Performance Based Financing at Hospital - Process of Care Quality Assessment

1. Performance Based Financing at Hospital- Process of Care Quality Assessment July 11, 2013 James Sorsor, FodayKanneh Shun Mabuchi

2. Focus of this presentation Assessment/Monitoring Financing Use of Finance Management and Structural Checklist Business/Operation Plan HSSP provides a set of management tools for hospital management PBF Bonus Calculation Tool Process of Care Quality Checklist Health Worker Bonus Allocation Quantity Checklist 1

3. Overview of Quality Checklists for Hospitals Process of care is an important part of quality 24% of Total Quality Score 2

4. Hospital will be reviewed by 14 checklist to assess the process of care in hospitals 3

5. Process of Care Quality Assessment Process Process of care quality will be assessed every quarter • Find relevant patients from register (e.g., “Malaria” patient for Malaria checklist) • Record names and patient numbers • Request health workers to bring charts • Team of minimum 2 verifiers from LMDC will compare charts and guides/checklists • 2 charts (tentative) for all 14 checklists will be reviewed quarterly • Total scores will be calculated as % for each checklist • LMDC will enter average % for each checklist in Bonus Calculation Tool 4

6. Aggregate Score Calculation Acquired score (%) of each checklist will be linked to quarterly performance bonus to the hospital (1/2) 2 3 4 1 Weight defined by importance Total 60pt are allocated by weight Assessment results (%) “Point Allocation” * “Actual %” 5

7. Quality Bonus Calculation Process Acquired score (%) of each checklist will be linked to quarterly performance bonus to the hospital (2/2) 1 Total aggregated process of care score 2 “Actual Points”/ “Max points” 3 40% of Total max quality bonuses 6

8. 1 2 Hospital SMT and QI team should use the checklist results for continuous quality improvement • Find major gaps in scores • Review scores of all checklists 3 4 • Look into the actual checklists to see what are wrong • Plan specific activities to improve the low-score checklists in operational plan 7

9. Self-Assessment Tracking and Feedback 1 2 QI team and LMDC coach will motivate health workers to improve key indicators through tracking and coaching (2/2) • Weekly/daily chart review • Monthly management and structural checklist review • Post scores on a wall • Provide detailed feedback to staff Support to Improvement Activities 3 • Support improvement activities (e.g., standardize chart, waste disposal, cleaning) • Training on the treatment protocol and chart writing • …… 8

10. Process • Look into a patient chart • Identify the relevant checklist for the chart • Score the chart based on the guide • Calculate the percentage (%) score • Discuss with your group • One person present the group’s answers to the questions below Exercise – Review medical records with the Process of Care checklist Discussion Questions • What is the overall percentage (%) score? • What are the issues in the patient chart? • What does a hospital management and staff need to do to improve the score of the chart? 9