Introducing Quality Management in District Hospitals in Tanga Region

1
Introducing Quality Management in District
Hospitals in Tanga Region

• First Experiences from Korogwe District Hospital

2
Improving Patient Care a strategic framework
for Tanzanian Hospitals

• Goal
• To improve the health and well-being of all
  Tanzanians with a focus on those most at risk and
  to encourage the health system to be more
  responsive to the needs of the people
• Purpose
• To provide access for all Tanzanians to good
  quality, equitable and affordable hospital
  services

3
Why?

• Public dissatisfied with services
• Efficiency and effectiveness of services low
• Poor value for money
• Low motivation and morale amongst health workers
• Weaknesses in management
• Inadequate quality control

4
Some objectives in the framework

• Strengthen management systems and capability in
  the Ministry and Hospitals
• Improving quality and effectiveness of clinical
  care, e.g.
• Introduction of peer hospital appraisal
• Establishment of evidence-based protocols,
  standards, guidelines and benchmarks
• Introduction of internal and external clinical
  audits of patient care
• Ensure financial sustainability of hospital
  services

5
Quality Assurance Guidelines for health workers

• Introduces HWs to
• concept of quality and quality assurance
• Quality control
• Professional standards
• Package of minimum essential health interventions
• Team work
• Management skills
• Communication skills
• Data collection and use

6
Activities in Tanga Region

• QM activities established aimed at Dispensaries
  and Health Centres
• Supervision checklist
• Ranking and scoring of HFs
• Public awarding of best performing HFs
• Next step inclusion of Hospitals in QM
  activities

7
5 important Principles of QM

• Client orientation - satisfaction
• Focus on improving systems and processes
• Decisions based on (good) data
• All staff members are involved and responsible
  for quality of services TEAM WORK important
• Commitment to continuous improvement

8
Quality Management Triangle
Defining Quality
Improving Quality
Measuring Quality
9
3 key conditions required to succeed with quality
improvement activities

• Management is committed to meet staff needs
• Empowerment and support of staff to initiate and
  implement changes in terms of
• Decision-making
• Access to resources
• Adequate infrastructure for service delivery

10
Adequate infrastructure

• Adequate buildings and working space
• Necessary equipments always available and
  functioning
• Necessary medications and medical supplies always
  available

11
Situation at District Hospital

• Availability of equipments
• Basic equipments available but not always in
  sufficient number
• Some essential equipments missing
• Availability of drugs and medical supplies
• Stock- outs still occurred from time to time for
  various reasons
• State of buildings etc
• old electrical and water system
• old buildings
• Some wards overcrowded
• Inadequate staffing levels and staff mix

12
Getting ready1

• Strengthening the Hospital Committees

13
Getting ready 2

• Raise availability of drugs and medical supplies
• Support of pharmacy
• Review logistics system
• Purchase of equipments as planned in CCHP 2003

14
Introduction to QM - 1

• Initial 2 day seminar for clinical and nursing
  in-charges of the hospital
• Meaning of quality
• Basic principles of quality management
• Introduction to quality improvement cycle using a
  practical example

15
Introduction to QM 2

• 5 day workshop organised by Ministry of Health
• Participants Hospital Matron and 1 Nurse
• Topics
• COPE Methodology
• Quality Measuring Tool
• Cost Analysis
• Clinical Monitoring
• Supervision

16
Quality Circles

• Definitions
• A group of health workers who form a group to
  identify and solve specific quality problems at
  their workplace
• Peer Review a group of health professionals, e.g
  clinical officers who review case management
  together in order to improve / maintain quality
  of services

17
Kamati ya ubora wa huduma

• Appointed by the hospital management team
• Multi-disciplinary
• Members
• MO I/c
• Matron
• 1 Clinical Officer
• 1 Health Officer
• 1 Nurse / Midwife
• 1 Medical Attendant

18
Tasks of the Hospital Quality Committee

• Establish a Comprehensive quality plan for the
  Hospital in close cooperation with departments
• Initiate, coordinate and support Quality Groups
  in the various hospital departments
• To give advice to Quality Groups for developing
  their action plans
• Support implementation of action plans of the
  Quality Groups
• Motivation and appraisal of Quality Groups
• Feedback to Hospital Management Team

19
First Activities of HQC

• All departments of the hospital were asked to
  compile a list of quality problems
• Review of the list by the Hospital Quality
  Committee
• Provide feedback to the departments and support
  departments for the analysis of problems and
  design of solutions

20
Planned activities

• Establish quality circles in all departments
• Train more staff with QM skills
• Work on the problems with each department

21
Results

• Quality is a topic in the hospital

22
Quality Activities initiated by staff of
Maternity ward

• Improvement of dispensing of medications
• Problem identified in recording
• Development of a dispensing sheet
• Prevention of prolonged labour of Prime Gravida
• Problem identified in interpreting partograph and
  initiating appropriate action
• Development of a flow chart

23
3 pillars of Quality Management
Defining Quality
Improving Quality
Measuring Quality
24
Data management

• Data collection
• Patient records
• Financial records
• Inventories etc.
• Data analysis
• Feedback and use of data

25
Patient records

• Information about
• Patient
• Symptoms and diagnosis
• Investigations
• Treatment given
• gives information about quality of
  care

26
(No Transcript)
27
(No Transcript)
28
(No Transcript)