Measuring quality: SafeCare experience

Transcription

1 Measuring quality: SafeCare experience Millicent Olulo Orera Program Director SafeCare Kenya Phiilipines, October 24,

2 In resource-restricted settings... The challenge ISQua-based accreditation systems such as implemented by COHSASA and JCI are difficult if not impossible to achieve As a result, few facilities are accredited Quality of care is unknown and benchmarking not possible Often standards are lowered instead of having healthcare quality improved The solution A system for resource-restricted settings should: Focus on progression Be a specified, recognizable product, independently awarded Be solutions-based with achievable goals Have data widely available Be sustainable

3 SafeCare, established 2011 Organization Based in Dutch NGO dedicated to strengthening health services in resource-restricted settings Netherlands Council for Health Service Accreditation of South Africa, Accreditation body of Southern Africa South Africa Accreditation body, Global leader in patient safety and quality with a presence in 90 countries worldwide USA

4 ISQua Who? International Society for Quality in Healthcare (ISQua), an international body that accredits the accreditors Why? Confidence and credibility Impartial and independent review system Accredits What? Accreditation bodies Service-specific external evaluation bodies (blood transfusion) Healthcare standards Surveyor training programs

5 Principles 1 Innovative & realistic Innovative and realistic standards for healthcare providers in resource-restricted settings. ISQUa approved 2 Step-wise approach Step-wise improvement process that can be measured and used by governments, donors, health insurers, (social) investors, and banks 3 Certificates Improvements rewarded with certificates 4 Local capacity Build local capacity and a sustainable model

6 Principles (cont d) 5 Practical & achievable Quality is not necessarily high-tech or high-cost. SafeCare allows for realistic, practical and achievable solutions 6 Scale & scope Facility level determines scale & scope 7 Priorities first Standards are designed to address priorities

7 SafeCare standards Management and Leadership Primary Healthcare Management Human Resource Management Patient & Family Rights & Access to Care Management of Information In-patient Care Operating Theater & Anesthetics Scale & scope determined by facility level Clinical Risk Management Clinical Support Laboratory Diagnostic Imaging Medication Management Facility Management Support Technology

8 Standards for healthcare facilities are written statements that define the key functions, activities, processes and structures required for organisations to be in a position to provide quality services as determined by professional bodies, health care professionals, staff, patients and citizens.

9 Measuring the compliance of standards are measurable elements that define the specific requirements needed, to ensure that the intention of the standards is met. Each criterion is evaluated separately. The weighted average of criteria compliance indicates the level of standard compliance. Standard

10 Evaluating the facility as a whole The average of service elements scores provides an overall evaluation of the facility. Standard Standard Performance Indicator Service Element Standard Standard Standard Standard Performance Indicator Performance Indicator Service Element Overall Facility Score Standard Standard Performance Indicator

11 6. Primary health care services Service Element PI Standard 6.1 Organisation and co-ordination The service is organised to provide a safe and effective service and is co-ordinated with other relevant services in the referral hospital and in the community The lines of communication between the health facility, referral hospital and community services are clearly defined Relations are established, and contact is maintained with other relevant services and agencies, including both governmental and nongovernmental agencies An on-call roster is available for after hour, weekend and holidays emergency coverage (e.g. for infectious diseases) Arrangements are in place to ensure that adequate referral services are available Radiology services are available for the level of care provided. These we score Laboratory services are available for the level of care provided Ultrasound services are available for the level of care provided There is an organised process for referring patients. 6.2 Facilities and equipment The required furniture and equipment are available and functioning appropriately.

12 Example standard

13 Assessing compliance with standards DOCUMENTATION REVIEW Preparation at facility documents: Organisational: Patient record audits!!

14 Observation - Vigilant attentiveness Paying close and continuous attention - Objectivity - Validation Protocols versus practice

15 Methods of assessment INTERVIEWS

16 Triangulation Team Work!

17 Services offered Certification Consultancy Baseline assessments Assisted self-assessments Data collection and reporting External evaluation visits Research on evidence-based quality-improvement programs Training of local assessors Quality control of local systems & data Consultancy with respect to existing qualityimprovement methodologies Different branding SafeCare branding Stepwise improvement Technical assistance

18 Change is the Only Constant Change is disturbing when it is done to us. Change is exhilarating when it is done by us. - Rosebeth Kantor

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20 Rewarded by certificates Improvements rewarded with certificates Motivates clinics and staff Benchmarking of facilities Transparency for patients

21 Annual cycles of improvement and recognition

22 Focus Planthe process of improvement Act (adopt, adjust, change) Do the improvement, data collection & analysis Check (results & lessons learnt) The Cycle

23 Identification of priority areas

24 What is important in the SC report? Which departments score lower than others? Which criteria are critical and score NC? Which criteria are severe and score NC? These are your main priorities!

25 Example of a QIP Good hope medical clinic February 2014 January 2015

26 Information management Before After

27 Before and after

28 Financing quality improvement Improved theatre services Innovative soap taps

29 AfriDB: data collection & analysis Preliminary reports are available within 30 minutes of submitting data

30 Measuring compliance with standards 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Antenatal guidelines Referral complicated pregnancies Trained Birth Attendant Oral Rehydration Visit 1 Visit 2 Visit 3 N=73 Visit 1: 0 Visit 2: N=88 Visit 3: N=24

31 Measuring compliance with standards 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Diarrhoeal guidelines Hand washing facilities Waste management ART administration guidelines Visit 1 Visit 2 Visit 3 N=73 Visit 1: 0 Visit 2: N=88 Visit 3: N=24

32 SafeCare rolled out in NHIF Network Launched on 25 th June 2013

33 Building local capacity reduces costs and creates ownership

34 Benchmarking of clinics 300 Clinic distribution SC1 SC2 SC3 250 Number of Clinics Percent

35 Benchmarking of facilities 100 All countries Average % Low Score High Score 75 Percent

36 Best Practice Hospital X 1 - Dec Oct Apr 2014 SafeCare score Service element

37 Impact: Business & Output improvements Preliminary data analysis of 150 clinics which had a baseline survey and a postloan disbursement survey average increase BUSINESS # OF PATIENT VISITS 22% AV. ANNUAL PATIENT VISIT INCREASE IN # 512 ADDITIONAL REVENUES PER YEAR PER FACILITY IN $ 5,146 HIV/AIDS MOTHER & CHILD CARE LAB TESTS REPRODUCTIVE HEALTH # OF HIV TESTS 44% # ULTRASOUND SCANS 64% # OF LAB TESTS 42% # MALARIA TESTS 46% # MALE CONDOMS DISTRIBUTED 50% # FAMILY PLANNING SESSIONS 42%

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