quality quality what is in health care ? quality as defined by customers internal & external...
TRANSCRIPT
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QUALITYQUALITYWhat isWhat is
in Health Care ?in Health Care ?
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QUALITYas defined by
CUSTOMERSInternal & External
QUALITYas defined by
CUSTOMERSInternal & External
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1985 Scott Report1985 Scott Report
• Recommend to establish the Hospital Authority as a statutory body to transform the management of public hospitals in Hong Kong
• Recommend to establish the Hospital Authority as a statutory body to transform the management of public hospitals in Hong Kong
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The HA ReformThe HA Reform
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• Manages 44 public hospitals
• Staff force nearly 50,000• Recurrent budget HK$30 billion• In-patients 1.2 million• A & E attendances 2.6 million• Specialist out patient attendances 9.5 million• Public spending on health 2.7% GDP
• Market share in secondary & tertiary care 94%
• Manages 44 public hospitals
• Staff force nearly 50,000• Recurrent budget HK$30 billion• In-patients 1.2 million• A & E attendances 2.6 million• Specialist out patient attendances 9.5 million• Public spending on health 2.7% GDP
• Market share in secondary & tertiary care 94%
The HA ReformThe HA Reform
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Daily hospital charge below US$9Daily hospital charge below US$9
Including:• Meals• Nursing care• Medical
Intervention• Drugs
Including:• Meals• Nursing care• Medical
Intervention• Drugs
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HA OrdinanceHA Ordinance
• To advise the Government of the needs of the public for hospital services
• To provide hospital services of the highest possible standard within the resources obtainable
• To advise the Government of the needs of the public for hospital services
• To provide hospital services of the highest possible standard within the resources obtainable
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Mission StatementMission Statement
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19931993HA’s Year of QUALITYHA’s Year of QUALITY
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• Defining the customer context of quality• Developing the philosophy of quality• Integrating quality improvement into
organizational systems and processes• Focusing on clinical quality improvement
• Defining the customer context of quality• Developing the philosophy of quality• Integrating quality improvement into
organizational systems and processes• Focusing on clinical quality improvement
Quality in the HA ContextQuality in the HA Context
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“What constitutes the healthcare productthat the organization
is supposed to produce?”
“What constitutes the healthcare productthat the organization
is supposed to produce?”
Quality as Defined by CustomerQuality as Defined by Customer
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Needs of PatientsNeeds of Patients
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• Access and convenience• Decent environment and hygiene• Staff attitude and empathy• Information and explanations• Respect for dignity and rights• Channels for feedback and complaints
• Access and convenience• Decent environment and hygiene• Staff attitude and empathy• Information and explanations• Respect for dignity and rights• Channels for feedback and complaints
Quality Aspects Important to PatientsQuality Aspects Important to Patients
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• Elimination of camp beds• Reduction of overcrowding• Environmental improvement• Building new hospitals
• Elimination of camp beds• Reduction of overcrowding• Environmental improvement• Building new hospitals
Quality Improvement in Early YearsQuality Improvement in Early Years
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• Promulgate Patients’ Charter• Promulgate Patients’ Charter
Introducing Customer ConceptsIntroducing Customer Concepts
• Communication courses • Communication courses
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3-tiered Complaints Management Structure3-tiered Complaints Management Structure
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Internal CustomersInternal Customers
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Extension of the Customer ConceptExtension of the Customer Concept
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Organizational Philosophy on QualityOrganizational Philosophy on Quality
“Quality Patient Centered Care through Teamwork”
“Quality Patient Centered Care through Teamwork”
Core Value Core Value
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Prevention and System ApproachPrevention and System Approach
QC ==> QA ==> TQMQC ==> QA ==> TQM
Focusing on preventionNo blame culture
Focusing on preventionNo blame culture
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Promoting a Quality CulturePromoting a Quality Culture
• Quality involves everybody• All hospital staff are healthcare workers• Patients’ participation• Optimize existing resources• Adopting Preventive and System approach• Spirit of CQI even with no additional
resources
• Quality involves everybody• All hospital staff are healthcare workers• Patients’ participation• Optimize existing resources• Adopting Preventive and System approach• Spirit of CQI even with no additional
resources
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Continuous Quality ImprovementContinuous Quality Improvement
• Cultivate an attitude of constant improvement
• Critical re-look to eliminate non-value added work
• Prevention of errors• Do the right things right, first time and
every time• Quality Tools - BPR, 5-S
• Cultivate an attitude of constant improvement
• Critical re-look to eliminate non-value added work
• Prevention of errors• Do the right things right, first time and
every time• Quality Tools - BPR, 5-S
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Structure for Assuring Quality Structure for Assuring Quality
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Clear Lines of Accountability Clear Lines of Accountability
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Accountability at Department Level Accountability at Department Level
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Internal and external task forces to do quality audits on clinical
and non-clinical areas
Internal and external task forces to do quality audits on clinical
and non-clinical areas
Structure Structure
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HA’s Annual Planning ProcessHA’s Annual Planning Process
A key management tool to:• Align value and directions• Demonstrate public accountability• Manage quality improvement• Tie in with resource allocation exercise
A key management tool to:• Align value and directions• Demonstrate public accountability• Manage quality improvement• Tie in with resource allocation exercise
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Annual Planning ProcessAnnual Planning Process
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Resources PlanningResources Planning
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Outcome Focused PlanningOutcome Focused Planning
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50 Areas of Quality Standards50 Areas of Quality Standards
Systems are in place to ensure cost-effective use of drugs andsafety of drug administration
Reference Standard
(i) To ensure cost-effective use of drugs, a hospital formulary review system isin place, as measured by
¥ s% of pharmacological class of drugs reviewed in each quarter
¥ t number of new drug entities added in the hospital in each quarter
¥ u number of drug entities deleted in each quarter
¥ v number of cost-effective drug utilisation programmes performed,e.g. through multi-disciplinary approach as directed by DrugTherapeutic Committee, including e.g. prescribing guidelines,treatment protocols
(ii) To achieve safety use in drug administration, to report on x% Compliance tothe Recommendations checklist of the Drug Administration Report 2000edition
(iii) Programmes are implemented to review and improve patient compliancelevel to drug therapy
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Perspectives of Annual Planning
Perspectives of Annual Planning
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HA is the Mark in Hong KongHA is the Mark in Hong Kong
CQI versus AccreditationCQI versus Accreditation
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Donobedian model of Structure, Process and
Outcome
Donobedian model of Structure, Process and
Outcome
Improving Clinical QualityImproving Clinical Quality
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Inverse Pyramid ConceptInverse Pyramid Concept
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Hospital Quality Improvement CommitteesHospital Quality Improvement Committees
•Promotes quality awareness•Representative from all departments•Trains and aligns methodology•Monitors feedback and evaluation
•Promotes quality awareness•Representative from all departments•Trains and aligns methodology•Monitors feedback and evaluation
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CQI MethodologyCQI Methodology
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• Process of developing alignment, trust and leadership
• Engage clinicians to look at the bigger picture
• Territory-wide service rationalization• Consensus on improvement programs and
outcome• Cross-hospital clinical audits• Pooling resources in specialist training
• Process of developing alignment, trust and leadership
• Engage clinicians to look at the bigger picture
• Territory-wide service rationalization• Consensus on improvement programs and
outcome• Cross-hospital clinical audits• Pooling resources in specialist training
Clinical Specialty Coodinating CommitteesClinical Specialty Coodinating Committees
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Process:• Discussion and sharing• Consensus building• Planning for quality
improvement
Process:• Discussion and sharing• Consensus building• Planning for quality
improvement
Improving Clinical QualityImproving Clinical Quality
Means:• Clinical guidelines• Protocols• Clinical audits
Means:• Clinical guidelines• Protocols• Clinical audits
Good
Practice
Good
Practice++ ==
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Web-based IT InfrastructureWeb-based IT Infrastructure
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• Champions in Evidence-based Medicine
• Electronic Knowledge Gateway (eKG)
• Publication of
• Champions in Evidence-based Medicine
• Electronic Knowledge Gateway (eKG)
• Publication of
Knowledge ManagementKnowledge Management
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Qualityfilteredresources
Level Ie-journals
Internalknowledgecapture
Interactiveparticipation
Multi-facetaccess
Auto alerts
Crystal in Paediatrics
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• Central Drug Advisory Committee• Hospital Drug Advisory Committees• Striking a balance between Innovation
and Risk• HA Mechanism for Safe Introduction of
New Procedures (HAMSINP)
• Central Drug Advisory Committee• Hospital Drug Advisory Committees• Striking a balance between Innovation
and Risk• HA Mechanism for Safe Introduction of
New Procedures (HAMSINP)
Central Mechanisms on Clinical EffectivenessCentral Mechanisms on Clinical Effectiveness
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Ethics CommitteesEthics Committees
Clinical EthicsClinical Ethics Research EthicsResearch Ethics
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Risk Management StrategyRisk Management Strategy
• Systematic environmental scanning• Appraisal of risks in all aspects of clinical
and non-clinical areas• Part of CQI philosophy
• Systematic environmental scanning• Appraisal of risks in all aspects of clinical
and non-clinical areas• Part of CQI philosophy
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Quality in Healthcarea Journey of Lifelong LearningQuality in Healthcarea Journey of Lifelong Learning