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Quality improvement ISO experience IN EAG STATES. National Health Systems Resource Centre (NHSRC), New Delhi. PILOT PROJECT IN EAG STATES.
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Quality improvementISO experience IN EAG STATES National Health Systems Resource Centre (NHSRC), New Delhi
PILOT PROJECT IN EAG STATES • In line with the objectives of NRHM to enhance quality of services in Govt. Hospitals and strengthen Indian Public Health (IPHS),NHSRC took up a pilot project for improving the quality of services at one district hospital each in eight EAG states respectively • Ministry of Health &Family Welfare sent a request letter to all eight EAG states respectively to select one district hospital for the project. • The selection of the district hospital was done by the state authorities.
Project Objective • To facilitate quality improvement as applicable to public health facilities based on : • participatory management, • patient’s perception • rational utilisation of untied funds • equity and access • To hand hold the health care facility on site • through continued presence of competent personnel duly supported by other experts, • towards achievement of prevailing ISO 9001 standards and to sustain it.
Methodology • Detailed Organisational Survey for “As- Is” study • Gap Analysis: mainly against the IPHS & other allied standards • Action planning to traverse gaps • Documenting processes • Providing Training/ Building Capacity • Implementations of process and protocols • Evaluation
Need for Technical support partners • Service of technical support team was obtained for each hospital who provided :- • Personnel and know-how for “as-is” survey, for action planning, for continued handholding on site, and for supervision. • Development of training and advocacy materials: Audio Visual aids, print materials for all participants/ employees. Implementing Customised training . • Materials for quality system documentation: for distribution amongst all document holders
Action Planning • Gaps Identified and Categorized: • Gaps where local action was required • Gaps where district administration’s action was required • Gaps where Higher level intervention is required
GAPS • Categories of Gaps by theme :-
Gap Category 1-Safety Security & Dignity Patient’s privacy during general/internal examination in OPD remains compromised
Gap Category 2-Regulatory Requirement X ray machines are operating without Atomic Energy Regulatory Board(AERB) clearance
Gap Category 3- Administrative Process Below Poverty Line (BPL) status verification process causes inconvenience to BPL patients
Gap Category 3- Administrative Process Number of patients admitted is more than the sanctioned bed strength Beds placed in the hospital corridors to accommodate a patients beyond sanctioned bed strength Crowded IPD Area because of insufficient bed strength of the hospital
Gap Category 4-Clinical Process While it is ensured that injections are given to the patients, no practice exists to ascertain that admitted patients have actually consumed oral medicines
Gap Category 4-Clinical Process Absence of Blood Bank or Storage Unit But we have no blood bank or storage facility. Will have to arrange it from another hospital, and that will take some time Quick! There is a case of severe postpartum haemorrhage. We need to transfuse blood immediately
Gap Category 5-Support Process Common food is served to patients irrespective of their needs. No special provision is made for patients with special conditions like diarrhea, diabetes, hypertension etc.
Gap Category 5-Support Process Rodents create a nuisance and cause damage to equipment wires and kitchen food.
Gap Category 6- Human Resources The Cycle time of testing and reporting for common tests exceeds one day
Gap Category 7 -Infrastructure Seepage problem in the walls of the OT, wards, and other sections of the hospital building
Gap Category 8 -RCH While 80% of newborns at the District Hospitals receive the 1st dose of vaccination, only 14% of the children complete their immunization. There is no system to trace the progress of vaccination in the remaining newborns
Gap Category 8 -RCH Inability of most registered pregnant women to complete the three ANCs and receive treatment for severe anaemia. In addition, only 28% of registered mothers receive two doses of Tetanus Toxoid.
Gap Category 9 - TOOLS TACKLE EQUIPMENT Clinical skills are available in one of the hospitals, but support equipment to make full use of these skills is not
I. GAPS WHERE LOCAL ACTION WAS REQUIRED • The action plan was developed with the name of responsible person and timelines for addressing the gap • Review of progress was done on a regular basis • Majority of the gaps could be addressed at facility level. • Untied funds was used for this purpose
II. THOSE GAPS WHERE DISTRICT ADMINISTRATION’s ACTION WAS REQUIRED • The issues were collated and were discussed during RKS meeting • The review of such issues was in the early stages done once a month during RKS Meeting. Later, spontaneously meeting frequency increased at much higher frequency • Use of RKS Funds and mobilization of funds from other District schemes
III. Those gaps where Higher level intervention WAS required • NHSRC coordinated the process of gap filling which required state directorate support . Several meetings were held with Director, Mission Director and secretary besides other officials in the States where Project was undertaken • Most of the issues at this level had either financials or policy related implications. • This role has to be continued by SHSRC/ State level Support arrangements
Gaps which needed State Support • Human resource shortage • Infrastructural development • Blood Bank and blood storage facility • Procurement of Drugs, Equipment and Consumables . • AMC for maintenance of equipments • Mobilizing Engineering wing for building maintenance • State guidelines for outsourcing services like cleaning, security, laundry, kitchen ,supplementary power supply, Ambulance services, pest control services
UTILIZATION OF SERVICES – No of sterilization & JSY beneficiary
