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Module 3 Improving Quality

Module 3 Improving Quality. Quality Improvement. QI is achieving the best possible results with the available resources

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Module 3 Improving Quality

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  1. Module 3 Improving Quality

  2. Quality Improvement • QI is achieving the best possible results with the available resources • Includes any activities or processes that are designed to improve acceptability and effectiveness of service delivery and contribute to better health outcomes as an on-going and continuous process

  3. What do we mean by best possible results • Meeting standards • Meeting targets – compliance with norms and standards • Reliable implementation of best practice guidelines

  4. Tools for quality improvement

  5. Process mapping

  6. Process mapping • Flow diagram – visual tool • Care pathway is a good example • Looks at a series of activities in order to identify gaps – barriers, bottle necks, duplication of effort, waste, unnecessary steps • Must reflect reality – not what you want!

  7. The five steps for PMCT care 5 4 2 Infant gets NVP at birth and then daily for 6 weeks HIV+ Rapid referral for HAART: Start FDC CD4 >350 and no breastfeeding stop CD4<350 continue FDC 1 P C R @ 6 weeks Counsel Test for HIV Late bookings status unknown test status HIV + HIV – Retest every 6 weeks 3

  8. Case - study: Example flowchart Post natal care PP problems BF and HE etc Mother to be arrives No Delivery care Yes Reception to midwife Discharge procedures App care Yes Serial examinations Examination by midwife No Discharge Monitoring of labour Referral Adapted from USAID Health Care Improvement Project

  9. From National and Provincial sources and individuals and media May be received by: Health Care Institutions, National or Provincial structures COMPLAINT RECEIVED COMPLAINT RECORDED AND CODED By complaints manager Within 3 working days of receipt by complaints manager or provincial office if received there COMPLAINT ACKNOWLEDGED Institutional complaints committee set terms of reference, appoints investigator & suggests process INVESTIGATION COMMENCED Within 5 working days of receipt of complaint By institutional complaints committee unless delegated to complaints manager RESPONSE TO COMPLAINANT Within 12 working days of receipt of complaint Referral within 14 working days of receipt of complaint to SAEC or other relevant structure As decided by Instit. Complaints Committee e.g. closure of case, changes in systems, training, purchase of equipment etc. REMEDIAL ACTION REFERRAL TO OTHER STRUCTURE Information on all complaints entered into data base and sent to Region by 5th of every month. Regions to QAD by 12th day of month in requiredquarter COLLATING DATA On institutional, regional and central level ANALYSIS AND FEEDBACK To SMS & institutional managers each quarter This document must be read together with the policy guidelines for the management of complaints

  10. Root cause analysis

  11. Understanding the root cause of problems • Once you have identified your problem – need to explore under-lying causes • Root cause analysis • Cause and effect diagram • Five why’s

  12. Action plan

  13. PDSA Cycle

  14. How do you eat an elephant?

  15. Start small to end big

  16. The model for improvement What are we trying to accomplish? How we will know that a change is an improvement? What change can we make that will result in an improvement? PLAN ACT STUDY DO Langley, Nolan, Nolan, Norman & Provost 1999

  17. The only man who behave sensibly was my tailor; he took my measurement anew every time he saw me, while all the rest went with their old measurements and expect them to fit me. (George Bernard Shaw)

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