QAP in KKM QAP in KKM Dr Suhazeli Abdullah Dr Suhazeli Abdullah Family Medicine Specialist Family Medicine Specialist Klinik Kesihatan Marang Klinik Kesihatan Marang Courtesy slides from Dato’ Dr Abdul Jamil Abdullah, Head of Surgery Department, HSNZ
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QAP in QAP in KKMKKM
Dr Suhazeli AbdullahDr Suhazeli AbdullahFamily Medicine SpecialistFamily Medicine SpecialistKlinik Kesihatan MarangKlinik Kesihatan Marang
Courtesy slides from Dato’ Dr Abdul Jamil Abdullah, Head of Surgery Department, HSNZ
What is What is QUALITY?QUALITY?
Excellence, goodnessExcellence, goodness
mutu - mutu - baik buruk sesuatubaik buruk sesuatu
Kamus DewanKamus Dewan
Vision for HealthVision for HealthMalaysia is to be a nation of healthyMalaysia is to be a nation of healthy
individualsindividuals families families and and communities,communities,
through a health system that is through a health system that is equitableequitable affordableaffordable efficientefficienttechnologically appropriatetechnologically appropriate environmentally adaptable environmentally adaptable andand consumer-friendlyconsumer-friendly
, ,
MOH’s vision……MOH’s vision……with emphasis on with emphasis on qualityquality innovationinnovation health promotion health promotion and and respect for human dignity,respect for human dignity,
which promotes which promotes individual responsibility individual responsibility and and
community participation community participation
towards an enhanced quality of lifetowards an enhanced quality of life
AimsAims To improve the quality, To improve the quality,
efficiency and effectiveness of efficiency and effectiveness of the delivery of health servicesthe delivery of health services
To facilitate the planned and To facilitate the planned and systematic evaluation of systematic evaluation of quality processquality process
QA - KKM QA - KKM definitiondefinition
““Securing Securing optimum achievable resultoptimum achievable result for for each patienteach patient,,avoidance of iatrogenicavoidance of iatrogenic complications complicationsand giving attention and giving attention to the to the patientpatientand and family needsfamily needsin a mannerin a mannerthat is that is cost effectivecost effectiveand reasonably and reasonably documenteddocumented
Adapted from ThomsonAdapted from Thomson
QA APPROACHESQA APPROACHES
National Indicator Approach (NIA)National Indicator Approach (NIA)
Hospital Specific Approach (HSA)Hospital Specific Approach (HSA)
Specificity of problemSpecificity of problem Specific to hospSpecific to hosp Common to allCommon to all
Priority for hospitalPriority for hospital HighHigh VariableVariable
Setting of standardsSetting of standards Hospital levelHospital level KKM levelKKM level
Problem verificationProblem verification Related dataRelated data Data collectedData collectedin hospitalin hospital for indicatorfor indicator
QA studyQA study Similar Similar approachapproach
Re-evaluationRe-evaluation Decided byDecided by Once a yearOnce a yearhospitalhospital
NIANIA
* MOH set & provides:* MOH set & provides: -- a a standardstandard for each for each indicatorindicator
-- monitoring format for data collection , monitoring format for data collection , analysis & reportinganalysis & reporting
-- protocols & format for protocols & format for SIQSIQ investigation.investigation.
* Hospital has to carry out remedial * Hospital has to carry out remedial actions & relook of its effectiveness.actions & relook of its effectiveness.
NIANIA
Indicator Std.Indicator Std.1. Typhoid CFR1. Typhoid CFR 002. Elective cholecystectomy deaths2. Elective cholecystectomy deaths 003. Death due to haemorrhage of pregnancy3. Death due to haemorrhage of pregnancy 004. Eclampsia CFR4. Eclampsia CFR 005. Gross death rate5. Gross death rate 2.13% 2.13%6. POP cast complication 6. POP cast complication <5%<5%7. Clean Wound Infection 7. Clean Wound Infection <4%<4%8. Pressure sores in bed-ridden pts8. Pressure sores in bed-ridden pts<5%<5%9. BOR 9. BOR 50 - 80% 50 - 80%10. ALOS 10. ALOS 3 - 6.3 days3 - 6.3 days
NIA IndicatorsNIA Indicators
Indicator Std.Indicator Std.1. AMI CFR1. AMI CFR <34.7%<34.7%2. AGE CFR in children2. AGE CFR in children <0.6%<0.6%3. Head injury CFR3. Head injury CFR <7%<7%4. ARI CFR4. ARI CFR <3.1%<3.1%5. Lab specimen rejection rate5. Lab specimen rejection rate <0.86%<0.86%6. Proportion of urgent lab test6. Proportion of urgent lab test <19.6%<19.6%7. Proportions of Ops undergoing x-rays7. Proportions of Ops undergoing x-rays <8%<8%8. Proportions of Ips undergoing x-rays8. Proportions of Ips undergoing x-rays <70%<70%9. Proportions of x-ray films rejected9. Proportions of x-ray films rejected <10%<10%
Average Notification Time Index for Average Notification Time Index for TyphoidTyphoid <14 days<14 days
Morbidity Index for TyphoidMorbidity Index for Typhoid <2<2
Vector Borne DiseaseVector Borne Disease Dengue Notification Time IndexDengue Notification Time Index
80% within 24 hours80% within 24 hours
Dengue Outbreak Control IndexDengue Outbreak Control Index100% controlled within 14 days of 2100% controlled within 14 days of 2ndnd case case
Dengue Law Enforcement IndexDengue Law Enforcement Index80% positive premise taken legal action80% positive premise taken legal action
Malaria DeathMalaria Death No deathNo death
Family HealthFamily Health Incidence Rate of EclampsiaIncidence Rate of Eclampsia
8 per 10,000 deliveries8 per 10,000 deliveries
Incidence Rate of Severe Neonatal Incidence Rate of Severe Neonatal JaundiceJaundice< 100 cases per 10,000 live births< 100 cases per 10,000 live births
Incidence Rate of Tetanus Incidence Rate of Tetanus NeonatorumNeonatorum 0 case per 10,000 live births0 case per 10,000 live births
HSAHSA
Hospital/Unit/Dept. Hospital/Unit/Dept. identify own identify own areas of weakness to remedyareas of weakness to remedy
Idea of local people solving local Idea of local people solving local problems problems
Useful tool in improving quality Useful tool in improving quality servicesservices
HSAHSA
To ensure that To ensure that the patient, family the patient, family and communityand community obtain obtain the the
optimum achievable benefitoptimum achievable benefit from the services of MOH from the services of MOH
within the within the available resourcesavailable resources
General ObjectiveGeneral Objective
With unlimited resourceWith unlimited resource ideal level of careideal level of care
Optimal Achievable LevelOptimal Achievable Level targeted level within targeted level within
meansmeans
ABNAABNA difference between OA & difference between OA &
present levelpresent level QA aims at narrowing or QA aims at narrowing or
eliminating the gapeliminating the gap0
25
50
75
100
ABNA}IdealOptimum
Actual
ABNAABNA
Problem Problem PrioritisationPrioritisation
Problem Problem AnalysisAnalysis
Quality Quality Assurance Assurance
StudyStudy
Identification of Identification of Remedial ActionsRemedial Actions
Implementation of Implementation of Remedial ActionsRemedial Actions
Re-evaluation of the Re-evaluation of the ProblemProblem
These may seem varied, butThese may seem varied, butthey almost sound similar;they almost sound similar;
thethe requirements of the requirements of the customercustomer are always a are always a consideration in a valid consideration in a valid definition of qualitydefinition of quality
Patients/RelativesPatients/Relatives Pleasant Staff & Pleasant Staff &
KKM DefinitionKKM DefinitionSecuring Securing optimum achievable result optimum achievable result
for for each patienteach patient,,Avoidance ofAvoidance of (MINIMISE)(MINIMISE) iatrogenic iatrogenic
complicationscomplicationsand giving attention and giving attention
to the to the patientpatientand and family needsfamily needs
in a mannerin a mannerthat is that is cost effectivecost effective
and reasonably and reasonably documenteddocumentedAdapted from ThomsonAdapted from Thomson
ASSURANCEASSURANCE
Implies one party is Implies one party is convincing another convincing another that certain that certain standardsstandards will be will be maintainedmaintained
Quality Quality AssuranceAssurance
In general terms In general terms means that means that
all the measures are takenall the measures are taken in in order that the customer or order that the customer or interested party will be interested party will be consistently provided with quality.consistently provided with quality.
(show them what you are doing)(show them what you are doing)
WhyWhy we need we need QualityQuality
Professional NeedProfessional Need related to the fundamental responsibility related to the fundamental responsibility
of all professionals – appropriateness & of all professionals – appropriateness & necessitynecessity
for the highest standards of excellence.for the highest standards of excellence.
A Social NeedA Social Need related to the accountability of every related to the accountability of every
profession to the society profession to the society
from which the profession obtain from which the profession obtain authorization and economic support authorization and economic support to practice their skillsto practice their skills
EthicalEthical
A Practical NeedA Practical Need The need for continuous The need for continuous
improvementimprovement Where errors are costlyWhere errors are costly
CostsCosts
““, it is always the , it is always the result of high result of high