Hospital Administration

Quality Improvement Programme (Toward Excellence Health center for the Community) Excellence Health center for the Community) CoH CoH Quality Improvement Programme CoH Quality is very Sweet for speak, but difficult to implement.

“Quality at Grassroots levels: Patient Perspectives ” because because Quality is Never Improved without accepting facts without accepting facts. Dr. J. L.

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Meena State Quality Assurance Officer Commissionerate of Health & FW Government of Gujarat Email:- [email protected] com Web:- www. gujhealth.

gov. in/quality-assurance-program. htm www. gujhealth. gov.

in Dr. J. L. MeenaHealth & Family Welfare, Govt of Gujarat Old Scenario of Health Centers. 1 CoH www.

gujhealth. gov. in Dr.

J. L. Meena Health & Family Welfare, Govt of Gujarat Old Scenario of Health Centers.

3 CoH Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 5 2 CoH • Poor sanitation and cleanliness. • Very poor Drainage facility. • Poor housekeeping service.

• Very poor Biomedical waste & infection control practice. • No cattle guard. www. gujhealth. gov. in Dr. J. L.

Meena Health & Family Welfare, Govt of Gujarat Old Scenario of Health Centers. • Non sterile suction tube & oxygen mask? • Empty Oxygen Cylinders. Instrument with rust & Non sterile. www. gujhealth. gov.

in Health & Family Welfare, Govt of Gujarat Old Scenario of Health Centers. Building maintenance was extremely unsatisfactory – Leaking roof, eroded floors, over flowing toilets, broken doors, No patient safety (Open transformer with Parking facilities. Invite for disaster ? ), No safe drinking water facilities. no employee safety, poor lighting and no ventilation sign. www. gujhealth. gov. in Dr.

J. L. Meena 4 CoH • Un-used instrument & equipments ??? • No proper used of instruments ??? Crush Card trolley contained:- Comb, Toothpaste, Oil, Glass etc for save the pt. th www. gujhealth.

gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 6 Old Scenario of Health Centers. CoH CoH • Very poorly managed end of life??? • No respect to Human body ??? • Very worst condition of Post Martum Room. www.

gujhealth. gov. in Dr. J.

L. Meena Health & Family Welfare, Govt of Gujarat 7 ???????????????????????? CoH ?Why should we care? should we care? ?Is improvement possible? ?What seems to make seems to make a difference? ?Why aren’t we doing a better job? www. gujhealth.

gov. in GOAL Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat National Human Right Commission (NHRC Report 1999 NHRC ) Report – 1999 CoH D Grade for Mental Hospital Ahmedabad www. gujhealth. gov.

in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat HOW TO ACHIEVE EXCELLENCE IN HEALTH TQM-NABH………… 9 • To develop a healthcare system based on total quality management principles (NABH / NABL) and application of information technology to achieve efficiency in operations, faster & standard communication across the state. • To enhance the quality of healthcare services by providing specialized treatment and preventive healthcare at free / affordable cost.

MISSION VISION • To develop a pool of healthcare professionals in he public health sector trained in the implementation of health care quality standards and information technology to bring productivity and effectiveness in health care delivery system. • “To be the network of finest Public Healthcare Institutions which providing quality medical care services, preventive, promotive, curative & rehabilitative health care services with the state of art technology, easy accessibility, affordability and equity to the people of Gujarat and beyond. 12 8 ?Health centers is committed to provide quality healthcare services. ?To provide the treatment as per the national and international standards. To provide treatment with the latest technology. ?To conduct trainings and workshops on regular intervals for skill development of the staffs.

?To improve the quality on continuous basis. ?To improve the quality of treatment as per the patient satisfaction survey. www. gujhealth. gov.

in Dr. J. L. Meena Quality Objectives CoH CoH Quality Policy Health & Family Welfare, Govt of Gujarat 13 ? Implementation of safety and quality practices. ? Incorporation of management tools. ? Building sustainability ? Benchmarking the indicators ? Continuous Quality Improvement ? To provide 24X7 quality services to the community. To organize and implement all the national programs. ? To provide right treatment through latest technology.

? To ensure safety of patient & employee. ? To manage Human Resources for enhancing productivity. www. gujhealth. gov.

in PRACTICES IMPLEMENTED CoH ? Formation of the committees & give role and responsibility. ? Gap analysis in a standards formats and fulfilled these gaps. ? Patient and employee satisfaction survey ? Clinical protocol & Standard Operation Procedure (SOPs). ? Monitoring of the quality indicators. ? Implementation of Patient Rights & Responsibilities ? Facility Management Practices www. gujhealth. gov. in Dr.

J. L. Meena Health & Family Welfare, Govt of Gujarat A Case Study JOURNEY TOWARDS QUALITY JOURNEY TOWARDS QUALITY 15 1 2 • Internal assessment by Quality Assurance Team. • Gap analysis and submission of report and Planning for full filling the gaps. 3 • Develop the action programme for filled these gaps.

• Proposed to TSP, NREGA, NRHM, State budget and Vanbandhu for financial requirements to full fill the gaps. 4 role & www. gujhealth. gov. in Cont…. Health & Family Welfare, Govt of Gujarat www. gujhealth.

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L. Meena Health & Family Welfare, Govt of Gujarat A Case Study JOURNEY TOWARDS QUALITY JOURNEY TOWARDS QUALITY 7 8 17 Health & Family Welfare, Govt of Gujarat 14 ? Disaster Preparedness Plan ? Basic Infection Control Practices ? Management of Medication of Medication Code alerts ? Incidence Reporting System RED for FIRE, YELLOW for EXTERNAL ? Hospital Safety Programme CALAMITIES, BLUE for CARDIAC ARREST, ? Patient Information BLACK for BOMB THREAT, ? Inventory Management PINK for CHILD ABDUCTION ? Quality Control & Safety in diagnostics Control Safety in diagnostics 5 • Regular training of core team on standards and objective elements. • Formation of QA Manual, Policy, Procedure, Forms & Formats and implement.

Dr. J. L. MeenaPRACTICES IMPLEMENTED CoH CoH • Orientation to Quality & NABH Standards to staffs. • Formation of Committees and clarified their responsibility. CoH 16 CoH • Fulfilled the Human resource, Infrastructure, equipment, instrument related gaps and Statuary requirements. • AMC, Calibration & insurance of the instruments.

• Internal Quality Control, External Quality Control. • Regular Internal audit. • Plan, Do, Check & Act (PDCA Cycle for improvement) • Application for Pre Assessment. • Pre Assessment done by NABH Assessors from Quality Council of India.

• Fulfilled the Pre assessment gaps and application for final Assessment. Final Assessment done by NABH Assessors from Quality Council of India. • Fulfilled the Final assessment gaps and accredited by NABH board, Quality Council of India.

www. gujhealth. gov. in Dr. J. L.

Meena Health & Family Welfare, Govt of Gujarat 18 CoH CoH Journey of Quality Improvement (Cont)… 5 Years Back CoH Today Lack of standards of standards NABH Standards for Health Centers Standards for Health Centers No Gap analysis report in standard format. Health & Family Welfare, Govt of Gujarat Journey of Quality Improvement (Cont)… 5 Years Back 19 CoH Hygienic, Clean & Green Hospital environment with infection control audit.Recruitment of staff as per workload through RKS and take specialist service outsource. Lack of trained health care staff for emergency (resuscitation) services, patient care service & Healthcare management.

No concept of internal audits (medical audit, clinical audit & death audit etc). Dr. J.

L. Meena Written policies & procedures available. Poor sanitation, cleanliness & infection control practices.

Staff shortage so very poor specialist service. www. gujhealth. gov. in Statutory requirements fulfilled Absence of written policies & procedures. Outcomes…..

Gaps identified and addressed. Lack of Statutory requirements (e. . Licenses, Acts, Rules & Certificates). Staff trained in Basic Life Support, Advanced Cardiac Lif Ad Life Support, PG QM & AHO, NABH / NABL Assessors & Kaizen. Staff trained as internal auditors, audits conducted to find out non conformances, corrective & preventive measures taken to rectify it Dr. J.

L. Meena www. gujhealth. gov. in Journey of Quality Improvement (Cont)… Today 5 Years Back All required practices in place No Blood storage, CSSD, no separate OT for Eye & Gynec.

, Patients attendant launch facilities. Gynec Patients attendant launch facilities Blood storage, CSSD, separate OT for Eye & Gynec,Patients attendant launch facilities are available Patients attendant launch facilities are available. Damaged and poor condition of building & Staff Quarters. Repairing & renovation done gynecology No Calibration system of Instruments for Quality check.

Calibration system of Instruments for Quality check are available. CoH Shortage of equipments and proper ambulances (transport vehicle) . Sufficient equipments and ambulances with regular monitoring by a responsible person. Lack of accountability & planning. Policy and processes for care of the patients in place Non Implementation of Different Codes in the facilities. Poor signage system.

Well developed signage and displays for patient information. Absence of Patient & Employees’ satisfaction. Established. No measurable parameter for patient safety. Measurable parameters for patient safety are available. No realization of problems and weaknesses.

A clear understanding of what is lacking and what needs to be done. No monitoring or reporting of adverse events, needle stick injury, Sentinel events etc. These are being reported and are monitored. Practically non-existent security arrangement Availability of well trained security guards Absence of quality standards. Quality standards e. g. medical audit, management f medication, care of patients etc practiced No participation in EQAS/ inter laboratory Participation in EQAS / inter laboratory comparison comparisons and achieving good scores in it.

Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Journey of Quality Improvement (Cont)… 21 5 Years Back BLACK for BOMB THREAT, PINK for CHILD ABDUCTION www. gujhealth. gov.

in Today Poor publicity of available services in the villages and in the community. Name of the Facility 3rd Party evaluation & monitoring system by PRI members. All the service which are provide by the healthcare centre are display in the community and emergency ontact number also display. Dr. J. L.

Meena Health & Family Welfare, Govt of Gujarat A Success Story Quality Improvement Programme:- Gujarat Team work is available, role and responsibility of all staff is cleanly mention. No Evaluation and monitoring system by PRI members (3rd party evaluation). (3 RED for FIRE, YELLOW for EXTERNAL CALAMITIES, BLUE for CARDIAC ARREST, CoH No team work, only Individual approach rather then team . Unidentified role and responsibility of staffs.

Total Facility Under NABH /NABL Total Facility Under NABH /NABL which catering Tribal population Total Accredited facilities CoH 23 11 2 Medical college Hospitals 2 0 0 Medical college, Blood banks 0 6 2 5 2 No display of the Right and responsibly of the patients and employees in the facilities. www. gujhealth. gov. in Dr. J.

L. Meena 4 2 1 2 1 2 0 0 0 1 1 0 0 Primary Health Centers (PHCs) 29 14 12 6 Community Health Centers (CHCs) Proper display of Right and responsibly of the patients and employees in the facilities. 2 2 Paraplegia Hospital, Ahmedabad Progress of the referred patient also monitoring by th the health centre on regular basis. ( Bi directional referral service). 6 Mental Hospitals Dental Hospitals No responsibility of referred patients .

Medical college, LaboratoriesProper monitoring of Up time, down time & utilization of the instrument & equipment. 26 11 1 1 NABL Food & Drug Laboratories Total Health & Family Welfare, Govt of Gujarat 23 22 Total Accredited facilities which catering tribal population District Hospitals No monitoring of Up time & down time of the instruments. 20 Today Inadequate infrastructure for handling biomedical waste and infection control safety practices www.

gujhealth. gov. in Health & Family Welfare, Govt of Gujarat www.

gujhealth. gov. in 2 1 103 45 Dr. J. L.

Meena 2 1 28 13 Health & Family Welfare, Govt of Gujarat 24 India’s 1st & 2nd NABH Accredited PHC CoHCoH from Tribal Area from Tribal Area www. gujhealth. gov. in Dr.

J. L. Meena Health & Family Welfare, Govt of Gujarat Benefits to Patients 25 CoH Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Quality Improvement Programme High Quality of Care cont High Quality of Care cont… www.

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Meena Health & Family Welfare, Govt of Gujarat 29 Time Morning: 9. 00 to 13. 00 Evening: 16. 00 to 18. 00 ,, ,, ,, 24 hours ,, ,, ,, ,, 9. 00 to 14. 00 Tuesday & Friday 9.

00 to 16. 00 Daily ( Except holidays) Morning: 9AM to 1 PM Evening: 4 to 6 PM Dr. J. L. Meena Health & Family Welfare, Govt of GujaratProvided baby kits to new born for prevent Infection & hypothermia www. gujhealth. gov. in CoH Day Certificates of age, fitness and sickness Lab services Homeopathic treatment treatment Indoor services Delivery Emergency services Vehicle for referral Medico legal services MAMTA Clinic ( Immunization, medical check-up, treatment IEC Family planning services for treatment, IEC & Family planning services for expectant mothers, children & adolescent) 11 NSV, Abdominal tubectomy , MTP & Hydrocele operation 12 All National Programme www.

gujhealth. gov. in 26 Daily ( Except holidays) ,, ,, ,, Daily ,, ,, ,, ,, Monday OPD Services 2 3 4 5 6 8 9 10 27 CoH Availability of Services at PHC level 1 CoH Health & Family Welfare, Govt of Gujarat www. gujhealth.

gov. in Sr Name of service ?Availability of Health services with High quality of care. ?Dedicated and sincere medical staff ?Access to a quality focused organization ?Rights respected and protected ?Patient Satisfaction evaluated ?Involvement in care process ?Patient safety ?Pain management ?Safe transport ?Continuity of care www.

gujhealth. gov. in India’s 1st NABH Accredited CHC Welcoming infrastructure…… infrastructure…… Dr. J.

L. Meena 28 CoH Health & Family Welfare, Govt of Gujarat 30 Quality Improvement ProgrammeHigh Quality of Care cont High Quality of Care cont… www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Quality Improvement Programme High Quality of Care cont High Quality of Care cont… www.

gujhealth. gov. in CoH CoH CoH Health & Family Welfare, Govt of Gujarat Quality Improvement Programme Management of Medicine Management of Medicine… 31 33 CoH Quality Improvement Programme High Quality of Care cont High Quality of Care cont… www. gujhealth. gov. in Dr.

J. L. Meena Health & Family Welfare, Govt of Gujarat 35 Health & Family Welfare, Govt of Gujarat Quality Improvement ProgrammeQualitative Laboratory services Qualitative Laboratory services… www.

gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Safety of patients & employees… of patients employees www.

gujhealth. gov. in 32 CoH Change the Scenario……. Before www. gujhealth. gov. in CoH 34 CoH After Dr. J.

L. Meena Health & Family Welfare, Govt of Gujarat 36 Change the Scenario…. Biomedical waste practice… waste practice Before www. gujhealth. gov. in After Dr.

J. L. Meena Health & Family Welfare, Govt of Gujarat Recreational & skill development www. gujhealth. gov. in CoH CoH Dr. J. L.

Meena CoH Health & Family Welfare, Govt of GujaratOccupational Therapy Unit 37 39 CoH Change the Scenario…… Safe drinking water…… drinking water After Before www. gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Recreational & skill development www. gujhealth.

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L. Meena CoH CoH Health & Family Welfare, Govt of Gujarat Quality Improvement Programme Quality food services to patients attendants Quality food services to patients & attendants… 38 40 CoH CHC Bardoli, which catering Tribal Population www. gujhealth. gov. in Dr. J.

L. Meena Health & Family Welfare, Govt of Gujarat 41 www. gujhealth. gov. in Health & Family Welfare, Govt of Gujarat 2 India’s 1st NABH Accredited Mental Hospital Vadodara Hospital Vadodara CoH CoH NO. OF DELIVERY AT PHC CoH 44077 45000 41146 585 36867 40000 35000 600 33729 31359 582 586 513 500 30000 400 25000 20000 282 300 15000 200 10000 5000 86 1777 1719 1530 1414 1386 100 0 2008-09 2009-10 2010-11 No. of OPD per Year 2011-12 Dr. J.

L. Meena www. gujhealth. gov.

in 0 2012-13 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 IPD Number per Year Health & Family Welfare, Govt of Gujarat 43 PHC:- Salun, Dist:- Kheda www. gujhealth. gov. in CoH Adverse Donor Reaction CoH Health & Family Welfare, Govt of Gujarat 44 CoH Issue of Components CoH 9 59,481 50 45 40 40 35 30 25 20 15 10 5 0 60,000 39 54,067 50,000 42,033 32 40,000 25 20 30,000 23,849 20,000 13,820 10,000 0 2008-09 www. gujhealth. gov. in 2009-10 2010-11 2011-12 Blood Bank:- Civil Hospital Ahmedabad 2012-13 2008-09 Health & Family Welfare, Govt of Gujarat Specimen Analysis 100000 45 CoH CoH 98 2012-13 Health & Family Welfare, Govt of Gujarat 46 100 105 85 70 80 60000 2011-12 Critical value reporting CoH CoH 100 69010 59897 2010-11 Blood Bank:- Civil Hospital Ahmedabad 120 88660 78105 80000 www.

gujhealth. gov. in 2009-10 60 40000 30522 40 20000 20 0 0 2008-09 2009-10 2010-11 2011-12 2012-13 2009 2010 011 2012 www. gujhealth. gov. in Biochemistry Lab:- Sir T Bhavnagar Health & Family Welfare, Govt of Gujarat 2008-09 2009-10 2010-11 2011-12 2012-13 2008 2009 2010 2011 2012 47 www. gujhealth. gov.

in Biochemistry Lab:- Sir T Bhavnagar Health & Family Welfare, Govt of Gujarat 48 Benefits to Staff Surgical Site Infection (SSI) CoH CoH ?Professional staff development ?Provides education on laid down standards ?Provides leadership for quality improvement within medicine and nursing ?Increases satisfaction with continuous learning, good working environment, leadership and ownership 0. 59 0. 6 0. 5 0. 35 0. 4 0. 27 0.

3 0. 16 0. 0. 1 0 2009-10 www. gujhealth.

gov. in 2010-11 2010 2011-12 2011 Dist Hospital:- Gandhinagar 2012-13 2012 Health & Family Welfare, Govt of Gujarat Professional staff development Managerial / Administrative training to MO / Head. www. gujhealth. gov. in CoH Health & Family Welfare, Govt of Gujarat Professional staff development Special clinical skill training on minor surgical procedure, obstetrics care, new born care, basic life support and local anesthesia block. www. gujhealth.

gov. in 49 Programme implementation training to MO / Head. Dr.

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J. L. Meena CoH CoH 51 CoH www. gujhealth.

gov. in Dr. J. L. MeenaHealth & Family Welfare, Govt of Gujarat Professional staff development Induction training to staff at all levels.

ll www. gujhealth. gov. in 50 CoH Job based skills training. based skills training. Dr. J.

L. Meena Health & Family Welfare, Govt of Gujarat Quality Management & Internal Audit Training Audit Training 52 CoH Disaster Management Disaster Management Health & Family Welfare, Govt of Gujarat 53 www. gujhealth. gov. in Dr. J. L.

Meena Health & Family Welfare, Govt of Gujarat 54 NABH ACCREDITATION AWARD FUNCTION BY GOVT. OF GUJARAT & QCI, NEW DELHI www. gujhealth. gov. in Dr.

J. L. Meena CoH CoH Health & Family Welfare, Govt of GujaratAward for India 1st NABH Accredited Mental Hospital :- Hospital for Mental health – Vadodara, Govt of Gujarat given by Shri Jaynarayan Vyas, Hon’ble Health Minister, Government of Gujarat 55 Award for NABH Accredited PHC :- Primary Health Center – Kandolpada, Navsari-Gujarat, Govt of Gujarat given by Shri Jaynarayan Vyas, Hon’ble Health Minister, Government of Gujarat Benefits to Hospital CoH ?Improves care care ?Brings in Corporate Governance ?Stimulates continuous improvement ?Demonstrates commitment to quality care commitment to quality care ?Raises community confidence ?Opportunity to benchmark with the bestAward for NABH Accredited PHC :- Primary Health Center – Tankal, Navsari-Gujarat, Govt of Gujarat given by Shri Jaynarayan Vyas, Hon’ble Health Minister, Government of Gujarat www.

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J. L. Meena Health & Family Welfare, Govt of Gujarat 60 Main entrance should be easily identifiable, welcoming, well lit and with mattress. CoH CoH PHC Mahuwas, Tribal area PHC www.

gujhealth. gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 61 Quality Improvement Programme Welcoming infrastructure…… infrastructure…… CHC Bardoli, which catering Tribal Population www. gujhealth.

gov. in Dr. J. L. MeenaHealth & Family Welfare, Govt of Gujarat Quality Improvement Programme District Hospital Godhara (Tribal area) Hospital Godhara (Tribal area) CHC Bardoli, which catering Tribal Population CoH HMH Ahmedabad presents an excellent example of effective functioning of Boards of Visitors and active involvement of NGO sector in patients Care, Capacity building & rehabilitation , and has the potential to become a good center of education and research in Mental Health Field Field. www.

gujhealth. gov. in A – Grade Health & Family Welfare, Govt of Gujarat 62 CoH DH Godhara, which catering Tribal Population www.

gujhealth. gov. inRemarks of representative of National Human Right Commission (NHRC) now… CoH 65 Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat Benefits to Community 64 CoH ?Quality revolution ?Disaster preparedness preparedness – Epidemics – Physical ?Access to comparative database www. gujhealth.

gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat 66 All the Services provided by PHC Gadboriad are displayed in all the villages & roadside www. gujhealth. gov.

in Dr. J. L. Meena CoH CoH Health & Family Welfare, Govt of Gujarat Mock drill and training for disaster management management 67 CoH Mock drill and training for disaster anagement management www. gujhealth.

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L. Meena Health & Family Welfare, Govt of Gujarat Quality Improvement Programme Involvement in National Programme Involvement in National Programme… www. gujhealth. gov. in Dr.

J. L. Meena 68 CoH PHC PHC Tankal, Kandolpada & Mahuwas, Navsari 69 CoH Health & Family Welfare, Govt of Gujarat Health & Family Welfare, Govt of Gujarat Mock drill and training for disaster management management PHC Tankal, Kandolpada & Mahuwas, Navsari www. gujhealth. gov. in Dr. J. L.

Meena CoH 71 www. gujhealth. gov. in Dr. J. L.

Meena Health & Family Welfare, Govt of Gujarat Quality Improvement ProgrammeInvolvement in National Programme Involvement in National Programme… www. gujhealth. gov. in 70 CoH Health & Family Welfare, Govt of Gujarat 72 Quality Improvement Programme Malnutrition awareness Malnutrition awareness… www. gujhealth. gov. in CoH CoH Health & Family Welfare, Govt of Gujarat PRI Monitoring & Evaluation of CHC 73 CoH Quality Improvement Programme AIDS awareness programme AIDS awareness programme… www. gujhealth.

gov. in Dr. J. L. Meena Health & Family Welfare, Govt of Gujarat National & International Team Visit Niziriya Team Visit CoH 74 CoH Visit by Rajasthan Govt. MLAs with Speaker WHO Team Visit www. gujhealth. gov. in