health care quality and safety governance dimentions 33333333 · and if any one saved a life, it...

MBBS, DPHC, FRCGP, FFPH,FRCP (UK)Prof of Public Health- Imperial College-

LondonFamily and Community Medicine Consultant

Secretary General of Arab Hospital Federation

Health CareQuality & Safety StandardGovernance Dimensions

and if any one saved a life, it would be as if he saved the life of the

whole people. “Holy Qur’an”

and if any one saved a life, it would be as if he saved the life of the

whole people. “Holy Qur’an”

Is an often quoted term from Hippocrates. “Every one working in

Health care is familiar with the term”

THE PROBLEM OF ADVERSE EVENTS INHEALTH CARE IS NOT NEW

Studies as early as the 1950s and 1960s1 reported on adverse events, but thesubject remained largely neglected.

A body of evidence started to emerge in the early 1990s with thepublication of the results of the Harvard Medical Practice Study in 1991.

Subsequent research in Australia, the United Kingdom and the UnitedStates of America in particular, the 1999 publication

To err is human: building a safer health system

by the Institute of Medicine in the United States of America providedfurther data and brought the subject to the top of the policy agenda and theforefront of the public debate worldwide. Today more countries, includingCanada, Denmark, the Netherlands, Sweden and most member countries ofOECD are taking a serious look at the problem.

USA:The Harvard study :•4% of patients suffer some kind of harm in hospital;•70% of the adverse events result in short-lived disability,•14% of the incidents lead to death.

The Institute of Medicine:Report estimated that “medical errors” cause between 44 000and 98 000 deaths annually in hospitals in the United States ofAmerica – more than car accidents, breast cancer or AIDS.

United Kingdom :Adverse events occur in around 10% of hospital admissions, orabout 850 000 adverse events a year.

Europe:Every tenth patient in hospitals in Europe suffers from preventable harm and adverse effects related to his or her care. The Hospitals for Europe’s Working Party on Quality Care.

Australia:Adverse-event rate of 16.6% among hospital patients. TheQuality in Australian Health Care Study (QAHCS).

The new study reveals that each year preventable adverseevents (PAEs) lead to the death of 210,000-400,000 patientswho seek care at a hospital.

Those figures would make medical errors the third leadingcause of death behind heart disease and cancer, accordingto Centers for Disease Control and Prevention statistics.

September 20, 2013 | By Ilene MacDonald, Published on FierceHealthcare (http://www.fiercehealthcare.com)

Zayed Alsulami. Sharon Conroy, Imti Choonars Eur J Clin Pharmacol (2013) 69.995-1008

Quality problem. Recent evidence in the level of patientsafety from hospitals in six developing countries in theEastern Mediterranean Region has demonstrated the highprevalence of adverse events, the excessive rate of deathand permanent disability and their high preventability.

S. SIDDIQI1, R. ELASADY1, I. KHORSHID1, T. FORTUNE2, A. LEOTSAKOS3, M.LETAIEF4, S. QSOOS5, R. AMAN6, A. MANDHARI7, A. SAHEL8, M. EL-TEHEWY9AND A.ABDELLATIF1International Journal for Quality in Health Care 2012; Volume 24,Number 2: pp. 144–151 10.1093/intqhc/mzr090Advance Access Publication: 2 February 2012

Standards Maxscore

Baseline scores achieved by hospitals

Egy

pt

Jord

an

Mor

occo

Paki

stan

Suda

n

Tuni

sia

Yem

en

Critical 20 15.578%

1050%

10.553%

1365%

840%

1155%

28%

Core 90 41.546%

33.537%

25.528%

34.538%

24.527%

3842%

16.518%

Developmental 30 0.52%

3.512%

27%

3.512%

13%

620%

1.55%

Total score 140 57.541%

4734%

3827%

5136%

33.524%

5539%

2014%

Patient safety baseline assessment scores for hospitals

Source: World Health Organization, Executive Board 109th session, provisional agenda item 3.4, 5. 2001, EB 109/9 [19].a. Revised using the same methodology as the Quality in Australian Health Care Study (harmonizing the fourmethodological discrepancies between the two studies).b. Revised using the same methodology as the Utah–Colorado Study (harmonizing the four methodological discrepanciesbetween the two studies).Studies 3 and 5 present the most directly comparable data for the Utah–Colorado and Quality in Australian Health Carestudies.

Study Year in which data was collected

Number of hospital admissions

Number of adverse events

Adverse event rate (%)

USA (Harvard Medical Practice Study) 1984 30195 1133 3.8

USA (Utah–Colorado study) 1992 14565 475 3.2

USA (Utah–Colorado study)a 1992 14565 787 5.4

Australia (Quality in Australian Health Care Study)

1992 14179 2353 16.6

Australia (Quality in Australian Health Care Study)b

1992 14179 1499 10.6

UK 1999-2000 1014 119 11.7

Denmark 1998 1097 176 9.0

Table . Data on adverse events in acute-care hospitals in Australia,Denmark, the United Kingdom and the United States of America

15

Financial Cost:Adverse events exact a high toll in financial loss:

United Kingdom of Great Britain and Northern Ireland: The consequent additional hospital stays alone cost about £2000 million a year, Paid litigation claims cost the National Health Service around £400 million annually, Estimated potential liability of £2400 million for existing and expected claims, Hospital-acquired infections – 15% of which may be avoidable – are estimated to cost

nearly £1000 million every year.

United States of America:The total national cost of preventable adverse medical events,including lost income, disability and medical expenses, is estimated atbetween US$ 17 000 million and US$ 29 000 million annually. (Addedto these costs is the erosion of trust, confidence and satisfactionamong the public and health care providers).

Prof. Tawfik A. Khoja, & Dr. Abdulrahman Kamel

17Estimated cost to NHS per year UK

730 million pound

Estimated cost in USA 170-200 billion dollar

Estimated cost in Canada 401 billion

The situation in developing countries and countries in economic transition: The probability of adverse events is much higher than in industrialized nations for

many reasons.

The poor state of infrastructure and equipment,

Unreliable supply and quality of drugs,

Shortcomings in waste management and infection control,

Poor performance of personnel because of low motivation or insufficient technicalskills,

Severe under financing of essential operating costs of health services make.

MAJOR CHALLENGES

Poor Performance

Barriers to access

Poor Quality & Safety

Irrational/inefficient use

High Cost

Low Satisfaction

Expanding equitable Universal access access to comprehensive, quality, people and community centered health services

Patient safety defined by as “the preventionof harm to patients.”Emphasis is placed on the system of care delivery that:

(1) prevents errors;(2) learns from the errors that do occur; and(3) is built on a culture of safety that involves health careprofessionals, organizations, and patients.

Quality & Patient Safety

Major Reasons for Implementing Quality &Patient Safety Programs : Stimulate improvement of quality of health care

delivered. Strengthen community confidence in its health care

institutions. Reduce unnecessary costs and wastages. Increase efficiency. Provide credentials for education, internships, etc. Can protect against law suits. Facilitates acceptance by and funds from third-party

payers.It embraces all health care disciplines and actors, requires acomprehensive multifaceted approach to identifying and managingactual and potential risks to quality & patient safety in individualservices, and finding broad long-term solutions for, programs andprocedures the system as a whole.

We Need Strategic Plan For Quality & Patient Safety In Health

To BEInternalize & Institutionalize in Health System

22

GovernanceFor Health

الحوكمة من أجلالصحة

Governance For

Health

“good governance is

perhaps the single most

important factor in

eradicating poverty and

promoting development” Kofi

Annan The former Secretary General of the United Nations,

Governance in the healthsectorThe concept of STEWARDSHIP, orGOVERNANCE, in the health sector isrelatively new, and there is little guidance forcollection or standardization of information onthis aspect of the health system.Evidence shows a positiverelationship betweengovernance indices andmeasures of health performanceand outcomes .

Governance refers to

“the set of values, policies andinstitutions by which a society manageseconomic, political and social processes”. Governance comprises thecomplex mechanisms, processesand institutions through whichcitizens and groups articulate theirinterests, mediate their differencesand exercise their legal rights andobligations.

By “Governance,” I rely on the definition fromWeill and Ross in their book, IT Governance:… the framework of decision rights and accountability thatencourages desirable behavior and utilization of scarceresources in the achievement of a shared objective.”

This entails organizational structuresand the processes of decisionmaking, communication, andinformation flow, appropriatelyallocating scarce resources to theirhighest and best use, within wellunderstood objectives.

1. _ The inclusion of several actors from both inside and outside the

organization;

2. _ The use of horizontal and vertical management;

3. _ Accountability and control mechanisms;

4. _ High-level political commitment;

5. _ Financial and human resources support;

6. _ Skills development;

7. _ The existence of knowledge production systems.

Elements of Good Governance

1. Public Participation:

2. Accountability and transparency.

3. Respect for the rule of law and Human Rights

4. Efficient and effective public sector management:

Governance in HealthcareWhat’s the biggest contributing factor tosuccess when it comes to outcomesimprovement?Superior technology !!!Really smart people !!!Dumb luck !!!While these all play a role, none strikesme as the most important.The one thing that stands out to me asthe single greatest predictor of success isEFFECTIVE GOVERNANCE.

Specific Drivers of Health care Quality & Safety Governance:

1. Technology2. Cost3. Meaningful use4. Innovation5. Safety6. Healthcare consumers7. Legal and compliance pressures

Although its widespread , adoption is not occurring as rapidly as somemay prefer, Health care Quality & Safety Governance is becoming anemerging business priority in healthcare, and health care professionalsneed to be aware of it, and help their organizations recognize thepotential of governance in meeting some of their own critical prioritieson standard of care.

Making the governance load manageable means each of us carrying our share.

10

Adverse EventsPatient Safety

LOOKING AHEAD-PRIORITY CHOICES

THE CONTEXT

• The standard provides the safety and qualitygovernance framework for health serviceorganisations. It is expected that theStandard will apply to the implementation ofall other Standards of health care delivery.

• The standard is particularly important in thecontext of the changing governancearrangements in the public health caresystem.

WHY HAVE A STANDARD ABOUT GOVERNANCE FOR SAFETY AND QUALITY?

• Evidence base:• Considerable literature and expert opinion about

the need for a ‘systems approach’ to governance.

• The community expects that ‘someone’ is ensuring appropriatesystems are in place and working well.

• Evidence of safety and quality performance challenges in healthcare.

• Multiple case studies of clinical governance failure.

• Evidence that capability in good governance of safety and quality isstill developing – reviews have confirmed variable performance.

THE STANDARD

• Health service organisation leaders implementgovernance systems to set, monitor and improvethe performance of the organisation andcommunicate the importance of the patientexperience and quality management to all membersof the workforce.

• Clinicians and other members of the workforce usethe governance systems.

FIVE CRITERIA

1) Governance and quality improvement systems- There are integrated systems of governance to actively manage

patient safety and quality risks.

2) Clinical practice- Care provided by the clinical workforce is guided by the best current

practice.

3) Performance and skills management- Managers and the clinical workforce have the right qualifications, skills

and approach to provide safe, high quality health care.

4) Incident and complaints management- Patient safety and quality incidents are recognized, reported and

analyzed, and this information is used to improve safety systems.

5) Patient rights and engagement- Patient rights are respected and their

engagement in their care is supported.

21/07/35Prof. Tawfik Khoja

41:

1. GOVERNANCE AND QUALITY IMPROVEMENT SYSTEMS

1.1: Implementing a governance system thatsets out the policies, procedures and / orprotocols for:

• establishing and maintaining a clinical governance framework

• identifying safety and quality risks

• implementing prevention strategies based on data analysis

• ensuring compliance with legislative requirements and relevantindustry standards

• communicating with and informing the clinical and non-clinicalworkforce

• Why?

• Evidence suggests a significant correlation between the governancesystem of a health organisation and the level of performance achievedwithin that organisation……

Michel S. Putting quality first in the boardroom. The King’s Fund. 2010. Available at: http://www.kingsfund.org.uk/publications/putting_quality.html


• Effective clinical governance involves settingdirection, making policy and strategydecisions, overseeing and monitoringorganisational performance and ensuringoverall accountability for a service.

• WHAT?

• Establish an organisation-wide management systemfor the development, implementation and regularreview of policies, procedures and / or protocols.


• Consider the impact onpatient safety and quality ofcare in business decisionmaking.

1.2: The board, chief executive officer and / or other higher level ofgovernance within a health service organisation taking responsibility forpatient safety and quality of care:

• Why?• Both leadership and performance monitoring are essential elements of good

clinical governance.• The board and senior managers are responsible for setting a positive

organisational culture of safety and quality and ensuring appropriate systemsare in place.

• What?• The executive level of governance monitors reports on safety and quality

indicators and other safety and quality performance data.• Action is taken to improve the safety and quality of care.


1.3: Assigning workforce roles, responsibilities andaccountabilities to individuals for:

• patient safety and quality in their delivery of health care.



• WHY?• Systems for delegating and exercising authority, accountability and

responsibility are essential elements of good clinical governance.

•

• Effective governance also requires personal responsibility, where staffaccept personal ownership of their actions and their role in the safety andquality of services provided by their organisation.


• WHAT?• Effective delegation of safety and

quality roles and responsibilities.

• Ensuring agency or locum workers are aware of their designated roles and responsibilities .


1.4: Implementing training in the assigned safety andquality roles and responsibilities:

• WHY?

• Health care workers who are educated and trained to worktogether can reduce risks to patients, themselves and theircolleagues and when they manage incidents proactively andmaximise opportunities to learn from adverse events and nearmisses.

• Organisations also have a responsibility to provide the appropriatesystems and support to enable their workforce to learn and applythe skills and knowledge required for patient safety.

National Patient Safety Education Framework 2005


• WHAT?• Providing the workforce with the skill and information

needed to fulfil their safety and quality roles andresponsibilities .

• Providing annual mandatory training programs to meetthe requirements of the Standards .

• Providing competency-based training to the clinicalworkforce to improve safety and quality .


1.5: Establishing an organisation-wide risk management system

that incorporates identification, assessment, rating, controls andmonitoring for patient safety and quality:

• WHY?• Risk management is an essential componentof clinical governance .

• WHAT?• Establishment and monitoring / maintaining of an organisation-wide risk register.

• Taking actions to minimise risks to patient safety and quality of care .


1.6: Establishing an organisation-wide quality management system

that monitors and reports on the safety and quality of patient careand informs changes in practice:

• WHY?• A planned, systematic approach to defining quality, monitoring quality, designing and

implementing quality initiatives and evaluating outcomes is necessary when there arecomplex, inter-dependent systems.

• WHAT?• Establishment and monitoring / maintaining of an organisation-wide quality management

system .

2. CARE PROVIDED BY THE CLINICAL WORKFORCE IS GUIDED BY CURRENT BEST PRACTICE

2.1 Developing and / or applying clinical guidelines or pathways that aresupported by the best available evidence and implementingmechanisms to escalate care and call for emergency assistance wherethere are concerns that a patient’s condition is deteriorating:

• Why?

• Research has shown that clinical practice guidelines can be effective in bringing aboutchange and improving health outcomes.

• What?

• Making agreed and documented clinical guidelines and/or pathways available to theclinical workforce .

• Monitoring the use of agreed clinical guidelines by the clinical workforce .


2.2 Adopting processes to support the early identification, early interventionand appropriate management of patients at increased risk of harm:

• Why?

• Evidence shows that warning signs preceding adverse events in healthcare facilities ( hospital settings ) are not always recognised or actedupon.

• What?

• Establish mechanisms to identify patients at increased risk of harm .

• Take early action to reduce the risks for at-risk patients .

• Establish systems to escalate the level of care when there is anunexpected deterioration in health status .


2.3 Using an integrated patient clinical record thatidentifies all aspects of the patient’s care:

• Why?

• The patient clinical record acts as both a toolfor critical communication and a historicalrecord of care, for quality and medico-legalpurposes.

• What?

• Ensure accurate, integrated and readilyaccessible patient clinical records are availableto the clinical workforce at the point of care .

• Ensure the design of the patient clinical recordallows for systematic audit .

3. MANAGERS AND THE CLINICAL WORKFORCEHAVE THE RIGHT QUALIFICATIONS, SKILLSAND APPROACH

3.1 Implementing a system that determines and regularly reviews theroles, responsibilities, accountabilities and scope of practice for theclinical workforce:

• Why?

• There have been multiple reported occasions when clinicians have workedoutside their or their organisation’s level of competence, resulting in significantpatient harm.

• Responsibility for ensuring clinicians work within an appropriate scope ofclinical practice rests at various levels in the system, including with thegoverning body.


• What?• Ensure a system is in place to define and regularly review the scope of

practice for the clinical workforce.

• Ensure organisational clinical service capability, planning and scope ofpractice is directly linked to the clinical service roles of the organisation .

• Ensure supervision of the clinical workforce is provided whenever it isnecessary for individuals to fulfil their designated role .

3. MANAGERS AND THE CLINICAL WORKFORCEHAVE THE RIGHT QUALIFICATIONS, SKILLSAND APPROACH3.2 Implementing a performance development system for the clinical

workforce that supports performance improvement within theirscope of practice:

• Why?

• There is strong evidence that implementation of well-designed performancemanagement systems can enhance the achievement of individual and organisationalgoals.

• What?

• Implement a valid and reliable performance review process for the clinicalworkforce.

• Ensure the clinical workforce participates in regular performance reviews thatsupport individual development and improvement .


3.3 Ensuring that systems are in place for ongoing safety and qualityeducation and training:

• Why?

• Health care workers who are educated and trained to worktogether can reduce risks to patients, themselves and theircolleagues and when they manage incidents proactively andmaximise opportunities to learn from adverse events and nearmisses.


• What?

• Offer the clinical and relevant non-clinical workforce access toongoing safety and quality education and training for identifiedprofessional and personal development .


3.4 Seeking regular feedback from the workforce to assess theirlevel of engagement with, and understanding of the safety andquality system of the organisation:

• Why?

• The effectiveness of education and training systems needs to be monitored.

• What?

• Analyse feedback from the workforce on their understanding and use of safetyand quality systems .

4. PATIENT SAFETY AND QUALITY INCIDENTS ARERECOGNIZED, REPORTED AND ANALYZED ANDINFORMATION IS USEDTO IMPROVE SAFETY

4.1 Implementing an incident management and investigationsystem that includes reporting, investigating and analysingincidents (including near misses), which all result in correctiveactions:

• Why?

• Research has shown that adverse patientevents can be detected, and their frequencyreduced, using multiple detection methodsand clinical improvement strategies as part ofan integrated clinical risk managementprogram.

4. PATIENT SAFETY AND QUALITY INCIDENTS ARERECOGNIZED, REPORTED AND ANALYZED ANDINFORMATION IS USEDTO IMPROVE SAFETY

• What?• Establish processes are to support the workforce recognition and

reporting of incidents and near misses .

• Provide feedback on the analysis of reported incidents to the workforce .

• Take action to reduce risks to patients identified through the incident management system .

• Review incidents and analysis of incidents at the highest level of governance in the organisation .

4. PATIENT SAFETY AND QUALITY INCIDENTS ARE RECOGNIZED,REPORTED AND ANALYZED AND INFORMATION IS USED TOIMPROVE SAFETY

4.2 Implementing a complaints management system that includespartnership with patients and carers:

• Why?

• Complaints are an important improvement opportunity

• Consumers have a right to be engaged

• Consumers can contribute to finding system solutions

• What?

• Processes are in place to support the workforce to recognise and report complaints .

• Systems are in place to analyse and implement improvements in response to complaints .

• Feedback is provided to the workforce on the analysis of reported complaints .

• Patient feedback and complaints are reviewed at the highest level of governance in theorganisation .

Engagingwith patientsand carers

4. PATIENT SAFETY AND QUALITY INCIDENTS ARE RECOGNIZED,REPORTED AND ANALYZED AND INFORMATION IS USED TOIMPROVE SAFETY

4.3 Implementing an open disclosure process basedon the national open disclosure standard:

• Why?

• Consumers expect honest disclosure and discussion whenthings go wrong.

• Open disclosure is an element of an integrated positivesafety and quality culture.

• What?

• Implement an open disclosure program, consistent withthe national open disclosure standard .

• Train the clinical workforce in open disclosure processes .

5. PATIENT RIGHTS ARE RESPECTED ANDTHEIR ENGAGEMENT IN THEIR CARE ISSUPPORTED

5.1 Implementing through organisational policies and practices apatient charter of rights that is consistent with the current

national charter of healthcare rights:

• Why?• Stating consumer rights, even in a non-enforceable statement, provides a

basis for those rights to be implemented.

• There is broad recognition of the need for the health care system to be “consumer focused ” “ person centred “ but there is significant evidence thatthis is not yet achieved.

• Patients and carers can be assisted and encouraged to engage in healthcaresafety and quality if they understand their rights.

5. PATIENT RIGHTS ARE RESPECTED AND THEIR ENGAGEMENT IN THEIR CARE IS SUPPORTED

• What?• Adopt a charter of patient rights

that is consistent with the current national charter of healthcare rights.

• Provide and explain information on patient rights to patients and carers.

• Establish systems to support patients who are at risk of not understanding their healthcare rights .

5. PATIENT RIGHTS ARE RESPECTED AND THEIRENGAGEMENT INTHEIR CARE IS SUPPORTED

5.2 Implementing processes to enable partnership with patients indecisions about their care, including informed consent to treatment:

• Why?• Patients have a legal right to consent, or refuse consent.

• Informed patients can contribute to better decision-making.

• What?• Engage patients and carers as partners in the planning for their treatment .

• Establish mechanisms to monitor and improve documentation of informed consent .

• Establish mechanisms to align the information provided to patients with their capacity tounderstand .

• Support patients and carers to document clear advance care directives and / ortreatment-limiting orders .


• 5.3 Implementing procedures that protect the confidentialityof patient clinical records without compromising appropriateclinical workforce access to patient clinical information:

• Why?• Patients have a legal right to privacy and confidentiality.

• Clinicians need access to relevant information to plan and deliver quality care.

• What?• Ensure patient clinical records are available at the point of care .

• Establish systems to restrict inappropriate access to and dissemination of patientclinical information .


• 5.4 Implementing well designed, valid and reliable patientexperience feedback mechanisms and using these to evaluate thehealth service performance:

• Why?

• Patient feedback is a rich source of information about safety and quality of careand improvement opportunities.

• Systematic collection provides different data from ad hoc complaints andcompliments.

• What?

• Use data collected from patient feedback systems to measure and improve healthservices in the organisation.

71

For a country to achieve, several factors must be in place.


72


73

GENERAL ISSUES

GOVERNANCE is the responsibility of the governingentity, but governance systems permeate the organisation.There should be an identifiable system throughout theorganisation of:

1) Strong cultural leadership

2) Delegation and clarity of roles and responsibilities

3) Quality management

4) Risk management

5) Performance monitoring and reporting, through to the governing entity

• The key to effective governance isensuring:

1. There is a positive organisational culture that valuesperformance and promotes continuous inquiry

2. Systems of care are well-designed and performance ismonitored.

3. There are systems to ensure people with the necessary skillsand competencies are appointed and supported at all levels ofthe organisation.

4. The right facilities and supports are available .5. Risk is identified and managed.

GENERAL ISSUES

The governing entity is responsiblefor the ‘tone at the top’. Strongclinical governance requires explicitleadership of safety and quality.

In a well-governed organisation,people will thrive on the question“how do we know?” (not see it asreflecting lack of trust).

GENERAL ISSUES

• Governance is different from management :• good management includes management of safety and quality• good governance adds to good management by importing a layer

of leadership, accountability and risk management.

• Good governance requires constant inquiry:• Have we got a system?• Is it a good system?

• Good governance requires a focus on evidence, not just‘trust’

• How do we know? Are there standards that apply? Do wecomply?

GENERAL ISSUES

Its not just about compliance and assurance - goodgovernance requires the governing entity to support andcoach the CEO and senior staff.

Good clinical governance draws from experience in othersectors and industries – the principles of delegation,responsibility, quality management, accountability and riskmanagement are the same.

The complexity of clinical governance systems will varydepending on the size and complexity of the health service.

GENERAL ISSUES

GENERAL ISSUES

• The structure of most criteria requires:

• Documentation of the elements of the governance system:• Clearly specified roles and responsibilities

• Policies

• Delegations

• Contractual specifications

• Methods of monitoring and feedback

• Evidence of continuous and systematic testing of the governance system – “howdo we know?”

• Evidence of monitoring of effectiveness.

• Evidence of governance responses.

• GOVERNANCE is the activity of leadership,delegation, oversight of quality management, monitoring,reporting and risk management.

• It is the responsibility of the governing entity to ensurean effective governance system is in place, permeatingthe organisation.

• Managers are responsible for designing good systems ofcare and ensuring quality care is delivered – goodgovernance develop another ‘arms-length’ layer ofleadership and assurance.

SUMMARY

• At a governance level, the questions arealways “Do we have a good system?” and“How do we know?”.

• The standard guidesthe governing entity toaddress the variouselements of leadership,assurance,accountability and riskmanagement.


82

Drivers for

Effective Governanc

e for Quality

andPatient Safety

Prof. Tawfik Khoja

83

CONCLUSION• The national profile of quality and safety governance has increased and

highlighted the importance of local delivery contexts in implementing anational policy.

• Engaging with clinical, manager and director level staff to develop agovernance framework created a shared ownership of the agenda.

• The development process highlighted the need for the large number ofstakeholders to achieve the vision of Health Care Quality & SafetyGovernance Dimensions.

• The governance framework has enabled the first baseline data on hospital/ PHC -based health care to be established and can now be used tobenchmark future progress within the country.

Treat the patient as if you are the patient in the eyes of the patient

A vision without a task is a dream.

A task without a vision is a job.

A vision with a task can change the world.

3

Leadershipasactivity,notposition

“Leadership is no longer about your position. It’s now more about your

passion for excellence and making a difference. You can lead without a title”.

Robin Sharma

LeadersSave Lives

88

Health CareQuality & Safety

StandardGovernance Dimensions

Dr. Tawfik A. Khoja 89

Strengthening Health System GovernanceBetter policies, stronger performanceScott L. Greer, Matthias Wismar, and Josep Figueras. 2016

A Framework to Promote Good Governance in Healthcare KENNETH Y. HARTIGAN-GO FACULTY, ASIAN INSTITUTE OF MANAGEMENT

MARY KRIS N. VISPERAS RESEARCH AND PROGRAM COORDINATOR AIM HILLS PROGRAM ON GOVERNANCE RAMON V. DEL ROSARIO, SR. – C.V. STARR CENTER FOR CORPORATE GOVERNANCE

MARIAN THERESIA VALERA PROGRAM COORDINATOR AIM DR. STEPHEN ZUELLIG CENTER FOR ASIAN BUSINESS TRANSFORMATION

Working Paper

An approach to addressing governance from ahealth system framework perspectiveMikkelsen-Lopez et al. BMC International Health and Human Rights 2011, 11:13

Governance for Safety and Quality in Health Service OrganizationsHeather WellingtonAccrediting Agencies Surveyor Workshop, 12 August, 2012

Governance in Health Care DeliveryRaising PerformanceMaureen Lewis and Gunilla PetterssonThe World Bank - Development Economics Department &Human Development Department - October 2009

REFERENCES

Dr. Tawfik A. Khoja 90

Developing a national governance framework for health promotionin Scottish hospitals.Lorna Smith World Conference on Health Promotion August 25-29th Pattaya, Thailand 21st IUHPE 2013

Governance For HealthDr. Ahmed-Refat AG Refat . www.SlideShare.net/AhmedRefat.Dec 2013

Governance in Healthcare: Leadership for Successful ImprovementDan LeSueur,© 2016 Health Catalyst

Corporate Governance in the Health SectorIPA Governance Forum/CIPFAJim BreslinSecretary GeneralDepartment of Health8 March, 2016

health care quality and safety governance dimentions 33333333 · and if any one saved a life, it...

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