Quality assessment activities Prinsip-prinsip dasar audit mutu klinis & Siklus audit klinis

1. Quality assessment activitiesPrinsip-prinsip dasar audit mutu klinis&Siklus audit klinis

2. Mengapa perlu melakukan quality assessment ?

3. The purpose of quality assessment To review Gap Better quality of care Better clinical outcome Quality assessment To control Potential problems Opportunity For improvement To measure/evaluate

4. Approach Quality assessment Retrospective Prospective Concurrent

5. Methods Review Appraisal Quality assessment activities surveilance Clinical audit evaluation Monitoring

7. Methods for evaluation of small scale quality improvement projects Harvey, G., Wensing, M., Qual Saf Health Care 2003;12:210-214

8. Metoda pengumpulan data • Observasi • Survei kuesioner • Interview • Cek dokumen dan laporan • Focus group (discussion) • dsb

9. Workshop 1 • Jelaskanbedainspeksidan audit

10. Audit klinis • The systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patient (NHS, 1989) • The process of reviewing the delivery of care to identify deficiencies so that they may be remedied. • Audit: a systematic framework for investigating and assessing the professional work and for introducing and monitoring improvements

11. Jenis-jenis audit • Medical audit: involves the review of activities intiated directly by doctors • Nursing Audit: A detailed review and evaluation of selected clinical records by qualified professional personnel for evaluating quality of nursing care. • Clinical audit: covers all aspects of clinical care including that provided by nursing and paramedical staff • Organizational audit: refers to investigation of aspects of practice (such as appointments systems) which are regarded as primarily administrative

12. Jenis audit • Audit internal • Audit eksternal

13. Langkah-langkah audit klinik(Ogilvie, G., Walsh, A., Rice, S: The Problem-based Medical Audit Program: Influence on Family Practice Residents’ Knowledge and skills: Fam Med 1998:30(6):417-20) • 1. Memilih topik audit • 2. Menetapkan standard • 3. Menyusun lembar kerja: menetapkan variabel (kriteria), indikator penilaian, threshold dan instrumen audit • 4. Melaksanakan audit • 5. Membandingkan kinerja dengan target standar, cari peluang perbaikan, lakukan paparan hasil audit • 6. Implementasi perubahan • 7. Kembali ke langkah 1

14. Audit cycle Setting aims Choose the topic Define criteria and thresholds Identify the changes required and implement them Collect the data Assess performance against criteria and standards

15. Audit cycle (NHS, 2004)

16. Audit cycle (NHS) • Defining standards, criteria, targets or protocols for good practice aginst which performance can be compared • Gathering systematic and objective evidence about performance • Comparing results against standards and/or among peers • Identifying deficiencies and taking action to remedy them • Monitoring the effects of this action (closing the audit loop)

17. Mengapa perlu dilakukan audit(Al-Bah, A.K, Serour, M., Clinical audit in general practice: Bulletin of The Kuwait Institute For Medical Specialization 2002:1:63-68) • Pengembangan pendidikan profesi dan self regulation • Perbaikan mutu pelayanan pasien • Akuntabilitas • Peningkatan motivasi dan kerja tim • Alat bantu untuk kajian kebutuhan • Stimulus untuk penelitian

18. Clinical audit is not • A resource management tool • To used to threaten an individual clinician suspected of poor practice • A batch of computers of set of statistics • Competition between clinical professionals

19. Clinical audit is • Neutral measurement process • Improving patient care through ensuring consistent application of standards of care

20. Scheme to choose the appropriate method for practice evaluation

21. Apa yang menghalangi untuk memulai audit • Time --- use small sample, tackle a small topis • Records and computers • Lack of skills and protocols • Negative attitudes to audit, general lack of support from the practice team

22. Benefits of audit (Johnston et al., 2000) • Professional benefits: • Improvement in communication between profesional groups • Increase professional satisfaction and knowledge • Changing in prescribing behavior • Stimulus to learn from colleagues behavior • Increase staff enthusiasm • Patient care and service delivery: • Improvement in patient care • Improved patient satisfaction • Better patient feedback • Improved team work

23. Disadvantage of audit (Johnston et al. 2000) • Increased workload • Restriction of clinical freedom • Professional threat

24. Barriers to successful audit (Johnston et al. 2000) • Lack of resources • Lack of expertise or advice in project design and analysis • Lack of an overall plan for audit • Dysfunctional group membership or ineffective group dynamic (poor relationship between groups and group members) • Organizational impediments

25. Promoting successful audit (Johnston et al., 2000) • Quantifying success • Factors which promote success: • Mechanism to make data collection easier, IT • Supportive organizational environment • Leadership and direction of audit program • Strategy and planning in audit program • Resource and support for audit program • Monitoring and reporting audit activity • Commitment and participation

26. Points to ponder:(Johnston et al., 2000) • Foster an environment for audit • Tackle the problems of multidisciplinary audit • Emphasis audit facilitation • Review staff training program • Establish confidentiality of finding • Ensure all relevant staff are involved • Establish evaluation program Source: Johnton, G., Crombie, I.I., Davies, H.T.O., Alder, E.M., Millard, A., Reviewing Audit: Barriers and facilitating factors for effective clinical audit Quality in Health Care, 2000, 9:23-36

27. Kasus untuk diskusi • Di sebuahrumahsakitumumdaerahdengan TT 500, Dalam 4 bulanterakhir, 35 % persalinandilakukandenganoperasicaesar, dari 120 pembedahancaesar yang dilakukan, terjadi 25 kasusinfeksilukaoperasi • Perlukahdilakukan audit klinis ? Mengapa ? • Lakukanidentifikasifaktorpendorongdanpenghambatpelaksanaan audit klinisdirumahsakit!

28. Review cluster A • Dari seluruh sessions yang diikutipada cluster A, diskusikanapa yang sudahdipelajari (lesson learnt) danapamanfaatbagisaudara ?

29. Cluster A • Basic concept of micro system • Pengukurankinerja • Variasiproses • Prinsipdasarpenggunaandana • Konsepdasar clinical governance • Risk analysis padasistem micro • Komunikasidan team work • Information system padasistemmikro