module 3 improving quality. quality improvement qi is achieving the best possible results with the...
TRANSCRIPT
Module 3
Improving Quality
Quality Improvement
QI is achieving the best possible results with the
available resources
Includes any activities or processes that are designed
to improve acceptability and effectiveness of service
delivery and contribute to better health outcomes as an
on-going and continuous process
What do we mean by best possible results
Meeting standards
Meeting targets – compliance with norms
and standards
Reliable implementation of best practice
guidelines
Tools for quality improvement
Process mapping
Process mappingFlow diagram – visual tool
Care pathway is a good example
Looks at a series of activities in order to identify gaps –
barriers, bottle necks, duplication of effort, waste,
unnecessary steps
Must reflect reality – not what you want!
The five steps for PMCT care
CounselTest for HIV
HIV+Rapid referral
for HAART:Start FDC
HIV – Retest every
6 weeks
Infant gets NVP at birth and then daily for 6 weeks
1
3
52 4
CD4 >350 and no breastfeeding stopCD4<350 continue FDC
Late bookings
status unknown test statusHIV +
PCR
@ 6 weeks
Case - study: Example flowchart
Mother to be arrives
Reception to midwife
Examination by midwife
Monitoring of labour
Serial examinations
Delivery care
Referral
PPproble
ms
App care
Post natal care
BF and HE etc
Dischargeprocedures
Discharge
Yes
No
No
Yes
Adapted from USAID Health Care Improvement Project
COMPLAINT RECEIVED
COMPLAINT RECORDEDAND CODED
INVESTIGATIONCOMMENCED
RESPONSE TO COMPLAINANT
REMEDIAL ACTION
COLLATING DATA
From National and Provincial sources and individuals and media
May be received by: Health Care Institutions, National or Provincial structures
COMPLAINT ACKNOWLEDGEDWithin 3 working days of receipt by complaints manager or provincial office if received there
Within 5 working days of receipt of complaint
Institutional complaints committee set terms of reference, appoints investigator & suggests process
By institutional complaints committee unless delegated to complaints manager
By complaints manager
Within 12 working days of receipt of complaint
As decided by Instit. Complaints Committee e.g. closure of case, changes in systems, training, purchase of equipment etc.
Referral within 14 working days of receipt of complaint to SAEC or other relevant structure
Information on all complaints entered into data base and sent to Region by 5th of every month. Regions to QAD by 12th day of month in required quarter
REFERRAL TO OTHER STRUCTURE
Root cause analysis
Understanding the root cause of problems
Once you have identified your problem – need to explore under-lying causes
Root cause analysisCause and effect diagramFive why’s
Action plan
ACT PLAN
What are we trying to accomplish?
How we will know that a change is an improvement?
What change can we make that will result in an improvement?
DOSTUDY
The model for improvement
Langley, Nolan, Nolan, Norman & Provost 1999
The only man who behave sensibly was my tailor; he took my measurement anew every time he saw me, while all the rest went with their old measurements and expect them to fit me.
(George Bernard Shaw)