Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Quality Improvement Initiatives and
Strategies in a LMIC: The Case of a Large
Teaching Hospital in Ghana
OTCHI, Elom Hillary
e l omotchi@gmail . com
KBTH
July 21, 2014
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
1 Introduction
2 QI Objectives
3 QI Strategies
4 QI Initiatives and Activities over the period
5 Best Practices and Challenges
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Background
Founded in 1923.
Largest Teaching
Hospital in Ghana and
3rd largest in Africa.
2000 bed capacity.
4000 members of staff.
18 different professional
groups.
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Background
21 Clinical n
Diagnostics
Units/Departments.
3 Centers of Excellence
(i.e. Cardiothoracic
Center; Reconstructive
Plastic Surgery and
Burns Center; and
Radiotherapy and
Nuclear Medicine
Center).
Average daily OPD
attendance of 1,500.
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Background
Average daily
admissions of 250.
21,000 surgeries (2013)
Total deliveries of
11,186 (2013)
Maternal deaths of 86
(MMR 771/100,000 live
births in 2013)
Hypertensive Disorders
is the No. 1 cause of
MM
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Organization and Management
The day-to-day management of the Hospital is by a CEO.
Eight member management team including directors and
the CEO.
12 member Board of Directors.
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
The Journey t o Ql
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Brief History of QI
•
2002 and driven by a few individuals.
•
QI Framework adopted by the Hospital Management.
Appointment of QI Manager.
•
Vision and Mission are consistent with larger KBTH.
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Organization of QI in KBTH
KBTH Board/Technical
& Planning Committee
of the Board
QI Governing Board
(Convener CEO)
Clinical
Audit
QI Central Committee
(Convener DMA)
PHU/QI
Secretariat
Sub-BMC 1 QI
Focal Person
(HOD/DDNS/IPC)
Sub-BMC 1 QI
Focal Person
(HOD/DDNS/IPC)
Sub-BMC 1 QI
Focal Person
(HOD/DDNS/IPC)
QI Teams (Problem
solving group)
QI Teams (Problem
solving group)
QI Teams (Problem
solving group)
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Broad Objectives of QI in KBTH
•
To establish systems and structures for QI.
•
To reduce morbidity and mortality rates in the hospital.
To continously improve staff technical competence,
morale and satisfaction.
To ensure patient safety.
To provide a clean friendly environment throughout the
Hospital.
•
•
•
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
2014 QI Objectives
•
•
•
•
•
•
Framework for QI Governance.
Framework for the management of pressure ulcers/bed
sores.
Module for accreditation by professional groups for
capacity building.
Surveys to assess QI dimensions as timeliness, safety and
patient centeredness.
Process mapping and redesign of some outpatients
departments.
Unit/Departmental QI Visits.
Accreditation and Benchmarking.
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
QI Structures
Development of QI Framework.
Clinical Audit and Governance Framework developed and
Committee well constituted.
17 Member QI Central Committee (CC) constituted.
QI Focal Persons identified across the Units/Departments
of the Hospital.
21 Departmental QI Teams constituted with varied QI
Projects being undertaken.
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Capacity Building
Training of ALL QI
CCMs and FPs.
Capacities built to
enable participants lead
and undertake various
improvement projects in
their UDS’s.
Developed a modeule
for CPD awards.
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Instrument Design
Time and Motion Survey instrument.
Client and Provider satisfaction instrument.
Infection Prevention and Control (IPC) Assessment
Instrument.
Adverse Event notification form.
Performance review assessment instrument.
Patient safety culture assessment instrument.
Time and Motion surveys
Aimed at assessing how
timely and efficient the
delivery of care in the
hospital is
Obstetrics OPD and ER
Child Health OPD and
ER
Polyclinic
ENT, Eye and Dental
OPDs
Provider Satisfaction Survey
What was working well?
What was working less
well?
What basic things
would you like to
change?
Which single important
change will be beneficial to
your unit/department?
What basic things
would you like to
change?
Client Experience Surveys
Aimed at assessing how
patient-centered the
delivery of care in the
hospital is
Obstetrics OPD
Eye, ENT and Dental
OPDs to assess client
experiences with service
delivery
IPC Assessment
Aimed at assessing
issues of safety
especially with respect
to patients
Obstetrics OPD and
wards
Department of Medicine
Department of Surgery
Department of Child
Health
Polyclinic
KAP of nurses in the management of
pressure ulcers/bed sores
Aimed at assessing the
knowledge, attitude and
practices of nurses in
the management of
pressure ulcers/bed
sores in the hospital
Identify what protocols
are available to guide
the management of
pressure ulcers
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Other surveys
•
•
•
•
Which dimension of quality is most important to you?
Why do inpatients stay beyond the visiting hours in the
Hospital?
Team effectiveness assessment among health workers in
the Hospital
What are some of the common causes of maternal
mortality in KBTH?
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Emergency Triaging Assessment and
Treatment-ETAT
Improved efficiency and
use of the ER
Triage teams who are
able to sort out cases
from the queues
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KBTH
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Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
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Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Appointment System
Reduced waiting time
by 57%
Reduced needless delays
associated with the
delivery of care to
patients
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Pressure Ulcer/Bed sore management
Developed a draft
protocol/guidelines for the
management of pressure
ulcers/bed sores in the
Hospital
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Best Practices
•
•
•
•
•
•
•
Functional QI Framework.
Commitment of various QI teams determined to see
improvement.
Leadership support and commitment to QI
especially from the Head of PHU
Interdisciplinary team approach to QI efforts and
activities.
QI Secretariat with a dedicated person overseeing day to
day QI activities.
Excellent rapport developed with all the QI teams and
their leads.
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Challenges
Varied understanding of the concept of QI.
Limited resources especially finances hamper QI activities.
Difficulties in getting recommendations implemented.
Lack of reliable and valid data to generate information for
planning.
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Challenges
Sometimes, it feels like...
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Visiting Delegation on Ql Tour
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Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
<\0KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Collaboration
Support, partnership and collaboration with others are
welcome especially in the areas of:
Maternal Health.
Newborn and Child Health.
Research.
Patient safety.
Data quality improvement.
Other areas of quality improvement especially in the areas
of systems strengthening.
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Concluding
”Quality is never an accident; it is the always the result of high
intention, sincere effort, intelligent direction and skillful
execution. it represents the wise choice of many alternatives”
(Unknown, cited in Pederson, 2009).
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Thank You
Very grateful for your audience and attention!
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
Outline Introduction QI Objectives QI Strategies QI Initiatives and Activities over the period Baseline Surveys QI Projects
Thank You
Questions & Suggestions…
Quality Improvement Initiatives and Strategies in a LMIC: The Case of a Large Teaching Hospital in Ghana
KBTH
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