Improving Quality and Patient Safety: UCMB Showcase

1. INTERACTIVE SHOWCASE BY UCMB Quality Improvement Efforts 1stFebruary 2012

2. QUALITY IMPROVEMENT Uganda Catholic Medical Bureau & Interactive Showcase National Quality Improvement Conference 27th – 29th February 2012

3. QUALITY AND PATIENT SAFETY • QUALITY & PATIENT SAFETY • 2010

4. PATIENT SAFETY 2010 PATIENT SAFETY INITIATIVES Piloted in UCMB hospitals : Kisubi, Nsambya, Virika, Nkozi, buluba,   AND Facilities in: Arua, Moroto, Kotido,  Nebbi, Luweero catholic dioceses Incident/ Error Report and investigation August 2010 : Reporting is done VOLUNTARILY in a systematic manner using a reporting forms to stimulate the culture of reporting reporting errors and incidents and analysing cause

5. PATIENT SAFETY 2010 PATIENT SAFETY INITIATIVES • Safe Surgery Checklist use August 2010 : • Used to intervene on the missing surgical processes, identifying risk factors, prepare patients accordingly. • To monitor and reduce morbidity and mortality through preoperative risk assessment. Piloted in UCMB hospitals : Kisubi, Nsambya, Virika, Nkozi, buluba,  

6. ERROR REPORTING AT WARD BY STAFF + SUMMARY BY IN-CHARGE AT DEPARTMENTAL LEVEL In-charge give a report to the chairperson Q&S and ward Staff CHAIRMAN COMMITTEE RECEIVES REPORTS (ANALYSIS AND DISCUSSION) AND PREPARES REPORT FOR MANAGEMENT MANAGEMENT RECEIVE REPORTS (FOR ANALYSIS AND DISCUSSION) IN- CHARGES HOLD MONTHLY MEETING TO DO ANALYSIS AND DISCUSS QUARTERLY CME / FEED BACK TO/FOR STAFF STAFF RECEIVE REPORT FROM THE IN- CHARGE IN ADDITION TO THE DAILY CLINICAL REPORT PATIENT SAFETY Incident reporting flow chart : case of Buluba Hospital

7. PATIENT SAFETY THE PROGRESS - COMPLIANCE • SAFE SURGERY CHECKLIST USE: • Total of 500 checklists per hospital were left behind for use. • The progress assessment indicated that 3 hospitals Buluba, Kisubi, Nkozi utilized the all checklist and were found useful. • Incompleteness was a major problem during the use of the checklist. • INCIDENT REPORT AND INVESTIGATION: • Total of 15 reporting books (with 100 forms) were given out hospital . • A total number of 128 incident reports / forms were submitted in period covering September 2010 to March 2011, from four hospitals (Buluba had not used the forms at all). • Most of the forms (98% of them) were submitted by the nurses and less by the Physicians.

8. QUALITY AND PATIENT SAFETY IMPROVEMENT TOOL / APPROACH & LESSONS LEARNT Root Cause analysis Approach Lessons Learnt: Reporting errors / incidents is possible. Nurses are more compliant than physicians Workload - Incompleteness of the forms Inadequate staff and attritions affect the institutionalisation and continuity of the quality But there is need for: Continuous Sensitisation Formalise inductions process Supportive leadership Change / strengthen safety culture System thinking – non punitive FISHBORNE

9. Quality Measurement UCMB MEASUREMENT GUIDE 2005 Indicators Maternal mortality death rate after admission in the hospital and know to be alive Fresh still birth rate Recovery rate on discharge Infection rate in caesarean section Patient satisfaction rate Drug prescription practices Proportional of clinically qualified staff. Seven Proxy indicators 1 input indicator ( structure input) 5 clinical indicators ( process of care) 1 outcome indicator • MEASUREMENT IS SPEARHEADED ANNUALLY BY THE HOSPITAL MANAGERS AND DIOCESAN HEALTH COORDINATORS • (THE DHCs ASSESS THE LOWER LEVEL UNITS QUALITY PERFORMANCE).

10. Quality Measurement Seven Proxy indicators

11. PATIENT INVOLVEMENT 2004 -2011

12. PATIENT INVOLVMENT Ensuring patient satisfaction through Patient experience’s Survey in Health Facilities ( All) Annual Patient Satisfaction • ADDRESSING FIVE ASPECT S • Clinical Effectiveness and outcomes • Humanity of care • Organisation of care ( WAITING TIME) • Environment • Overall impression

13. LEADERSHIP – GOVERNING SYSTEM • UCMB QUALITY AND SAFETY COMMITTEE 2010 • ACCREDITATION PROGRAM • SURVEY AND TRAINING • GUIDING DOCUMENTS

14. QUALITY ASSURANCE Strong Leadership – Governing System

15. QUALITY ASSURANCE UCMB QUALITY and SAFETY COMMITTEE 2010 Strong Leadership – Governing System

16. QUALITY ASSURANCE ACCREDITATION PROGRAM 2003-2011 Standards during Manager TWS: Hospitals, Lower Level Units , Health Training institution

17. QUALITY ASSURANCE SURVEY AND TRAINING • MHCP SURVEY EMOC SURVEY

18. SURVEY AND TRAINING Trainings: • Quality and Patient safety training into health service management • Clinical Mentor Training • Up-coming Module for use in-service and pre-service ( quality and patient safety Collaboration • Uganda Martyrs University • Nsambya Health Training School • Health Training Institutions

19. QUALITY ASSURANCE GUIDING DOCUMENTS

20. THANK YOU Monicah Luwedde Quality and Patient Safety Coordinator Uganda Catholic medical Bureau (UCMB) mluwedde@ucmb.co.ug +257 772 677 042