SDC Health Network Face 2 Face: Morges Apr 2014 Peter Campbell MBBS, MSc peterinwork@gmail.com

1. How to improve, strengthen and sustain the quality of Primary Health Care Are we sure we know the basics? SDC Health Network Face 2 Face: Morges Apr 2014 Peter Campbell MBBS, MSc peterinwork@gmail.com

2. “It is not enough to do your best… you have to know what to do, and then do your best”.

3. Before we begin… • I don’t expect you to believe • but would be glad if you begin to understand • At heart, I am an idealist • Counting numbers is good: interpretation is everything • Today’s talk is only an introduction…

4. Trends • Quality Improvement (QI) initiatives • Performance Based Financing (PBF) used to improve quality

5. http://siteresources.worldbank.org/EXTPBFTOOLKIT/Images/PBF_map.jpgRapid Expansion of PBF Programs in Africa between 2006 and 2013 • ..in 2013, 3 nationwide country programs, • 17 countries with ongoing pilots. • 6 countries are in the advanced planning stage, • PBF initiatives are being discussed in 9 countries.

6. From: Rewards for Good Performance or Results: A Short Glossary*BY PHILIP MUSGROVE: March 2011: World Bank

7. From a World Bank mission document: Jan 2014 • For every performance indicator, • an annual target goal will be defined in the performance agreements. • For example, if the indicator is increase in proportion of Antenatal Care (ANC) clients who received their first ANC visit in the first trimester, • the target for one area* may be 70 %, • whereas the target for a second area may be 85 %. • The performance goals will target improvements in quality and coverage of under-used services, • with performance goals increasing in difficulty level over time *italics= adjusted wording

8. Do targets improved Quality?

9. Story of the former- Soviet Union • Father of Quality: No numerical Targets !!

10. A “Tale of 4 Hours”

11. Macchiato anyone?

13. South East UK • http://www.telegraph.co.uk/health/8918796/Hospital-guide-compare-your-hospitals-performance.html Bad NormalGood

15. Why are results important? • Another Way

16. Back to our “Tale of 4 hours”

17. Have the origins of Quality Improvement been forgotten? • The discovery of an NBC News team

18. Is there a simple definition of Quality and how to achieve it? • Quality is joy of workmanship

19. Reward • No Reward Input/Structure- Process –Output – Outcome- Impact Results

20. Learn • Reward • No Reward Input/Structure- Process –Output – Outcome- Impact Results

21. Act Input/Structure-Process –Output – Outcome- Impact Results Plan Do Study

28. As we end … • I don’t expect you to believe • but would be glad if you begin to understand • At heart, I am still an idealist • Counting numbers is good: interpretation is everything • Today’s talk is only an introduction…

29. Thanks for understanding…. peterinwork@gmail.com

30. If there’s time:

31. http://ffemagazine.com/german-study-shows-alarming-trend-hospital-deaths/German study shows alarming trend in hospital Deaths22 January 2014 at 07:01:22 AM

32. A new German study released on Tuesday revealed that around 20,000 Germans die each year due to medical errors. • According to …AOK, of the 18.6 million patients that visit hospitals and clinics each year, 190,000 report mistakes in their treatment. A further 10% of these also lead to deaths. … • The Society of German Hospitals (DKG) however said that errors are not the result of bad jobs • but organisational problems and complicated procedures. • DKG CEO Georg Baum stressed that the safety standards in German hospitals are high by international comparisons • and that ‘Readiness to keep improving quality and safety has never been greater.’

33. CDU federal Health minister Hermann Gröhe proposed to institute a feedback table • that collects data from patients on the quality of treatment they receive. • The idea is to see which hospitals score poorly • and have to be punished by funding cuts.