Quality Assurance Orientation Program

1. Quality Assurance Orientation Program Quality Assurance Cell, State Health Society, Bihar

2. Quality Ability of service to satisfy the needs & expectation of users & to meet the purpose for which it is designed. • Appraisal of healthcare facility & services in terms of – • core healthcare services. • safety & hygiene. • comfortable atmosphere. • facilitation when a healthcare seeker visits. • Ambience.

3. Perception of Quality Quality may mean different things to different people. • For poor people - Quality in health services means accessibility and availability of services when in need at minimum cost. • For services provider - Quality means timely availability of services with minimum infection rate. • For community as whole- Quality means availability, accessibility, affordability with positive impact in the environment. • For state - Quality means ensuring health care services which is based on the concept of equity, which makes services available, accessible, affordable, and high level of infection control.

4. Quality Management System • It is an approach which encourages health facilities to analyze the requirement of service user, define the processes and keep the processes under control for consistency. • Identify the gaps in service delivery, trace its root causes & then suggests solution to close this gaps so that its effect is sustainable. • Corrective & preventive measures - Regular review of actions taken & result so that the problem doesn’t occurs again & again, it plans & implement system so that whenever gap emerges it gets resolve at the point of emergence.

5. ANY SUSTAINABLE CHANGE IN TERMS OF INSTITUTIONALISATION OF QUALITY ASSURANCE (QA) WILL COME FROM WITHIN THE SYSTEM & NOT FROM OUTSIDE. “ITS WE WHO CAN IMPROVE THE QUALITY TO OUR SYSTEM”

6. Why is quality needed in healthcare system Quality in healthcare is not a matter of choice, it is mandatory, as it can cost life. • Benefit users by ensuring quality of service provision. • Ensure efficient utilization of resources. • Provide for transparency and accountability in the functioning of the healthcare system. • Generate a sense of pride and achievement for the health care providers.

7. Quality: Is a continuous process that has to be sustained for continual improvement.

8. State’s focus Area in Quality Assurance • Formation, orientation & regular (monthly) meetings of QA committee. (For FY 2012-13 FMR code :- B.15.2) • Hospital level quality improvement as per standards. (For FY 2012-13 FMR code :- B.15.2+ RKS, Hospital maintenance grant,untied fund, MCH/FP funds,etc.) • Quality certification of hospitals • Qualitative operationalization of Facility Based Newborn Care Units (NBCC/NBSU/SCNU) {For FY 2012-13 FMR code :- A.2.2.2}; labour rooms,, Family Planning Corner (FP Corner) • Death review – Especially maternal deaths

9. QUALITY ASSURANCE COMMITEE -COMPOSITION, ROLES & RESPONSIBILITIES

10. State Quality Assurance Committee (Chairperson - Principle secretary – Health, Co-chairperson – Executive Director, SHSB) • State Quality Assurance Cell:- • QA Nodal Officer • Consultant –MCH – QA • Consultant –FP – QA • Quality Assurance Manager Formation & strengthening of Quality Assurance Committees Nodal Person - Regional Program Manager. Supported by R (M&E) Regional Quality Assurance Committee (Chairperson – Regional Deputy Director) Nodal Person - District Program Manager. Supported by DPC District Quality Assurance Committee (Chairperson – Civil Surgeon) Nodal Person - Dy. Superintendent /MOIC. Supported by Hospital Manager / Health Manager Facility level Quality Improvement Group

11. Regional Quality Assurance Committee Functions of RQAC :- • Monitoring of health facilities & guiding the District level teams on development of processing for ensuring quality health care services from that facility. • Ensuring adherence of treatment protocols on public health management and to ensure delivery of quality health care services focusing more on the medical colleges, district Hospital and FRUs. • Planning, controlling, management of the medical staff, demography and bio-statistic, management of research in health care, epidemiology and community health and strategic management. • Ensuring proper functioning of the Hospital Management information system and will also ensures and monitor the maintenance of the medical records, as prescribed. • Management of health and related services within the medical colleges/hospital premises to achieve optimal care by providing staff with managerial leadership, experts advice and opinion to aid diagnosis, management and treatment of patients • To provide quality of care through the monitoring and evaluation of services, development of protocols, supervision of staff and continuing education • Review the cases of maternal & infant deaths and report from cases of adverse outcomes/complications in maternal, neonatal health & child health. • To provide technical inputs to the medical colleges/District Hospital/FRUs within the division for improving their functioning.

12. {ks=h; xq.koÙkk ;dhuuksMyvkWfQlj & {ks=h; dk;ZØeizca/kdAdk;ksZdslle; fu"iknuesa {ks=h; M & E HkhmÙkjnk;hgksaxsA {ks=h; xq.koÙkk ;dhuuksMyvkWfQljdsdk;Z ,oaftEesnkfj;kW %& fu;ferRQACdkcSBd le; lslqfuf’prdjuk@djokukAcSBd dh dk;ZokghlssizeaMydslHkhftyksavkSjjkT; LokLF; lfefrdksvoxrdjuk@djokukA • {ks=h; xq.koÙkk ;dhulfefr dh xfrfof/k;k¡ ;kstukdsvuqlkjlle; fu"iknudjuk@djokukAbldsvfrfjDrfdlhHkhizdkjdsQA need based activity dksdjokukA • ftykxq.koÙkk ;dhulfefr(DQAC) dh ekfldcSBdfu;ferdjokusgsrqvko’;ddnemBkukA • ftykxq.koÙkk ;dhulfefr(DQAC) dksvko’;drkuqlkjrduhdhlg;ksxiznkudjukA • izeaMyvarxZrlHkhftyksaesapyjgsxq.koÙkk ;dhudk;ZØeksa dh izxfrdki;Zos{k.kfujh{k.kdjuk@djokukrFkklle; vuqikyulqfuf’prdjokukA • vLirkyksadksFFHI, ISO, bR;kfnizek.khdj.kdsfy, fuf’pr le; lhekdsvanjrS;kjdjokukA • xq.koÙkklq/kkjdk;ZØeksa dh izxfrgsrqjkT; o ftykLrjdslkFkliasioningdjrsgq, HkkSfrd ,oafoÙkh; izxfrdkslqfuf’prdjokukA • izxfrizfrosnudks ¼izk:i esa½ fu;fer :IklsjkT; LokLF; lfefrdksHkstukA • jkT; ds }kjk le;≤ ijekaxhxbZtkudkfj;ksa ;k funsZ’kksdklle; vuqikyudjuk@djokukA

13. District Quality Assurance Committee • Functions of DQAC:- • Meet once every month. • Develop half yearly action plan of district for quality assurance intervention in the facilities (Based on facility wise planning for infrastructure strengthening and strengthening of services at the facility). • Provide technical and managerial guidance to blocks on the implementation of action plan for improving the quality of services in the facilities disease control programme service delivery in the state. • Monitor the Quality Improvement of programme and track progress based on identified quality indicators at each level e.g. Sub Centres, PHCs, SDHs, District Hospitals and Medical College. Also keep a check whether the facilities are providing the essential service package as per standards and protocols being adhered to. • Review the cases of maternal & infant deaths at facility level and report cases of adverse outcomes/complications. • Collecting information on all hospitalization cases related to complications following sterilization as well as sterilization failure. • Processing all cases of failure, complications requiring hospitalization, and deaths following sterilization for payment of compensation. • Reviewing all static institutions, i.e. government and accredited private / NGOs and selected camps providing sterilization services and safe abortion services, for quality of care as per the standards laid down, and recommending remedial action for institutions not adhering to the standards.

14. Cont…. • Conducting medical audits from time to time of all maternal & infant deaths and deaths related to sterilization and sending reports to the State QAC office. • Review & monitor the quality of trainings under RHC II/National disease control programmes organized at state & district level and undertake follow-up of selected sample of trainees during field visits. • Review of different community based interventions, implementation of schemes under MNCH. • Plans QAC visits and make necessary preparations for visit to facilities and use the standardized QA Checklists to conduct assessment and debriefs the Medical Officer In-charge of the facility with guidance on what actions needs to be taken. • Compiles findings during the visits at the district level and distributes the District Summary Report and discusses these at the monthly meeting with medical officers. Forward the minutes of the monthly QAC meeting and actions to be taken to the concerned officials; regional and state QAC. • Shares the district visit reports with State Committee on monthly basis and initiates actions based on recommendations from state committee. To address the state level actions, the district has to take the initiation and pursue the state authorities and follow-up. • Keeps a record of follow-up and actions taken so that these can be reviewed on subsequent visits to the facility. • Ensure empanelment of doctors at district level performing sterilization operations & maintain / update their databases.

15. ftykxq.koÙkk ;dhuuksMyvkWfQlj & ftykdk;ZØeizca/kdAdk;ksZdslle; fu"iknuesa DPC HkhmÙkjnk;hgksaxsA ftykxq.koÙkk ;dhuuksMyvkWfQljdsdk;Z ,oaftEesnkfj;k¡ %& • ftykxq.koÙkk ;dhulfefrdscSBddksflfoyltZu dh v/;{krkesaizR;sdekgdjokuk( cSBdesavLirkyksadsxq.koÙkk ;dhulslacaf/krfy;sx;sfu.kZ;ksalslHkhvLirkyksadsDS/MOIC dksvoxrdjokukA • ftykxq.koÙkk ;dhulfefr dh xfrfof/k;ksads ;kstukuqlkjlle; fu"iknulqfuf’prdjokukAbldsvfrfjDrfdlhHkhizdkjdsQA need based activitydksdjokukA • ftykvarxZrlHkhp;furvLirkyksa ¼ISO, FFHI, bR;kfn½ esapyjgsdk;ksZa dh izxfrdki;Zos{k.kfujh{k.kdjuk@djokukrFkklle; vuqikyulqfuf’prdjokukA • buds vfrfjDrftysdsvU; lHkhvLirkyksa(PHC, SDH, RM, DM)esaxq.koÙkklq/kkjdk;ZØedksykxwdjusdsfy, ;kstukc} rjhdslsvisioning cum gap analysis exercisedjokuk] action plancuokukrFkkmldsvuq:Ikdk;Zdjokuk A • vLirkyksadksFFHI, ISO,bR;kfnizek.khdj.kdsfy, fuf’pr le; lhekdsvanjrS;kjdjokukA le;≤ ijVhexBudjvLirkyksadsxq.koÙkkizxfrdkewY;kadudjkukA • xq.koÙkklq/kkjdk;ZØeksa dh izxfrgsrqjkT; o {ks=h; LrjdslkFkliasioningdjrsgq, HkkSfrd ,oafoÙkh; izxfrdkslqfuf’prdjokukA • lHkhvLirkyksalsizkIrizxfrizfrosnudkslayXudjftykLrjdsizxfrizfrosnudslkFkjkT; dksrFkkmldhizfrfyfi {ks=h; LrjijmiyC/k djkukAlkFkghvLirkyksadsxq.koÙkklq/kkjlacaf/krQksVks] documentary, testimonialbR;kfn le;≤ ijjkT; dksmiyC/k djokukA • jkT; ds }kjk le;≤ ijekaxhxbZtkudkfj;ksa ;k funsZ’kksdklle; vuqikyudjuk@djokukA

16. ftykxq.koÙkk ;dhuuksMyvkWfQlj & ftykdk;ZØeizca/kdAdk;ksZdslle; fu"iknuesa DPC HkhmÙkjnk;hgksaxsA ftykxq.koÙkk ;dhuuksMyvkWfQljdsdk;Z ,oaftEesnkfj;k¡ %& • ftykxq.koÙkk ;dhulfefrdscSBddksflfoyltZu dh v/;{krkesaizR;sdekgdjokuk( cSBdesavLirkyksadsxq.koÙkk ;dhulslacaf/krfy;sx;sfu.kZ;ksalslHkhvLirkyksadsDS/MOIC dksvoxrdjokukA • ftykxq.koÙkk ;dhulfefr dh xfrfof/k;ksads ;kstukuqlkjlle; fu"iknulqfuf’prdjokukAbldsvfrfjDrfdlhHkhizdkjdsQA need based activitydksdjokukA • ftykvarxZrlHkhp;furvLirkyksa ¼ISO, FFHI, bR;kfn½ esapyjgsdk;ksZa dh izxfrdki;Zos{k.kfujh{k.kdjuk@djokukrFkklle; vuqikyulqfuf’prdjokukA • buds vfrfjDrftysdsvU; lHkhvLirkyksa(PHC, SDH, RM, DM)esaxq.koÙkklq/kkjdk;ZØedksykxwdjusdsfy, ;kstukc} rjhdslsvisioning cum gap analysis exercisedjokuk] action plancuokukrFkkmldsvuq:Ikdk;Zdjokuk A • vLirkyksadksFFHI, ISO,bR;kfnizek.khdj.kdsfy, fuf’pr le; lhekdsvanjrS;kjdjokukA le;≤ ijVhexBudjvLirkyksadsxq.koÙkkizxfrdkewY;kadudjkukA • xq.koÙkklq/kkjdk;ZØeksa dh izxfrgsrqjkT; o {ks=h; LrjdslkFkliasioningdjrsgq, HkkSfrd ,oafoÙkh; izxfrdkslqfuf’prdjokukA • lHkhvLirkyksalsizkIrizxfrizfrosnudkslayXudjftykLrjdsizxfrizfrosnudslkFkjkT; dksrFkkmldhizfrfyfi {ks=h; LrjijmiyC/k djkukAlkFkghvLirkyksadsxq.koÙkklq/kkjlacaf/krQksVks] documentary, testimonialbR;kfn le;≤ ijjkT; dksmiyC/k djokukA • jkT; ds }kjk le;≤ ijekaxhxbZtkudkfj;ksa ;k funsZ’kksdklle; vuqikyudjuk@djokukA

17. vLirkyxq.koÙkk ;dhuuksMyvkWfQlj & vLirky v/kh{kd@izHkkjhfpfdRlkinkf/kdkjhA dk;ksZdslle; fu"iknuesavLirkyizca/kd@LokLF; izca/kdHkhmÙkjnk;hgksaxsA • vLirkyxq.koÙkk ;dhuuksMyvkWfQljdsdk;Z ,oaftEesnkfj;kW %& • vLirkyLrjij ,d xq.koÙkklq/kkjlfefrdkxBuDS/MOIC dh v/;{krkesadjuk@djokukftlesavLirkydsinkf/kdkjh@dfeZ;kas (MO/HM/ANM/Nurses/BAM/LT/VI grade Staff representativebR;kfn) dh HkhHkkxhnkjhgksA • xq.koÙkklq/kkjlfefr dh cSBdizR;sdekgdjuk@djokukrFkkfy, x, fu.kZ;ksalsftyksadksvoxrdjkukA • vLirkylq/kkjgsrqxfrfof/k;ksads ;kstukuqlkjdk;ksZadklle; fu"iknudjuk@djokukrFkkvuqikyuizfrosnulayXuizk:IkesaizR;sdekgftyksadksmiyC/k djkukA • izR;sd =SeklGap Analysis Report dh leh{kkdjukrFkkmldksv|rudjuk@djokukA • vLirkydksFFHI/ISO,bR;kfndsfy, rS;kjdjokukA

18. HOSPITAL QUALITY IMPROVEMENT & CERTIFICATION

19. Approaches for Establishment of QMS in Hospital Implementation, Training/capacity building, Report compilation & timely reporting Visioning, Gap Analysis, Action Plan Development, SOPs, availability of standard documents & guidelines PLAN DO Quality service & better Environment for patient Quality certificate to hospital ACT CHECK Progress monitoring, review of developed action plan, Lags & lacunas in implementation of affecting final outcome Corrective & preventive action; redesigning of plans & system etc

20. Process of FFHI In Facility Meeting by Hospital Quality Improvement Group • Team building -Formation of Hospital Quality Improvement Group • Visioning Exercise & Problem Bank creation. • Vision statement of health facility / Quality statement. • Gap analysis • Action Plan Development with Time frame (Prioritizing the gaps, level at which gaps would be addressed, resources/FMR source, responsible person,etc) • Monthly Hospital Quality Improvement Group and RKS meetings for approval of work and associate line department. • Implementation of Plan according to activity plan. • Indicator development. • Monitoring & check. • Apprise District QAC on the processes & progress. • Once facility is ready it may apply to DQAC for certification. Hospital staff Independent assessment and certification

21. Diagrammatic representation for facility assessment and certification process Process of certification State Certification Body Submit report with recommendation or non-recommendation for certification visit Conduct certification Visit & award quality certificate State Quality Assurance Committee (SQAC) Forward request to -conduct assessment Submit final reports for -conducting certification visits Check readiness of facility and request for assessment • Regional level Assessment team (RQAC + any nominated member) Check readiness of facility and request for assessment District Quality Assurance Committee (DQAC) Apply for certification • Public Health Facility

22. PHOTO GALLERY- QUALITY ASSURANCE

23. SDH, Sherghati

24. PHC, Uchkagaon, Gopalganj

25. SDH, Danapur

26. Sadar Hospital, Aurangabad

27. Quality Poiicy Doctor list OT Duty roaster; sitting arrangement at OPD

28. Thanks.