roadmap to attaining quality in public healthcare centers through accreditation

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11www.gujhealth.gov.in Health & Family Welfare, Govt of Gujarat

Quality Improvement Programme(Toward Excellence Health center for the Community)

“Roadmap to attaining Quality in Public Healthcare Centers through Accreditation"

Dr. J. L. MeenaState Quality Assurance Officer

Commissionerate of Health & FWGovernment of Gujarat

Email:- [email protected] Web:- www.gujhealth.gov.in/quality-assurance-program.htm

Dr. J. L. Meena

mailto:[email protected]

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

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Quality Improvement Programme

Quality is very Sweet for speak, but difficult to implement.

because

Quality is Never Improved without accepting facts.

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Old Scenario of Health Centers.

Building maintenance was extremely unsatisfactory – Leaking roof, eroded floors, over flowing toilets, broken doors, No patient safety, No safe drinking water facilities. no employee safety, poor lighting and no ventilation sign.

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• Poor sanitation and cleanliness.

• Very poor Drainage facility.• Poor housekeeping service.• Very poor Biomedical

waste & infection control practice.

• No cattle guard.

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• Non sterile suction tube & oxygen mask?

• Empty Oxygen Cylinders.

• Instrument with rust & Non sterile.


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HOW TO ACHIEVE EXCELLENCE IN HEALTH IN TRIBAL AREA

TQM-NABH…………

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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.

Quality Policy

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Quality ObjectivesTo achieve standards as per IPHS & NABH.To provide 24X7 quality services to the community.To implement and monitor all the national programs

running in the district.To provide right treatment through latest technology.To ensure safety of employee.To ensure safety of patient.To manage Human Resources for enhancing

productivity.

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A Case Study JOURNEY TOWARDS QUALITY

Cont….

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A Case Study JOURNEY TOWARDS QUALITY

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Outcomes…..

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5 Years Back TodayLack of standards NABH Standards for Health Centers

No Gap analysis report in standard format. Gaps identified and addressed.

Lack of Statutory requirements (e.g. Licenses, Acts, Rules & Certificates).

Statutory requirements fulfilled

Absence of written policies & procedures. Written policies & procedures available.

Poor sanitation, cleanliness & infection control practices.

Hygienic, Clean & Green Hospital environment with infection control audit.

Staff shortage so very poor specialist service. Recruitment of staff as per workload through RKS and take specialist service outsource.

Lack of trained health care staff for emergency (resuscitation) services and patient care service.

Staff trained in Basic Life Support and Advanced Cardiac Life Support

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

Staff trained as internal auditors, audits conducted to find out non conformances, corrective & preventive measures taken to rectify it

Journey of Quality Improvement (Cont)…

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5 Years Back TodayInadequate infrastructure for handling biomedical waste and infection control safety practices

All required practices in place

No Blood storage, CSSD, no separate OT for Eye & Gynec., Patients attendant launch facilities.

Blood storage, CSSD, separate OT for Eye & Gynec, 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.

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

Absence of quality standards. Quality standards e.g. medical audit, management of medication, care of patients etc practiced

No participation in EQAS/ inter laboratory comparisons

Participation in EQAS / inter laboratory comparison and achieving good scores in it.

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5 Years Back TodayPoor 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

Non Implementation of Different Codes in the facilities.

RED for FIRE,

YELLOW for EXTERNAL CALAMITIES,

BLUE for CARDIAC ARREST,

BLACK for BOMB THREAT,

PINK for CHILD ABDUCTION

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5 Years Back TodayNo team work, only Individual approach rather then team . Unidentified role and responsibility of staffs.

Team work is available, role and responsibility of all staff is cleanly mention.

No Evaluation and monitoring system by PRI members (3rd party evaluation).

3rd Party evaluation & monitoring system by PRI members.

Poor publicity of available services in the villages and in the community.

All the service which are provide by the healthcare centre are display in the community and emergency contact number also display.

No monitoring of Up time & down time of the instruments.

Proper monitoring of Up time, down time & utilization of the instrument & equipment.

No responsibility of referred patients . Progress of the referred patient also monitoring by the health centre on regular basis.( Bi directional referral service).

No display of the Right and responsibly of the patients and employees in the facilities.

Proper display of Right and responsibly of the patients and employees in the facilities.

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Achievement: India’s 1st NABH / NABL Accredited Govt. Facilities:-•Dist. General Hospital Gandhinagar •Primary Health Centre Gadboriad, Dist: Vadodara •Medical College Hospital Labs Bhavanagar •Blood Bank (BJMC Ahmadabad)•Food & Drug laboratory Badodara •Mental Hospital BadodaraCommunity Health Center, Bardoli-Surat

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India’s 1st & 2nd NABH Accredited PHC

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India’s 1st NABH Accredited CHC

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A Success StoryQuality Improvement Programme:- Gujarat

Name of the Facility Total Facility Under

NABH /NABL

Total Facility Under NABH /NABL which

catering Tribal population

Total Accredited facilities

Total Accredited facilities which catering tribal

population

District Hospitals 23 11 2 0

Medical college Hospitals 6 2 0 0

Medical college, Blood banks 6 2 5 2

Medical college, Laboratories 6 2 4 2

Mental Hospitals 2 1 2 1

Dental Hospitals 2 0 0 0

Paraplegia Hospital, Ahmedabad

1 1 0 0

Primary Health Centers (PHCs) 29 14 12 6

Community Health Centers (CHCs)

26 11 1 1

NABL Food & Drug Laboratories 2 1 2 1

Total 103 45 28 13Dr. J. L. Meena

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Benefits to PatientsBenefits to PatientsAvailability of Health services with High quality of care.Dedicated and sincere medical staffAccess to a quality focused organizationRights respected and protectedPatient Satisfaction evaluatedInvolvement in care processPatient safetyPain managementSafe transportContinuity of care

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Availability of Services at PHC level

Sr Name of service Day Time1 OPD Services Daily ( Except

holidays) Morning: 9.00 to 13.00Evening: 16.00 to 18.00

2 Certificates of age, fitness and sickness ,, ,,3 Lab services ,, ,,4 Homeopathic treatment ,, ,,5 Indoor services Daily 24 hours6 Delivery ,, ,,7 Emergency services ,, ,,8 Vehicle for referral ,, ,,9 Medico legal services ,, ,,

10 MAMTA Clinic ( Immunization, medical checkup, treatment, IEC & Family planning services for expectant mothers, children & adolescent)

Monday 9.00 to 14.00

11 NSV, Abdominal tubectomy , MTP & Hydrocele operatipon

Tuesday & Friday 9.00 to 16.00

12 All National Programme Daily ( Except holidays)

Morning: 9AM to 1 PMEvening: 4 to 6 PM

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List of Laboratory Services Available at PHC

Sr No Name of test Availability1 Hb Yes2 Blood Group Yes3 Sickeling Test Yes4 H.I.V. Yes5 Leptospirosis strip test Yes6 Pregnancy test Yes7 Blood Malaria Parasite (BMP) Yes8 AFB Yes9 Urine Sugar /Alb. Yes

10 Routine urine Yes11 Bleeding Time/ Clotting Time Yes12 TC,DC,ESR Yes13 Syphilis Yes14 Typhoid Yes15 Water quality Yes16 Hb Electrophoresis YesDr. J. L. Meena

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List of services Outsourced at PHC

Proper Net working of ambulances with 108 for safe referral service.X -RAYSonographyGynaecologist services on call.Pediatric Services on call.

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Quality Improvement Programme High Quality of Care cont…High Quality of Care cont…

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Provided baby kits to new born for prevent Infection & hypothermia

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Quality Improvement Programme Qualitative Laboratory services…Qualitative Laboratory services…

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Quality Improvement Programme Management of Medicine…Management of Medicine…

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Change the Scenario……. Safety of patients & employees…

Before After

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Before After

Change the Scenario…. Biomedical waste practice…

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Change the Scenario…… Safe drinking water……Before After

RO plant provided by TSP Grant

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Quality Improvement Programme Quality food services to patients & attendantsQuality food services to patients & attendants……

CHC Bardoli, which catering Tribal Population

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Recreational & skill development

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Occupational Therapy Unit

Behavior modification training.

Social skill training.

Vocational Training.

Day care services

Job placement wherever possible.

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Vocational therapy

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NO. OF DELIVERY AT PHC

PHC:- Salun, Dist:- Kheda

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Adverse Donor Reaction

Blood Bank:- Civil Hospital Ahmedabad

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Issue of Components

Blood Bank:- Civil Hospital Ahmedabad

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Specimen Analysis

Biochemistry Lab:- Sir T Bhavnagar

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Critical value reporting

Biochemistry Lab:- Sir T Bhavnagar

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Surgical Site Infection (SSI)

Dist Hospital:- Gandhinagar

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Benefits to StaffProfessional staff developmentProvides education on laid down standardsProvides leadership for quality

improvement within medicine and nursingIncreases satisfaction with continuous

learning, good working environment, leadership and ownership

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% of film wasted in radiology department

Dist Hospital:- Gandhinagar

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Professional staff development

Managerial / Administrative training to MO / Head.

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Induction training to staff at all levels. Job based skills training.


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Special clinical skill training on minor surgical procedure, obstetrics care, new

born care, basic life support and local anesthesia block.


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NABH ACCREDITATION AWARD FUNCTION BY GOVT. OF GUJARAT & QCI, NEW DELHI

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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

Award 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

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Improves care Brings in Corporate GovernanceStimulates continuous improvementDemonstrates commitment to quality careRaises community confidenceOpportunity to benchmark with the best

Benefits to Hospital

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Main entrance should be easily identifiable, welcoming, well lit and with mattress.

PHC Mahuwas, Tribal area PHC

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Quality Improvement Programme Welcoming infrastructure……


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Quality Improvement ProgrammeDistrict Hospital Godhara (Tribal area)

DH Godhara, which catering Tribal Population

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FICCI Healthcare Excellence Award to India’s 1st NABH PHC:- Gadboriayad

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Quality revolutionDisaster preparedness

- Epidemics- Physical

Access to comparative database

Benefits to Community

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All the Services provided by PHC Gadboriad are displayed in all the villages & roadside

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Mock drill and training for disaster management

Ambulance provided by TSP Grant

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PHC Tankal, Kandolpada & Mahuwas, Navsari

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Quality Improvement Programme Involvement in National Programme…Involvement in National Programme…

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Quality Improvement Programme Involvement in National Programme…Involvement in National Programme…

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Quality Improvement Programme Malnutrition awareness…Malnutrition awareness…

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Quality Improvement Programme AIDS awareness programme…AIDS awareness programme…

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PRI Monitoring & Evaluation of CHC

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Quality Healthcare Service to Poorest of the Poor.

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Efficiency of Government hospitals as key contributors for building trust and confidence for the hospitals in the hearts of the citizens of the State through actively pursuing quality improvement programme in various facilities.

Given a sense of pride to the government for ensuring quality services to the poorest of the poor.Confidence has been restored of the community in Govt hospitals

Benefits to the Government

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Award received by Government of Gujarat for Quality Improvement

Appreciation awarded by QCI to Ministry of Health and Family Welfare Governmentof Gujarat for establishing Quality Assurance framework in providing quality healthcare to the people of Gujarat in 5th National Quality Conclave, New Delhi. Appreciation awarded to Department of Health and Family

Welfare Government of Gujarat for their pioneering effort to spearhead the Quality and Accreditation Programme in health care organization. In 3rd International Health Care Quality Conclave

FICCI Health care Excellence Award to Dist Hospital Gandhinagar & PHC Gadboriad, Govt of Gujarat in FICCI Heal 2010, New Delhi Date: 6th Sept 2010

FICCI Health care Excellence Award to Dist Hospital Gandhinagar, Govt of Gujarat in FICCI Heal 2011, New Delhi Date: 8th Sept 2011

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Strategies Adopted for sustainability:

•Appointment of Quality Assurance officers at State level, District level, Assistant Hospital Administrator (AHA) at facility level. We are designated NABH Coordinators & NABL Directors at Facility level. •NABH lead assessor training (Total trained persons 290 for hospitals & PHC / CHC) & NABL Internal audit training (Total trained persons221) to administrators, clinicians, paramedical & staff nurses etc. •Post Graduation Certificate Course in Quality Management and Accreditation of Health care Organization (PGQM & AHO) to the Additional Directors, Superintendents, Chief District Medical Officers, Clinicians and District Quality Assurance Officers (Total trained persons186) etc. •Other training as per requirement of NABH / NABL standards and mock drills are being conducted.•New posts of clinicians, paramedical and other are sanction by Government of Gujarat as per requirement. •Extra budget as per requirement of NABH / NABL are sanction from 13th finance commission, Government of Gujarat and NRHM. •Formation of the state level review committee under the Chairmanship of Commissioner of Health, Medical Service & Medical Education and Member secretary is State Quality Assurance Officer.

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Challenges & Solution Challenges Solution done by Govt. of GujaratInfrastructure Separate Project Implementation Unit (PIU) formed

under the Commissioner of Health.

Manpower :- lack of Section posts Regular New posts (About 2200) are sanction by Govt. of Gujarat

Manpower:- Vacant posts Campus Interview started in surrounding state e.g. Rajasthan, MP, Maharashtra etc.

6 New Medical College start.

Fund Section through Govt. of Gujarat, TSP, NRHM & Public private partner though donation etc.

Behavior & Motivation of the staffs

Regular skill development training & Award ceremony

Monitoring & Evaluation Regular Video conference, Meeting & Hospital Information Management System (HIMS)

Medical college Try to accredited Blood bank, laboratories & Radiology Dept. first for there motivation & confidence.

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Road Ahead

To create a Quality culture based on various standards which is sustainable, affordable, equitable & reliable having state of art technology and which can be easy to follow and replicate.

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It has been a quality revolution which is a “rewarding experience”.

The National delegates (Teams from Rajasthan, Bihar, Delhi, MadhyaPradesh, Kerala, Maharashtra, Chhattishghadh, Andhra Pradesh,

Orissa, Karnataka etc) and International delegates(Nigeria, WHO, Ireland etc ) visited the organizations, observedtremendous changes and have commendable remarks “which were thought to be unattainable in public sector. thus setting up anexample for Health Care Organizations to deliver best health careservices to masses”.

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Quality Improvement Programme:- Gujarat

Dr. J. L. Meena

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www.gujhealth.gov.inQuality Improvement Programme

Email:- [email protected] No:- 09099075162

Dr. J. L. Meena

roadmap to attaining quality in public healthcare centers through accreditation

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