Institutional System of the Health Services Quality Management in the NCPH

Transcription

1 Institutional System of the Health Services Quality Management in the NCPH National Centre for Public Health (NCPH), Republic of Moldova, Chişinău Natalia Costic, Head Quality Management Devision

2 NCPH National Center for Public Health is the practical and methodical scientific institution under the Ministry of Health, funded by the reorganization of the National Center for Preventive Medicine on State Supervision Service of Public Health Under: Law no. 10-XVI of on state supervision of public health and Government Decision no. 384 of 12 May 2010 Organizational structure of NCPР is shown in the flowchart.

3 New structure of the STATE SURVEILLANCE SERVICE OF PUBLIC HEALTH Ministry of Health Minister of Health Advisory Board Ministry of Health Deputy minister, Chief State sanitary doctor of Republic of Moldova Relevant Departments of Ministry of Health Internal Audit Service Department on public health policies National Centre of Public Health Municipal and district Counsels mun. Chişinău, mun. Bălţi, ATU Găgăuzia Centre for AIDS control Municipal and district Centers of Public Health Local Public Health Counsels Department of Health mun. Chişinău, Department of Health and Social protection UTA Găgăuzia, Division of Health mun. Bălţi, Public Medical institutions

4 Scientific Council ADMINISTRATION General Director, deputy directors Department on Research and Development in Public Health Department of management of Public Health Services and foreign relations Department of comunicable disease prevention and control Department on Health promotion noncomunicable disease prevention Department on Health protection and public health emergencies Department of logistic support Scientific Secretary Division on research management Division of public health policies research Division of noncommunicable disease research Division of communicable disease epidemiology research Management and public Health monitoring division Division of public health policies and programmes monitoring and foreign relations Division of quality management Laboratory Center with Reference Labs Division of Health Regulation and legal assistance Group of continuous training Centre on epidemiology and control of communicable disease and desinfection Division Epidemiology and control of viral disease Division on Epidemiology and control of preventable communicable disease with Reference Labs Division on Preparation of culture mediums and national Vaccine Store Centre of health promotion and public relations Center of noncomunicable disease and health determinance control Environmental Health Centre Division on children and Youth health Division of occupational health Divisionof hygiene in transports Group of nutrition and physical activity Centre of Extremely dangerous communicable disease biohazards control Division on public health allerts monitoring and notification Division on chemical hazards and toxicology Centre on radiological safety Division of sanitary expertise Division of food safety Human resources Economy and budget Service Countability Administrative division with archive Supply Service and public property administration Division of informational technologies Division of public procurements Library

5 Basic functions of state public health surveillance (1) 1) population health monitoring and evaluation of public health priorities; 2) the identification, evaluation, management and risk communication for public health, prognosis and reduce the negative impact on health; 3) health protection through development, coordination, supervision and state control of the implementation of legislative, regulatory, best practice guidelines and standard operating procedures, to the determinants of health; 4) authorizing the state's activities, products and services related to public health; 5) initiate, participate in developing, monitoring and implementation of public health policies and programs; 6) prevention of diseases by making interventions with the aim of primary and secondary prevention; 7) information, education and communication for health promotion;

6 Basic functions of state public health surveillance (2) 8) assessing the quality and effectiveness of personnel and public health services provided by the Community; 9) initiating, supporting and carrying out scientific research in public health practice; 10) ensuring appropriate awareness training to public health emergencies and public health emergency management, including the introduction of restrictions on movement of persons and goods; 11) human resources development and planning and institutional development in public health services; 12) the integration of public health priorities in sectoral policies and strategies for sustainable development. 13) coordination of public health and community-level administrative territory; 14) consultation and community involvement in the organization of public health service delivery; 15) providing laboratory support in investigating the biological, chemical, physical and radiological factors with impact on public health.

7 3P disease Prevention Prophylaxis health Promotion

8 Medium term priorities Reinforcing public health, health promotion and disease prevention, monitoring and control of communicable diseases (HIV/AIDS, tuberculosis, etc.) and non-communicable diseases with major impact on public health To develop appropriate sub-legal instruments for Law on State Surveillance of Public Health To reform laboratory network of Public Health Service Strengthen the capacities of the Ministry of Health in strategic planning, health policy elaboration/monitoring/evaluation, inter-sectoral collaboration and communication for the realization of Health in all policies approach Increase efficiency of human resources management in health sector and motivation of qualified medical personnel to work Development of quality management in public health centres. To establish new Surveillance system of noncomunicable diseases.

9 Public Health Services Activities designed to promote health, prevent disease and prolong life in the public health sector-oriented population

10 Implementing of based on ISO Quality Management System One of the main objectives of the Service is to provide quality public health services. Achievement of objectives was made possible through the implementation and operation in the National Center for Public Health Quality Management System based on the requirements of international standard ISO "General requirements for the competence of testing and calibration laboratories. NCPH having in its composition 14 laboratories is accredited by health system body and by national accreditation body in accordance with ISO

11 NCPР Quality Policy NCPН policy on quality means continuous and fully satisfy customer, personnel and employees' requirements and expectations, with legal requirements and the regulatory framework for all activities. The main purpose of the policy is to ensure State Service for Public Health Surveillance and the customers with quality provided services by applying quality management system The objectives of this policy: - Providing quality services (including laboratory testing); - Continuous process improvement to achieve performance and efficiency; - Training and motivating of all staff to achieve quality - Lack of complaints in activities (services); To achieve the policy objectives we use: - Management System according to SM ISO / IEC 17025:2006 which is regulated by the Quality Manual, PSM - Regulatory and organizational documents that regulate the activity areas of CNSP; - Qualified personnel and appropriate training system; - Appropriate of tasks technical sources; - NCPН optimal organizational structure; - Implementation of quality indicators for all activities;

12 Quality Manual (QM) of NCPН MC QM defines quality policy and objectives, organizational structure and operational responsibility of NCPН sectors, specific management system elements. QM describes the ways and methods for maintaining and improving the management system, the quality level required to obtain the reference documents for winning and maintaining customer confidence and its own leadership. The quality manual is a document available to each specialist of NCPН

13 The quality manual is designed based on following normative documents: SM SR EN ISO 9000:2002 Quality management systems Fundamentals and vocabulary SM SR EN ISO 9001:2002 Quality Management System (QMS). Requirements. SM SR EN ISO/CEI 17025:2006 General requirements for the competence of testing and calibration laboratories. SM SR ISO 10005:2002 Quality management systems. Guidelines for quality plans SM SR ISO 10013:2003 Guidelines for quality management system documentation Legislative documents, directives, regulations of the Ministry of Health, Department of State Public Health Surveillance Moldova.

14 Raporturile din cadrul managementului calităţii în structura componentelor ce le implică Managementul calităţii Politica calităţii Obiective Planificare Responsabilităţi Sistemul de calitate Organizare Proceduri Procese Resurse Necesităţile clienţilor Produs de calitate (obţinut prin control al calităţii) Încrederea în obţinerea calităţii (asigurarea calităţii) Satisfacţia clienţilor

15 Quality management system for public health services Quality management system for public health services - organizational structure, resources, accountability, planned activities of public health services provider for quality assurance. WHO defines quality in the public health system - degree of achievement the goals for the improvement of public health and responsiveness to the expectations of the general population.

16 Quality is never an accident, it is always the result of high intention, sincere effort, intelligent direction and skillful execution. It represents the wise choice of many alternatives. Willa Foster

17 Internal quality control Done during routine daily work Provides immediate control Errors are corrected immediately Why do we need internal quality control? - Ensure that the test results are reliable -Ensures that the test results are reproducible

18 External quality control Evaluate past performance Testing unknown samples comparing performance with others (other laboratories) Provides a forum for improving and correcting errors Why do we need external quality assessment? - To detect hidden problems - For have help and support from those who evaluates - To compare our performance with others and for continuous improvement of quality system

19 Laboratories in the NCPH The following labs working In NCPH : In the field of virology General virology laboratory; Scientific and practical laboratory viral respiratory infections; Enteroviroze polio laboratory and the operational area; The hygiene Central Sanitary-Hygienic Laboratory; Scientific and Practical Laboratory Bacteriology Health Laboratory Centre for radiation protection and radiation hygiene; Laboratory of physical factors; Toxicology Laboratory Disease epidemiology in general and conventional Parasitology laboratory section; Scientific and practical laboratory bacteriology conventional and highly dangerous diseases The direction in prevention and combating AIDS issues AIDS diagnostic and reference laboratory. Reference laboratory in the diagnosis of viral hepatitis and HIV / AIDS Production Laboratories: Lab Section of production and control of nutrient media Laboratory experimental production in prophylactic dizenfecţiei

20 The main documents of the MS implemented and maintained in laboratories are: Legislative and regulatory documents; Quality Manual; Management system procedures; Regulations of sections and laboratories; Nomenclature of investigations / tests / measurements Job descriptions; Standard operating procedures for methods / measurement / processes / activities; Instructions for use of equipment;

21 Management System Procedures (MSP) of NCPH (1) PSM 4.1. Organizare CNSP PSM 4.2. Sistemul de management al CNSP PSM 4.3. Controlul documentelor PSM 4.4. Analiza cererilor, ofertelor şi contractelor PSM 4.5.Subcontractarea încercărilor PSM 4.6 Servicii de aprovizionare şi furnituri PSM 4.7. Servicii către client PSM 4.8. Reclamaţii PSM 4.9. Controlul lucrărilor de încercare neconforme PSM 4.10 Înbunătăţirea PSM 4.11 Acţiuni corective PSM 4.12.Acţiuni preventive PSM 4.13 Controlul înregistrărilor PSM Audituri interne PSM Analiza efectuată de management

22 Management System Procedures (MSP) of NCPH (2) CERINŢE TEHNICE PSM 5.2. Personal PSM 5.3.Condiţii de acomodare şi de mediu PSM 5.4.Metode de încercare şi validarea metodei PSM 5.5. Echipament PSM 5.6. Trasabilitatea măsurărilor PSM 5.7. Eşantionare PSM 5.8. Manipularea obiectelor de încercări PSM 5.9. Modul în care este asigurată calitatea rezultatelor încercărilor PSM Raportarea rezultatelor

23 Establish quality council in NCPH The Ministry of Health Order No. 139 of "On health care quality assurance in health care institutions' medical institutions are responsible for developing its own system for ensuring quality services by establishing unity Quality Council, which will operate under regulations approved. Quality Council of the CSP will be a collegial advisory body, established to enhance the process of continuous quality improvement in public health services provided within the institution. Quality Council will ensure constant and continuous internal quality monitoring and maintaining quality management system according to the CSP Manual and Quality management system procedures.

24 Establish quality council in NCPH Quality Council's objectives will be: Short term: self-activity in terms of quality of services provided; efficiency, pursuing continuous improvement; evaluation of customer satisfaction (patient); medium term: designing and implementing a management system calităţiiconform ISO 9001:2000, ISO in CSP at all levels; selecting and defining quality standards and criteria applicable and acceptable to the national level; Basic functions will be: Implementing a quality management system based on ISO 9001:2000, ISO in the institution Quality Council planning activities to achieve quality objectives. Preparing the annual report on quality assurance of public health services, as approved in the form approved quality indicators.

25 QUALITY MEASUREMENT Measuring quality is the systematic identification of the current level of quality achieved by a unit or system, and consists in quantifying the level of performance standards prescribed. The first step in measuring quality is in identifying areas for improvement. Quality assurance activities included in the measurement of quality are: internal quality assessment, quality monitoring, external quality assessment.

26 QUALITY INDICATORS Indicators are tools that can provide information on the frequency, level, extent, severity, etc.. a problem. An indicator is a characteristic expression of a variable or for a specific problem, is the operationalizing the variable / variables that define the problem. Most commonly, indicators are used to diagnose a situation, to compare two populations or processes having the same characteristic, compared to assess changes over time and space of two or more features. The indicator is defined by a numerator-denominator ratio. The numerator is the observed phenomena, and the denominator is the amount that you want to compare (the standard, the general population, the reference value).

27 Quality assessment of public health services Assessment Tools: evaluation, comparing the data with maximum requirements "ideal" assessment based on the opinions of experts in the field comparison with statistical data Are welcome objective assessment questionnaires to evaluate various activities. Questionnaires should be developed by experts and approved. To assess the work we need to develop criteria for evaluating performance (results) We need to develop method of estimating the quality and efficiency of service resources and activities.

28 Efficiency and quality in Public Health Quantitative measure of the result (результативность) Public Health - is the value of real change in the state Public Health defined period. Efficiency in Public Health - is the result of the quantitative ratio of the unit as service resources. Resource service = functional potential. In other words, characterizing the efficiency of the service results in relation to resources consumed, the cost results. Quality of Public Health - complex characteristic of the results of various activities. Efficiency and quality of Public Health does not only depend largely on the organization and management of Public Health, working with IMS, local government, but also by socio-economic, environmental sanitary-epidemiological welfare of habitat services resources, health in the community. Quantitative measure of the result (результативность) Public Health to evaluate the difference between state business and original in the final period.

29 NCPH achievements in implementing quality management system It was developed and maintained quality management system documentation CNSP, in accordance with the requirements of the standard MS ISO / IEC 17025:2006 and Assessment and Accreditation Standards for Laboratories PHC: quality manual, general quality assurance procedures PSM, SOP for testing operational procedures and work instructions. Were approved for all forms of MS records and placed in Annex 1 Document Control PSM Staff were trained to knowledge CNSP ISO, MC and PSM Laboratories continued validation (checking) test methods, validation methods are implemented and microbiological laboratories. Internal audit is carried out periodically to maintain the quality management system, internal audit quality tests with those records; Participation in international inter-laboratory testing laboratories to CNSP. Annual Management System analysis is performed with the proposed continuous improvement of Laboratories were reacreditate CNSP MS in systems and CNEACP CNEAS

30 The objectives in implementing, developing and improving the institutional Quality Management System Establish Quality Council in CNSP Appointment of officers to maintain quality management system in departments and laboratories; Continue to develop standard operating procedures, best practice guidelines for all activities and services Continuous training of staff in quality management Develop, monitor and analyze public health quality indicators in each area of activity Further development of institutional information system, including quality assessment services Using statistical methods for evaluating and improving effectiveness processes e.g. Shewhart charts (already implemented in laboratories) Updating of existing Quality Manual under the NCPH new tasks (based on ISO 9000 and ISO 17025) To work in Management Sistem not for Management Sistem

31 Grazie! Mulţumesc! Thank You!