Quality in Healthcare Beyond Accreditation Dr Y P Bhatia

2. Quality in Healthcare Beyond Accreditation Dr Y P Bhatia

3. Defining Quality “ The degree to which health services for individuals and populations increases the likelihood of desired outcomes and are consistent with current professional knowledge” Institute of Medicine

4. MedicalQuality(Avedis Donabedian1970’s) Measurement of quality Structure Stable characteristics of the providers of care, tools and resources at their disposal Process Activities that go on between and within the practitioners and patients Outcome Changes in health status attributable to antecedent health care

5. FOOD FOR THOUGHT I Should Quality Initiatives lead to Accreditation OR II Should Accreditation lead to quality initiatives (TAKE YOUR PICK)

6. Quality Aspects • Conformanceto standards • An ongoing processof building and sustaining relationships and properties ofdeliverablesby assessing, anticipating and fulfilling stated and implied needs • Error-free, value addedcare that meets or exceeds the needs and legitimate expectations of theservedandserving Less mature More mature

7. The Quality Continuum • Medical Quality • Quality Assurance • Continuous Quality Improvement • Total Quality Management Less mature More mature

8. Approaches to Quality Initiatives The Quality Continuum Vision Current Strategic Perspective Involvement Local Global Focus Niche ProcessesComplete Processes Scope Organisation WideCommunity Wide Triggers ExternalInternal More mature Less mature

9. Defining Quality Policy Making Structural Reorganization Incentives Quality Redesigning Motivation • Benchmarking QUALITY ASSURANCE Problem Solving Standards setting Management Actions Monitoring systems Supervision Improving Quality Measuring Quality Regulation Audit Accreditation Quality Evaluation QUALITY ASSURANCE TRIANGLE

10. Importance Effectiveness And Efficiency Community confidence Improved Health Outcomes Waste Reduction Optimum Utilization of Resources Reduced Cost of Healthcare Safety and risk reduction Uniformity In Processes

11. A Voluntary Act Organisational Commitment HEALTHCARE ACCREDITATION Defined Standards Frame work for Quality Assurance Assessment by External Agency Unbiased approach An Effective Quality Improvement Tool

12. Vision VOLUNTARY ACT • Involvement • Focus • Triggers

13. Physical facility and spatial associations • Equipments Structural Standards • Materials • Human resource

14. Policies • Processes Process Standards • Guidelines • Programmes/Plans

15. Benefits ofAccreditation • A visible commitment by organisation towards quality of patient care • Safe working environment • Resource Optimisation • Stimulates continuous improvement • Benefits all stake holders • Raises community confidence

16. FOOD FOR THOUGHT (REVISITED) I Quality initiatives should lead to Accreditation (Philosophy leading to the goals) II Accreditation should lead to Quality initiatives (The goal prompting and directing philosophy) *NOW MAKE YOUR CHOICES*

17. P A D C Quality Improvement Process of Accreditation Decision NO YES Obtain Standards Comprehensive Review Identify Gaps and Bridge it Is standards Implemented and Integrated satisfactorily Yes No Apply NABH for Assessment Apply for re-assessment Assessments by NABH Is Assessment Result satisfactory No Receive recommendation & act accordingly Yes NABH Accreditation

18. Applying Accreditation Standards for Quality Improvement-A systematic approach • Initiation • Documentation • Implementation • Monitoring

19. Initiation • Sensitization • Constitution of teams Initiation • Understanding Standards • Customising Applicability • Action Plan

20. Documentation • Policies • Processes • Guidelines • Criteria and protocols • Programmes • Roles and Responsibilities • Formats for records and documents • Manuals • Organisational and departmental line of hierarchy

21. Documentation topics • Pricing Policy • Uniform care policy and processes • Emergency care policy and processes • Medico-legal cases • Triaging of patients • Uniform use of resuscitation • Rational use of blood and blood products • Care of patients in ICU and HDU • Situation of bed shortage in ICU/HDU • Care of vulnerable patients • Care of high risk obstetrical patients • Care of paediatric patients • Prevention of child/neonate abduction or abuse • Care of patients undergoing moderate sedation • Administration of anaesthesia • Care of patients undergoing surgical procedures • Prevention of adverse events • Registration policy and procedure • Admission policy and procedure • Transfer of unstable patients to another facility • Transfer of stable patients to another facility • Standardized initial assessment of patients in the OPD, emergency and IPD. • Processing and disposal of specimens in laboratory. • Handling and disposal of infectious materials • Identification and safe transportation of patients to imaging services. • Handling and disposal of radio-active and hazardous materials. • Safe use of radioactive isotopes for imaging services. • Referral of patients to other departments / specialties. • Discharge policy and process • LAMA policy and process • Informed Consent policy and process

22. Procurement of implantable prosthesis • Procurements, handling, storage, distribution, usage and replenishment of medical gases. • Antibiotic policy • Laundry and linen management • Kitchen sanitation and food handling • Engineering controls for infection control • Mortuary practices an procedures • Surveillance, data collection and monitoring of HAI • Isolation/barrier nursing • Outbreak control procedures • Quality control for sterilization • Handling of bio-medical waste • Quality assurance programmes • Operational and maintenance plan • Smoking policy • Human resource planning • Restraints techniques • Pain management guidelines • Rehabilitative services polices • Research activities policies and protocols • Nutritional assessment and reassessment • End of life care • Procurement, Storage, prescription and dispensing of Medications • Administration of medications • Monitoring of medications • Patient’s self administration of medication • Medication brought from outside the organisation • Adverse drug events • Use of narcotic drugs and psychotropic substance • Usage of chemotherapeutic agents • Usage of radioactive and investigational drugs • Safe storage, preparation, handling, distribution and disposal or radioactive and investigational drugs.

23. Committees • Medical audit / death audit committee • Infection control committee • Resuscitation committee • Sentinel event committee • Fire and non-fire emergency committee • Equipment management committee • Pharmaco-therapeutic committee • Ethics committee • Safety committee • Quality assurance committee

24. Central Vs. Departmental • Internal Vs. External Training of Staff • Theoretical Vs. Practical • Mock drills and Practises • Training Evaluation

25. Training topics • Policies and Processes • Advanced Care of Life Supports / Basic Care of Life Supports • Disaster management • Safe practices in laboratory • Handling of vulnerable patients • Restraint techniques • Hand washing • End of life care • Quality assurance • Handling of hazardous materials • Fire and non-fire emergencies • Handling patient in ambulance • Biomedical waste disposal • Universal precautions • Infection control surveillance and monitoring system • Managing patient during non-availability of beds • Radiation safety measures

26. Intra-departmental • Inter-departmental Self Assessments • Core team assessment • Assessment by ASTRON

27. Analyzing assessment results Continuous Effort Re-assessment Identifying weak areas Retraining and/or reformation of policy/process Improving weak areas

28. Time Frame

29. CHALLENGES • Lack of commitment • Lack of time • Lack of clarity on roles of team, team members • Difference of opinion on policy, procedures and standards • Unavailability of adequate information • Improper/Incomplete documentation

30. CHALLENGES • Improper/Incomplete records • Inadequate training • In-experienced trainers • Poor attendance • Lack of time and resources • Communication barriers • Biased assessments • Individual preferences • Improper assessment methodology • Improper assessment framework

31. Plan for Personal Excellence -Dianna Boober • Define success in your own terms • Assess your strengths • Set goals with deadlines • Develop discipline and be willing to pay the price • Use time wisely • Ask for advice • Be receptive to feed back

32. Plan for Personal Excellence -Dianna Boober • Stay informed • Learn to communicate well • Do Quality work • Take risks • Be dependable • Be ethical • Nurture relationships ABOVE ALL “HAVE A POSITIVE ATTITUDE”

33. ENVISIONING ASTRONOMICAL HEIGHTS FOR HEALTHCARE

34. THANK YOU BUILDING RELATIONSHIPS