Transcript What is in Health Care

What is
QUALITY
in Health Care ?
QUALITY
as defined by
CUSTOMERS
Internal & External
1985 Scott Report
• Recommend to establish the Hospital
Authority as a statutory body to
transform the management of public
hospitals in Hong Kong
The HA Reform
The HA Reform
• Manages 44 public hospitals
• Staff force nearly 50,000
• Recurrent budget HK$30 billion
• In-patients 1.2 million
• A & E attendances 2.6 million
• Specialist out patient attendances 9.5 million
• Public spending on health 2.7% GDP
• Market share in secondary & tertiary care 94%
Daily hospital charge below US$9
Including:
• Meals
• Nursing care
• Medical
Intervention
• Drugs
HA Ordinance
• To advise the Government of the needs of the public
for hospital services
• To provide hospital services of the highest possible
standard within the resources obtainable
Mission Statement
1993
HA’s Year of
QUALITY
Quality in the HA Context
• Defining the customer context of quality
• Developing the philosophy of quality
• Integrating quality improvement into
organizational systems and processes
• Focusing on clinical quality improvement
Quality as Defined by Customer
“What constitutes
the healthcare product
that the organization
is supposed to produce?”
Needs of Patients
Quality Aspects Important to
Patients
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Access and convenience
Decent environment and hygiene
Staff attitude and empathy
Information and explanations
Respect for dignity and rights
Channels for feedback and complaints
Quality Improvement
in Early Years
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Elimination of camp beds
Reduction of overcrowding
Environmental improvement
Building new hospitals
Introducing Customer Concepts
• Communication courses
• Promulgate Patients’ Charter
3-tiered Complaints
Management Structure
Internal Customers
Extension of the
Customer Concept
Organizational Philosophy
on Quality
Core Value
“Quality Patient Centered Care
through Teamwork”
Prevention and System Approach
Focusing on prevention
No blame culture
QC ==> QA ==> TQM
Promoting a Quality Culture
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Quality involves everybody
All hospital staff are healthcare workers
Patients’ participation
Optimize existing resources
Adopting Preventive and System approach
Spirit of CQI even with no additional
resources
Continuous Quality Improvement
• Cultivate an attitude of constant
improvement
• Critical re-look to eliminate non-value
added work
• Prevention of errors
• Do the right things right, first time and
every time
• Quality Tools - BPR, 5-S
Structure for Assuring Quality
Clear Lines of Accountability
Accountability at Department Level
Structure
Internal and external task forces
to do quality audits on clinical
and non-clinical areas
HA’s Annual Planning Process
A key management tool to:
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Align value and directions
Demonstrate public accountability
Manage quality improvement
Tie in with resource allocation exercise
Annual Planning Process
Resources Planning
Outcome Focused
Planning
50 Areas of Quality Standards
Systems are in place to ensure cost-effective use of drugs and
safety of drug administration
Reference Standard
(i)
To ensure cost-effective use of drugs, a hospital formulary review system is
in place, as measured by
¥ s% of pharmacological class of drugs reviewed in each quarter
¥ t number of new drug entities added in the hospital in each quarter
¥ u number of drug entities deleted in each quarter
¥ v number of cost-effective drug utilisation programmesperformed,
e.g. through multi-disciplinary approach as directed by Drug
Therapeutic Committee, including e.g. prescribing guidelines,
treatment protocols
(ii)
To achieve safety use in drug administration, to report on x% Compliance to
the Recommendations checklist of the Drug Administration Report 2000
edition
(iii) Programmesare implemented to review and improve patient compliance
level to drug therapy
Perspectives
of Annual
Planning
CQI versus Accreditation
HA is the
Mark
in Hong Kong
Improving Clinical Quality
Donobedian model of
Structure, Process and
Outcome
Inverse Pyramid Concept
Hospital Quality Improvement
Committees
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Promotes quality awareness
Representative from all departments
Trains and aligns methodology
Monitors feedback and evaluation
CQI Methodology
Clinical Specialty Coodinating
Committees
• Process of developing alignment, trust
and leadership
• Engage clinicians to look at the bigger
picture
• Territory-wide service rationalization
• Consensus on improvement programs
and outcome
• Cross-hospital clinical audits
• Pooling resources in specialist training
Improving Clinical Quality
Means:
• Clinical guidelines
• Protocols
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• Clinical audits
Process:
• Discussion and sharing
Good
• Consensus building =
Practice
• Planning for quality
improvement
Web-based IT Infrastructure
Knowledge Management
• Champions in
Evidence-based
Medicine
• Electronic Knowledge
Gateway (eKG)
• Publication of
Multi-facet
access
Auto alerts
Interactive
participation
Crystal in Paediatrics
Quality
filtered
resources
Internal
knowledge
capture
Level I
e-journals
Central Mechanisms on Clinical
Effectiveness
• Central Drug Advisory Committee
• Hospital Drug Advisory Committees
• Striking a balance between Innovation
and Risk
• HA Mechanism for Safe Introduction of
New Procedures (HAMSINP)
Ethics Committees
Clinical Ethics
Research Ethics
Risk Management Strategy
• Systematic environmental scanning
• Appraisal of risks in all aspects of clinical
and non-clinical areas
• Part of CQI philosophy
Quality in Healthcare
a Journey of Lifelong Learning