SafeCare and Kenya Quality Model of health Linkages

Lester Chawiyah - Lead Quality advisor - KMET
(MCF Program)

Outline
Promoting Quality in Health and Education
• Similarities
• Differences
• Process

Similarities
• Implementation based on a Quality Improvement Plan
• Focus on 3 key elements: structure, process, output/result
• Reference: healthcare strategic plan II , Constitution and SDGs.
• Principles –customer oriented, strong leadership and stakeholder engagement.
• A functional QIT must be established for each.
• Internal & external monitoring systems
• Evidence based medicine.
• Both have reward based on performance
• Plan, Do, Study, Act(PDSA) cycle –focused

Differences-SC & KQMH

KQMH & SafeCare process

Key assessment areas

PDSA
Outline
•Definition
•Process
•Examples

Definition of PDSA cycle
The Plan-Do-Study-Act (PDSA) cycle is Improvement Model for accelerating
quality improvement.
•The PDSA cycle is shorthand for testing a change
–by planning it,
–trying it,
–observing the results
– and acting on what is learned.
•It’s a scientific method, used for action-oriented learning.

Vital Points

PDSA Cycle

Remember
• Single Step —Each PDSA often contains only segment of the entire tool.
• Short Duration —Each PDSA cycle should be as brief as possible
• Small Sample Size —A PDSA will likely involve only a portion of the
practice

Remember…
Once an intervention has been introduced, the intervention and any
improvements need to be sustained. This involve:
• standardization of existing systems and processes
• documentation of policies, procedures, protocols and guidelines
• measurement and review of interventions to ensure that change becomes
past of “standard” practice
• training and education of staff

Examples of PDSA activities
• Eliminate waste
• Improve work flow
• Optimize inventory
• Change the work environment
• Enhance the producer/customer relationship
• Manage time
• Manage variation
• Design systems to avoid mistakes
• Focus on the product or service

SafeCare process
Outline
•Definition approach
•SafeCare levels
•Quality standards
•Sigma approach
•Assessment areas
•Sustaining factors
•Discussion

Definition of SafeCare
• Stepwise process
• Improve structure-process-outcome by applying Quality principles and tools
• Satisfy patients/clients needs in a culturally appropriate way
• Improve adherence to standards and guidelines based on Evidence-Based
Medicine (EBM)
• Facility improvement
• Collaborative
• Implemented in RRS
• End goal is accreditation /certification of a facility

SafeCare levels

Quality standards
•Innovative and realistic.
• Step-wise improvement process
• Improve the reputation of healthcare facilities
• Increase efficiencies
• Qualify facilities
• Increase patient flows and sustainability
• Increased trust in services provided to clients

A SafeCare facility
• Is safe for patients and staff
• Offers integrated clinical services which meet the needs of patients
• Adopts self monitoring process for its initiatives
• Consistently reports its achievements and gaps
• Increases access to services
• Utilized resources appropriately

A SafeCare facility…
• Begins with risk identification
• Analysis of risk and prioritization
• Planning
• Quality improvement implementation
• Standardize care
• Audit till positive results are achieved.
• Accreditation/Certification

Sample -Assessment Results

Factors to consider to sustain
quality
• Leadership (Frontline manager, Board members ,Departmental heads)
• Staffing (Employing qualified personal)
• Developing & using Policies/Guidelines/SOPs.
• Team work (Facility QIT /management and Patients)
• Stakeholders support and Public private partnership
• Clinical Audits
• Incentivization of Quality
• Recognition/Awarding Quality

Remember
• Achieving a 99% level of quality would mean accepting
error
In Kenyan health sector a 1% error rate
would mean everyday
W minutes without water or electricity
X patients dissatisfied by your services
Y new born/patients falling from the bed
Z lunches contaminated by bacteria
U medication errors reported
V hospitals lacking appropriate equipment
1%

Discussion
i. Share are the experiences of quality improvement in your facility.
ii. What solutions can we have within our limits
iii. How do we ensure that the culture of quality is cultivated within
the hospital despite challenges experienced

QI Planning & Monitoring
Definition
Roles and elements of QIP
Examples of QIP activities
Monitoring
QIT roles

What is a QIP
QIP (Quality improvement plan)- A set of activities aligned with specific
objectives on improving identified gaps in a health facility.
•QIP must be SMART
•QIP is not
– Too complicated
– Rocket science
– Just more to do
– Red tape

QI planning is…
• Finding the way to do it
– Better
– Faster
– Easier
• Part of everyday life
• Used to make improvement to a process
• Enhance systems

Benefits of QIP
• Monitor tool
• Improve patient experience and outcomes
• Focus on highest quality of service
• Builds on integration
• Informs decisions
• Achieves excellence
• Reference tool
• Prioritization

Examples

So what?

How to monitor QIP
• Review meetings
• Quality Improvement Teams(QIT)
• Audit reports
• Self assessment reports
• Exchange visits

How will you notice improvement?
Measure over time using run charts
Make measurement intervals as short as possible Monitor measurements and
change as needed.
Your systems are creating your outcomes.
To GET something different, you have to DO something different.

QIT roles
Coordinate planning and implementation of QIP activities
Document QIP activities.
Provide quarterly /monthly reports to management and stakeholders on
quality activities.
Ensures healthcare remains focused on safe and reliable patient care, staff
vitality, process efficiency and waste reduction.

QIT roles…
Creates a supportive environment within the hospital.
Manages, investigates, and concludes
Audits reports on patient and customer complaints, compliments.
Manages, organises, audits and reports on patient satisfaction feedback

QIT activities and Awards

Discussion
Do you have a quality committee?
How do you ensure the QIT stays focused
What are the challenges experienced?
How do you intend to improve this initiative?
How do you promote team work in a QIT

Sustaining quality
• Meetings
• Audits
• Capacity and orientation
• Benchmarking & Peer review

For more information. visit our Website:
www.kmet.co.ke
YOUTUBE: www.youtube.com/kmetkenya
Blog: www.kmetkenya.wordpress.com
Facebook: kmetkenya
Twitter: @Kmet_Kenya

SafeCare and Kenya Quality Model of health Linkages

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