Quality

(HEALTH DEPARTMENT)

MUNICIPAL CORPORATION OF DELHIMUNICIPAL CORPORATION OF DELHI

“QUALITY IMPROVEMENT

IN

HEALTH SERVICES ”

DR.P.P.SINGHDR.P.P.SINGH

Ex Medical Superintendent HRH & Ex Medical Superintendent HRH & SDN Hospital DelhiSDN Hospital Delhi

Ex. DIRECTOR PROJECT Ex. DIRECTOR PROJECT

IPPVIII- DELHIIPPVIII- DELHI

MEANNING OF QUALITYMEANNING OF QUALITY

•QUALITY IS A SET OF ATTRIBUTE OF SERVICES.

•TOTALITY OF FEATURES AND CHARACTRESTICS OF SERVICES THAT BEAR ON ITS ABILITY TO SATISFY GIVEN NEEDS.

•PROPER PERFORMANCE OF INTERVENTIONS THAT ARE KNOWN TO BE SAFE, AFFORDABLE TO SOCIETY AND HAVE ABILITY TO PRODUCE IMPACT ON MORBIDITY ,MORTALITY, DISABILITY AND MALNUTRITION.

WHY QUALITY.?

TO ENHANCE UTILISATION OF HEALTH SERVICES TO THE OPTIMUM.

•SUSTAINABILITY OF SERVICES.

THUS FOR QUALITY , REPRODUCTIVE HEALTH SERVICES HAS TO BE:-

1 . EFFECTIVE.

2. EFFIECENT.

3. OPTIMUM.

4. IN PROPER FRAMEWORK.

5.CLIENT SATISFACTION. OUTCOME.

INTER PERSONNNAL BEHAVIOUR

MODEL OF QUALITY FRAMEWORKMODEL OF QUALITY FRAMEWORK

THERE ARE A NUMBER OF FRAMEWORKS:-

1 .DONABADIAN.

2 .ZUDITH.

3 .I I P F FRAME WORK.

4. I C O M FRAME WORK.

5. U N F P A FRAME WORK.

EDUCATION ,SOCIOECONMIC

ENVIORNMENT SOCIAL,

POLITICAL,LEGAL.

TECHNOLOGICAL

FACTOR.

SYSTEM ORGANSATION SIDE EFFECT/

SUFFICIENT POLICIES SAFETY.

TRAINING

EDUCATION ,SOCIOECONMIC

ENVIORNMENT SOCIAL,

POLITICAL,LEGAL.

TECHNOLOGICAL

FACTOR.

SYSTEM ORGANSATION SIDE EFFECT/

SUFFICIENT POLICIES SAFETY.

TRAINING

CLIENT

MANAGEMENT

SERVICESDELIVERY

TECHNOLOGICAL

1 . DONABEDIAN FRAME WORK. STRUCTURE PROCESS. OUT COME.

2. I I PF FRAME WORK A. CLIENTS RIGHT– Information

----RIGHT OF INFORMATION

-- RIGHT OF ACCESS.

--Safe Services

--Privacy & confidentiality.

Dignity, Comfort,& expression of Opinion.

B. PROVIDERS NEEDS.-Facilitative supervision & Management

--- Informative Training & development

--- Supplies, Equipment & Infrastructure..

FOR F.P. METHODS (QUALITY AT EACH STEP)

. Choice of methods. . Information

.Technical competence .Client Provider Relation ship

.continuity of care. .Appropriate Services.

World of

mouth

Personnel

needPost exposure

expected

Perceived

services

Dimension of

services quality

reliability

responsive

ASSURNCE

EMPATHY

TANGIBLE

PERCEIVED QUALITY

SERVICES.

ES<PS(QUALITY)

ES=PS(SATISFACTORY)

ES>PS(UNACCEPTABLE)

CUTOMER SERVICES EXPECTATIOINMODEL

ADEQUATE DESIRED

ZONE OF TOLERANCE

LOW HIGH

LEVEL OF

EXPECTATION

LEVELS OF QUALITY1.QUALITY ASSURANCE(QA) BY MANAGEMENT LEVEL.

2. SYSTEM IMPROVEMENT

3.QUALITY IMPROVEMENT(Qi) BOTH EMPLOYER&EMPLOYEE

INVOLVED

4.TOTAL QUALITY MANAGEMENT (TQM)

CORPORATE THINKING.

Death Review and CPC.

S Q C – in X RAY & LAB.

Hospital Based Gross Death Rate,

Institutional Death Rates

Anesthetic Death Rates.

Postoperative Mortality Rate.

M M R & I M R in hospital.

Caesarian Rate

Post-operative Infection Rate.

H A I rate.

Bed Occupancy, Average of Stay., Re-admission rate

Recurrence Rate, Autopsy Rate.

MEDICAL AUDITS, EQUIPMENT AUDIT

HOW TO UNDERSTAND THE CLIENTS NEED/PERCEPTION

1.LISTENING,LIFE SITUATION, PREFERANCES, CHOICES

2 SURVEY&FOCUS GROUP DISCUSSIONS WITH COMMUNITY

3.OBSERVATION OF CLIENTS &FEEDBACK ABOUT SERVICES.

4 .STUDY METHODS/PROCEDURES

5 .STUDY CAUSE OF DISCONTINUATION/NON ACCEPTANCE OF SERVICES.

6 .BEING CLOSE TO CLIENTS(BEFRIEND)

QUALITY ASSURANCE PROCESS

NOT ACCEPTABLE

ACCEPTABLE

IDENTIFICATION OF REMEDIAL ACTION

IMPLEMENTATION OFREMEDIAL ACTION

PROBLEM ANALYSIS

INVESTIGATION

IDENTIFICATION OF PROBLEM AREA

PRIORITIZATION OFPROBLEM

ASSESSMENT OFQUALITY CARE

QUALITY IMPROVEMENT TOOLS

1.COMPARISION WITH STANDARD AVAILABLE.

2CLIENTS FEEDBACK BY SURVEY,EXIT INTERVIEWS

3.GROUP DISCUSSION

4.FOCUS

5.OPEN DISCUSIONS ON TOPIC PLANNED

6.MYSTERY CLIENT STUDIES.

OPERATION RESEARCH

PLANS FOR IMPROVEMENTS

ELEMENTS OBSERVATIONCHARACTRESTICS

STADERAD

A INPUTB. PROCESSC .OUTCOME

1.BY FLOW CHART ANALYSIS

2.BY CAUSE & EFFECT CHARTS

3. SYSTEM MODEL

(DONABADIAN FRAMEWORK)

DATA COLLECTION

INDICATOR SOURCE METHOD OF SAMPLE FREQUENCY PERSON

COLLECTION RESPONSIBLE

INPUT

PROCESS

OUTCOME

INTERVENTIONS TO IMPROVE THE QUALITY

A.TRAINING----I INDUCTION

IIREFENCE/PERIODIC

TYPE--INTER PERSONNAL

--SKILL

--MANAGEMENT

B,PROPER REFERALS--TIMELY

--SPECEFIC

C.SUPERVISON----FACILITATIVE / SUPPORTIVE

-CHECK LIST.

D.MODEST INVOLVENT OF CLIENTS--VOICE

---CHOICE

C O P E METHOD(CLIENT ORIENTED PROVIDERS EFFECTIVE SERVICES)

A.FORMATION OF COMMITTEE/TEAMS

(AFTER CLIENTS ASSESSMENT)

I.SELF ASSESSMENT.

II.CLIENT INTERVIEWS

IIICLIENT FLOW ANALYSIS

IV.MEDICAL RECORD REVIEW

V. ACTION PLAN.

B. ACTION PLAN STATUS

I.THE PROBLEMS

II.THE CAUSES

III.THE RECOMMENDATIONS

IV. BY WHOM

V.BY WHEN.

KEY SUCCESS FACTORS FOR RCH PROGRAMME

1.HEALTH WORKERS

2.TIMELY SUPPLY OF DRUGS,CONTTRACEPTIVES,VACCINE

3,TRAINING

4.SUPERVISION

5.METHOD MIX

.

6.ACCESSIBILITY.

KEY INDICATORS

1. TIMELY SUBMISSION OF REPROTS.

2.ADEQUACY OF MONITORING IN THE FIELD.

3ORGANISING I. E.C ACTIVITIES.

PROBLEM SOLVING &MOTIVATION SKILL.

Developing a Customer’s or Focus.

Creating Staff involvement and ownership in QI

Emphasis on Improving process and system rather than blaming individuals.( Environment )

Cost Consciousness and efficiency.

Continuous quality improvement.

Staff development and Capacity building.

12

3

5

47

6

8

THANK YOU VERY MUCH