Human Resources: The Essential Ingredient for a Culture of Quality

Human Resources: The Essential Ingredient for a Culture of Quality Rabab Diab, RN, MSN, CPHQHCAC, Deputy CEO, Director of Education & ConsultationMEDHEALTH Cairo 2014 Thursday, 13 March 2014

Outline • Introduction • Healthcare Human Resources in Jordan • Quality and Patient Safety Challenges • Standards for Human Resources Management • Competency based practice • Conclusion

Outlines • Introduction • Healthcare Human Resources in Jordan • Quality and Patient Safety Challenges • Standards for Human Resources Management • Competency based practice • Conclusion

Research has been showing that human resources are very essential in developing and sustaining any quality practices in the health sector • Most of literatures have showed the importance of human resources management on developing the quality of healthcare service (Yu, 2007; Michael, 2009; Patrick, 2011) • Incentives and providing motivation and use system of bonuses by competencies improve the performance of individuals working in hospitals (McKinnies, 2011) • Training courses for workers in the hospitals in the area of the dimensions of medical service quality, and to deepen the quality concept between the staff and to achieve the quality dimensions at the best degree (Diab, 2012). • Perceived safety climate in the relationship of high performance human resources and organizational performance is confirmed. • The finding suggests that organizational emphasis on safety issues contributes to establishing effective high performance human resources and driving organizational performance (Chan and Mak (2012))

Especially in developing countries or young health care systems, there are many challenges to having and retaining human resources that embrace quality • Supply of trained Health Professionals in local market • Insufficient and ineffective professional institutions • No structured career guidance. • Brain drain of skilled individuals. • Inappropriate placement and distribution of work • Lack of continuous capacity building • No embracing of latest technologies • Weak laws and regulations (and / or their enforcement) to ensure continuous medical education • No real HUMAN RESOURCES systems – everything still is a personnel management world

Human Resources in Jordan have different strengths but face several challenges Strengths Challenges • Lack of leadership competency • Lack of established human resources management programs • Lack of regulations • No policies, procedures, clinical guidelines • Lack of credentialing and privileging system for medical staff • No relicensing system • No mandatory continuous education • No medical liability laws • Established graduate and post graduate education programs • Qualified Healthcare professionals • Good health out come indictors in terms of communicable diseases, infant and maternal health

Although the numbers in Jordan are relatively sustainable…. Nursing and Midwifery/10,000 Population2005 – 2012 Pharmacists /10,000 Population2005 – 2012

…Jordan still faces similar challenges for the retention of skilled and patient centered resources Lack of proactive measures • No On The Job Training Programs • Still no Compensation alignment: • No Career Growth for Professionals • No Competency based Pay • Limited professional training institutes, • Lack of uniform and Structured Programs • No Licensing body, No accreditation and no affiliation of these programs

Additionally, Quality and Patient safety still faces many challenges in Jordan • chemical exposure • Lack of radiation safety • Absence of basic hygiene • Lack of privacy • No fire safety procedures and systems • Untrained staff on basic resuscitation • Lack of leadership competencies • Lack of medical staff management systems • Competency of healthcare providers • No documented policies, procedures, plans, • No clinical guidelines • Not in compliance with laws and regulations regarding fire safety, radiation safety, staff qualifications, and medication management processes. • Lack of qualified staff in quality management , risk management, and infection prevention and control • Reporting culture

But to address both challenges “quality issues and human resources challenges” Jordan adopted a two prong approach

Accreditation standards support the provision of qualified personnel: Leadership! • Each hospital leader’s job description identifies qualifications that include formal training and experience in health management. • Quality improvement, patient safety and risk management are part of that training. • The leaders have documented formal leadership training within the past two years.

The standards also require quality improvement coordinator who coordinates QI activities Quality Planning • The quality improvement coordinator has knowledge in risk management methodologies. • The quality improvement coordinator completes continuing education activities at least annually to increase knowledge regarding current quality improvement practices and risk management Manage Change Quality Improvement Quality Measurement

The standards require a qualified risk management coordinator who coordinates risk management • The hospital has a risk management coordinator who meets the qualifications outlined in a job description, which includes: • Attendance in formal risk managementtraining course or • Risk management certificationThe qualifications are met within one yearof assuming the position of the risk management coordinator • The risk management coordinator completes continuing education activities at least annuallyto increase knowledge regarding current qualityimprovement practices and risk management. • The risk management coordinator participates in training staff on risk management measures.

And the standards also stipulate a qualified nurse, or professional to coordinate the infection prevention and control activities • There is at least one qualified nurse, or professional in related field, who coordinates the infection prevention and control activities. • The IPC Preventionist is responsible for the surveillance, data gathering, aggregation and analysis of IPC data. • Infection prevention certification • The IPC Preventionist in the related field has knowledge in quality improvement and risk management methodologies. • The IPC Preventionist completes continuing education activities at least annually to increase knowledge regarding current ICP practices, quality, and risk management.

For example, the tailored certification courses introduce concepts of continuous education while ensuring applicability to the field Certification Complete Assignments Pass certification Exam Recertification every 2 years Recertification

There are several opportunities in place for human resources development crucial to the quality journey Enabling Services Not just academic, includespractical and hands on Certification courses Rich yearly schedules Workshops and Trainings Walkthroughs and1 to 1 consulting , coaching and mentoring Knowledge Transfer

Additionally, standards specify that at all times qualified individuals provide health care services in timely and efficient manner. • Individuals qualified to perform health care are defined in a policy, according to specific patient populations, e.g. emergency, pediatric, ICU. • Only those individuals permitted by license, certification and/or competency-based testing perform healthcare procedures. • Staff members demonstrate competency in managing patients within their area of work.

Additionally, in Jordan, we are trying to promote and push for competence based practice as it clearly supports quality improvement Definition Advantages • Establish recognition for the practice • Establish minimum standards in practice • Establish quality training programs • Establish criteria for evaluation of practice • Establish commitment to good practice Competency- based practice (CBP) is that it focuses on the ability of healthcare provider to provide safe, consistent care to patients when their performance is measured against valid, reliable and objective evaluation criteria.

Competency-based performance improvement frame work is a very straight forward and goal oriented approach feeding into quality improvement requirements External environment Internal environment Strategic goals, objectives, and business plans Need analysis, assessment, and planning Competency model development Education modules planning Learning intervention design and development Evaluation

The concepts and methods for developing competency based framework are supportive of quality improvement practices Competency Assessment Competency Continuum • Competencies should be assessed when • An individual is hired • During their orientation period to the position • Throughout employment as the requirements of the job and needs of the organization change. • Dynamic competencies should exist that address each period separately. • Competencies should be… • Ongoing • Systematic • Demonstrable ( capable of being demonstrated) • Improved • Addressing age-specific issues(if applicable)

CBP is continuum with ongoing work, and new education programs need to be developed to address development and changes in healthcare field. Ongoing Work Educational Program • New procedures • New equipment • Maintenance of current competencies • Improve Performance • Ongoing competency assessment is NOT annual re-assessment of the initial competencies for the job. • Ongoing competency assessment is a dynamic process that is based on the ever-changing needs required to carry out the organization’s mission and goals. • Ongoing competencies will be different than the initial competencies identified for the job.

To address Human resources challenges , interventions need to be introduced on the organizations level, as well as changes in the policy level. • Human resources management is an integral part of quality culture • Established continuous education programs and certification courses one of the key elements in addressing human resources challenges • Advocate for changes in laws, regulations that mandate continuous education to maintain licenses

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Human Resources: The Essential Ingredient for a Culture of Quality