndicatorsMax Points

Actual Points Quarter I

1. General Management 30 2.62. Human Resources for Health 16 93. Hygiene and Medical Waste Disposal 27 04. Drugs Management 30 85. Equipment and Supplies 84 48

6. Aggregated Process of Care Score 60 32

Total 247 100Total Percentage 100% 40%

Total Quality Bonuses (USD) 159,678 64,517

PBF Bonus Calculation Tool

Financing

Business/Operation Plan

Health Worker Bonus Allocation

LHSSP Indices Tool for Bonus Allocation to Individual Health Workers for Hospitals

1 200 50 30 300,000 0 6,944 2 200 70 30 420,000 0 9,722 3 150 80 30 360,000 0 8,333 4 - - - 5 - - - 6 - - - 7 - - - 8 - - - 9 - - - 10 - - - 11 - - - 12 - - -

Quarter:Total PBF Incentives Earned% for Individual Bonus

Attendance points [C]

Hospital Name

Total Individual Bonus

Redemption HospitalJuly-Sept 2013

No Name of staffStaff

categoryMonthly

salary [A]

Perfor-mance

points [B]

$50,00050%$25,000

Total points = [A] x [B] x [C]

Indices of the period

PBF individual

bonus

Signature of receipt

Use of Finance

Focus of this presentation

Process of care is an important part of quality

3


1. General Management 302. Human Resources for Health 163. Hygiene and Medical Waste Disposal 274. Drugs Management 305. Equipment and Supplies 84

6. Aggregated Process of Care Score 60

Total 247Total Percentage 100%

Total Quality Bonuses (USD) 159,678

I. Management

II. Structural

Quarterly Quality Verification Score

III. Process of Care (See below for details)

Total

24% of Total Quality Score

Overview of Quality Checklists for Hospitals

Hospital will be reviewed by 14 checklist to assess the process of care in hospitals

4

1. Obstructed Labor 0.80 3.872. Hemorrhage 1.00 4.843. Maternal Sepsis 1.00 4.844. Eclampsia 0.70 3.395. Neonatal Asphyxia 1.00 4.846. Neonatal Sepsis 1.00 4.847. Prematurity 0.50 2.428. Maternal Newborn Best Practices 1.00 4.849. ETAT 1.00 4.8410. Malaria 1.00 4.8411. Pneumonia 1.00 4.8412. Acute Diarrhea 0.80 3.8713. Severe Acute Malnutrition 0.60 2.9014. Surgical Safety 1.00 4.84

100% 60.00Total/Average

Childbirth:Maternal-Newborn

Pediatric (in-patient care)

Surgical Care

III. Process of Care Detailed Score

ChecklistsWeight (by

importance)Point

Allocation

Process of care quality will be assessed every quarter

5

Process of Care Quality Assessment Process

• Find relevant patients from register (e.g., “Malaria” patient for Malaria checklist)

• Record names and patient numbers

• Request health workers to bring charts

• Team of minimum 2 verifiers from LMDC will compare charts and guides/checklists

• 2 charts (tentative) for all 14 checklists will be reviewed quarterly

• Total scores will be calculated as % for each checklist

• LMDC will enter average % for each checklist in Bonus Calculation Tool

Acquired score (%) of each checklist will be linked to quarterly performance bonus to the hospital (1/2)

6

Aggregate Score Calculation



100% 60.00 100% 53% 32.20Total/Average

Quarter IChecklists

Weight (by importance)

Point Allocation

Max %

Weight defined by importance

Total 60pt are allocated by

weight

1 2

Assessment results (%)

3“Point

Allocation” * “Actual %”

4

Acquired score (%) of each checklist will be linked to quarterly performance bonus to the hospital (2/2)

7

Quality Bonus Calculation Process


Actual Points Quarter I

1. General Management 30 2.62. Human Resources for Health 16 93. Hygiene and Medical Waste Disposal 27 04. Drugs Management 30 85. Equipment and Supplies 84 48

6. Aggregated Process of Care Score 60 32

Total 247 100Total Percentage 100% 40%

Total Quality Bonuses (USD) 159,678 64,517

Total aggregated process of care score

1

“Actual Points”/ “Max points”

2

40% of Total max quality bonuses

3

Hospital SMT and QI team should use the checklist results for continuous quality improvement

8



100% 60.00 100% 53% 32.20Total/Average

Quarter IChecklists

Weight (by importance)

Point Allocation

Max %



100% 60.00 100% 53% 32.20

Quarter IPoint

AllocationMax %

2

• Find major gaps in scores

3

• Look into the actual checklists to see what are wrong

4

• Plan specific activities to improve the low-score checklists in operational plan

1

• Review scores of all checklists

QI team and LMDC coach will motivate health workers to improve key indicators through tracking and coaching (2/2)

9

• Weekly/daily chart review• Monthly management and

structural checklist review

1 Self-Assessment 2

W1 W2 W3 W40

1020304050

1520

3040

e.g., Sepsis

%

• Post scores on a wall• Provide detailed feedback

to staff

Code Evalaution Criteria Yes No Score 3.1

3.1.1Fence exists, can be closed at night and there are no holes

3 0

3.2

3.2.1Bin with lid accessible to clients which is not full, one for each ward

1 0

3.3

3.3.1One toilet/latrine per 10 beds working flush or water container with sufficient water

1 0

3.3.2Floor without fissures with single hole and lid (latrine) or lid with functioning cover (seating style toilet)

1 0

3.3.3Recently cleaned toilet/latrine without visible fecal matter

1 0

3.3.4Door lockable from the inside but not from the outside, super structure with roofing, without flies (mosquito screening), floor clean

1 0

3.3.5 Functional lighting (electricity or solar lighting) 1 0

3.3.6Water container/functioning tap and soap for hand washing available for each toilet block

1 0

3.3.7Cleaning schedule on the wall at all times next to toilet, and toilet/latrine smells of disinfectant or deodorant

1 0

3.43.4.1 One shower per 10 beds 1 0

3.4.2 1 0

3.4.3 1 0

3.4.4

3.4.5 1 0

3.5

3.5.1

3.5.2

3.5.3

3.5.4

3.5.5

3.6

3.6.1 1 0

3.7

3.7.1

3.7.2 Sharp box for needles well positioned, and used3.7.3

3.7.4

3.8

3.8.1

3.8.2

3.8.3

3.8.4

3.8.5

Fence health facility available and well-maintained in inpatient wards

Availability of a garbage bin in the facility yard in inpatient wards

Presence of sufficient showers which are well-maintained in inpatient wards

3. IN-PATIENT WARD HYGENE AND MEDICAL WASTE DISPOSAL (Max 27 pt)

Presence of sufficient latrines/toilets which are well-maintained in inpatient wards

Tracking and Feedback

3

• Support improvement activities (e.g., standardize chart, waste disposal, cleaning)

• Training on the treatment protocol and chart writing

• ……

Support to Improvement Activities

Exercise – Review medical records with the Process of Care checklist

10

• Look into a patient chart

• Identify the relevant checklist for the chart

• Score the chart based on the guide

• Calculate the percentage (%) score

• Discuss with your group

• One person present the group’s answers to the questions below

Process

Discussion Questions

• What is the overall percentage (%) score?

• What are the issues in the patient chart?

• What does a hospital management and staff need to do to improve the score of the chart?

Performance Based Financing at Hospital - Process of Care Quality Assessment July 11, 2013 James Sorsor, Foday Kanneh Shun Mabuchi.

Documents

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hospital process

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outcomes hospital

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