0
Shirley B. Domingo, MD, MPH        Vice President      PRO NCR & Rizal                       1
“ The Noblest Search is the   Search for Excellence.”     Lyndon B. Johnson
Legal Mandate• R.A. 7875 (as amended by R.A. 9241) Sec. 37. Quality  Assurance  …health care providers shall take part in ...
4                                            Coverage Accreditation                                     Premiums          ...
Minimal threshold standards  Inspection - “find what’s wrong”           Focus on inputsImprovement of Process and Outcomes...
Rationale for Benchbook Standards• Legal mandate• Existing standards do not promote quality improvement culture among  hos...
Relative Performance of Government and Private             Government    Hospitals       PrivateLeadership and ManagementM...
Government vs Private
National Performance
Implementing a Quality Assurance Program•   Accreditation•   HTA•   Peer Review•   Feedback Mechanism•   Performance Monit...
Providers being accredited by PhilHealth:• Professionals         • Institutions                           – Hospitals   – ...
14
Performance Area   Standards   Criteria   Indicators      Core                      n=78     n=141        n=239      Indic...
Benchbook Awards
Patient Rights & Organizational            EthicsGoal:•   To improve patient outcomes by respecting patients’ rights and  ...
Patient CareGoals:•   The organization is accessible to the community that it aims to serve•   The entry processes meet pa...
Patient CareGoals:•   Comprehensive assessment of every patient enables the planning    and delivery of patient care•   Th...
Patient CareGoals:• The health care team routinely and systematically evaluates and  improves the effectiveness and effici...
Leadership & ManagementGoals:• The organization is effectively and efficiently governed and  managed according to its valu...
Human Resource ManagementGoals:•   The organization provides the right number and mix of    competent staff to meet the ne...
Human Resource ManagementGoals:•   Recruitment , selection and appointment of staff comply with    statutory requirements ...
Information ManagementGoals:• Collection and aggregation of data are done for  patient care, management of services, educa...
Safe Practice & EnvironmentGoals:•   Patients, staff and other individuals within the organization are    provided a safe,...
Safe Practice & EnvironmentGoals:• Risks of acquisition and transmission of infections among  patients, employees, physici...
Safe Practice & EnvironmentGoals:• The organization demonstrates its commitment to  environmental issues by considering an...
Improving PerformanceGoals:• The organization continuously and systematically  improves its performance by invariably doin...
Benchbook Self-Assessment  Process & Accreditation                            29
Minimum Requirement for Accreditation         Compliance to 100% of CORE indicators         ANDCenter   60% Compliance to ...
Compliance to 100% of CORE indicators          AND          75% Compliance to each of the following:            •Patient’s...
Compliance to 100% of CORE indicators             ANDCenter of             90% Compliance to each of the 7Excellence      ...
What if we cannot meet the minimum requirements?                Compliance to 70% of CORE indicators AND                50...
Frequently hard to comply indicators/ evidences1.   Patient’s Rights and Organizational Ethics•    Per validation, patient...
Frequently hard to comply indicators/ evidences1.       Patient’s Rights and Organizational Ethics•        Policies and pr...
Frequently hard to comply indicators/ evidences1.   Patient Care•    Policies and procedures on patient waiting time•    M...
Frequently hard to comply indicators/ evidences1.   Patient Care•    Comprehensive history and PE within 24 hours from adm...
Frequently hard to comply indicators/ evidences1.   Patient Care•    Policies and procedures on implementation/compliance ...
Frequently hard to comply indicators/ evidences1.   Patient Care•    Policies and procedures regarding selection and procu...
Frequently hard to comply indicators/ evidences1.   Leadership and Management•    Analysis, conclusion and recommendation ...
Frequently hard to comply indicators/ evidences1.   Safe Practice and Environment•    Not all operating manuals of equipme...
Frequently hard to comply indicators/ evidences1.   Safe Practice and Environment•    Procurement policy and plan for equi...
Frequently hard to comply indicators/ evidences1.   Improving Performance•    Presence, Implementation and evaluation of q...
Feedback and Experiences during hospital surveyPositive•     Hospitals appreciate standards set by Benchbook, standards ar...
Accreditation Reforms• Third Party Accreditation   – Delegate accreditation functions exclusive of the decision-     makin...
New Accreditation Schemes• Strong collaboration with Licensing of the DOH      - Core indicators to be adopted by licensin...
“Excellent firms don’t believe in  excellence- only in constant   improvement and constant             change.”           ...
48
WARRANTIES OF ACCREDITATIONRepresentation of eligibilitiesCompliance to pertinent laws/rules &regulations/policies/admin...
Benchbook Indicators• Developed through consultative meetings• Stakeholders suggested indicators for each standard  and cr...
How does Benchbook measure against the       principles underlying ISQua Standards?•   Leadership through effective planni...
Trends of Health Expenditure                                     by Source of Funds                   100,000             ...
Quality Dimensions•   Safety•   Efficiency•   Appropriateness•   Accessibility•   Effectiveness•   Consumer Participation
Warranties of Accreditation, Institutions    they recognize the authority of PhilHealth to any inspection or    investiga...
The Quality Problem is Large                                                                                              ...
Legal Mandate• IRR Rule IX, PhilHealth shall… – Implement a Quality Assurance Program applicable   to all Health Care Prov...
PhilHealth’s MissionTo ensure adequate financial access of  every Filipino to QUALITY HEALTH  SERVICES through the effecti...
Minimal threshold standards  Inspection - “find what’s wrong”           Focus on inputsImprovement of Process and Outcomes...
Calls for improvement of  systems and processes,    focuses on customer orientation, collection and  assessment of relevan...
History of the Benchbook                  StandardsBenchbook      Requirement      Full              2nd year ofon        ...
7 Areas of Benchbook Standards•   Patient Rights and Organizational Ethics•   Patient Care•   Leadership and Management•  ...
Commitment to QualityBegins with management …    • ensures support for the deployment of      activities    • it is up to ...
Benchbook Awards
Relative Performance of Government and Private             Government    Hospitals       PrivateLeadership and ManagementM...
Government vs Private
National Performance
“Excellent firms don’t believe in  excellence- only in constant   improvement and constant             change.”           ...
Background:Universal Health Bawat Pilipino miyembro,Care             Bawat miyembro protektado,                 Kalusugan ...
Streamlining of Licensure and         Accreditation• Published January 14, 2012, Philippine  Star• Effective January 29, 2...
Third Party Accreditation:COQ/               COE              Directions ImplementationRecognition of          • Recognize...
Automatic Accreditation of Government•                            HCPs    Primary Care Benefit Provider (PCB): health unit...
“Automatic Accreditation”• No more pre-accreditation survey will be  conducted by PHIC• Automatic accreditation is only fo...
Regular Process                                                EligibleRegistration   Survey   Deliberation     PC        ...
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Institutionalizing Quality standards In  Health care
Institutionalizing Quality standards In  Health care
Institutionalizing Quality standards In  Health care
Institutionalizing Quality standards In  Health care
Institutionalizing Quality standards In  Health care
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Institutionalizing Quality standards In Health care

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  • IRR Rule IX – states the objective of the QA in NHIP
  • IRR Rule IX – states the objective of the QA in NHIP
  • Data from hereon came from BPASS. These are the average percentage of compliance of ALL hospitals in the 7 performance areas. Data as of November 2010
  • The PhilHealth QA program shall ensure that the health services rendered to the members by accredited health care providers are of the quality necessary to achieve the desired health outcomes and member satisfaction. Strategies include: Accreditation Health Technology Assessment Peer review Feedback Mechanism Performance Monitoring Medical Evaluation of Claims/ PNDF
  • LASTLY, IN RESPONSE TO THE UNDYING ISSUE ON WHETHER TO POSTPONE IMPLEMENTATION OF THE BENCHBOOK SET FOR NEXT YEAR, THIS IS WHAT I HAVE TO SAY: THE STANDARDS FOR QUALITY HAS BEEN SET, PHILHEALTH THRU THE BENCHCOOK HAS INSTITUTED A MECHANISM FOR A NATIONAL IMPLEMENTATION OF THESE STANDARDS. WE HAVE PUT IN MEASURES FOR LINIENCY IN THE FIRST RUN OF IMPLEMENTATION. THE STAGE HAS BEEN SET. IN THE IMPENDING GLOBALIZATION LET US NOT HOLD ON TO THE STATUS QUO AND FAIL TO SEE A WINDOW OF OPPORTUNITY NOW IN FRONT OF US. I HOPE YOU TAKE UP THE CHALLENGE TO MAKE OUR HOSPITALS AT PAR OR EVEN BETTER THAN OTHER HOSPITALS IN THE INTERNATIONAL COMMUNITY. FOR OUR PART IN GOVERNMENT, WE PROMISE TO WORK ON WHAT RESOURCES WE HAVE AND CONTINUOUSLY IMPROVE ON THIS SYSTEM OF ACCREDITATION. PROBABLY UNTIL SUCH TIME THAT THE PRIVATE SECTOR INITIATES THE PHILIPPINE NATIONAL HEALTH ACREDITATION SYSTEM AND MAKE IT A SYSTEM THAT IS RECOGNIZED AND CREDIBLE ABROAD. A MISSION IMPOSSIBLE? PROBABLY NOT.
  • IRR Rule IX – states the objective of the QA in NHIP
  • Financing for health remains a big issue in policy discussions because of the many social ramifications the health of the population can relate to. An unhealthy population can translate into unproductive workforce. It can mean a bigger burden on the government in providing health services. All, in turn, influencing the economy of the nation. A lot depends on the proper financing of health care. At present the burden of financing falls largely on the individual’s pocket. More than 50% of the source of fund in the Total Health Expenditure came from out of pocket spending. This is a regressive if not an unfair way of paying for health care. Simply because, it means without enough personal funds to pay for your healthcare, people either just do not seek care or are “lubog sa utang” However, remains an elusive dream. Since the inception of SHI, there was a constant increase in its contribution to the National health Accounts. However, its increase remain low at around 9 – 11% of total expenditure. Why is this so?
  • Lucian Leape created this graph to show how healthcare compares: the x-axis shows the numbers of encounters per fatality…in other words, you’d have to ride a European railroad 10 million times before there was a fatality. You’d only have to bungee jump or receive healthcare 100 times to have a fatality. Also reflected on this graph is the public health burden of the activities, measured in total lives lost. Although bungee jumping is dangerous, not many people do it, so not many die, and it’s not (relatively speaking) a significant public health burden. Healthcare, on the other hand, falls in the worst place: high risk and a high public health burden because so many people die from it. 1 out of every 20 patients who enter US Hospitals develop Hospital acquired infection – that means 36 people at Hopkins are infected In US 7% at risk for medication error Joint Commission 73% of sentinel events are caused by miscommunication and problems with handoffs Referencing IOM report, 100,000 people die from preventable deaths due to the way healthcare is delivered. Going back to the IOM, The IOM has said that the patient safety problem is large: going back thousands of years, the first rule of medicine is: “first do no harm.” The problem usually isn’t the fault of the workers, and most injuries are due to systems failures. Examples: 50% of the elderly fail to receive the pneumococcal vaccine 79% of eligible heart attack survivors fail to receive beta blockers 58% of patients with depression are not detected or treated adequately Overuse : 30% of children receive excessive antibiotics for ear infections 20-50% of many surgical procedures are unnecessary 50% of x-rays in back patients are unnecessary Misuse: 44,000 – 98,000 Americans die in hospitals each year due to injuries from care Safety is both a logical and scientifically appropriate place to begin to address the quality chasm.
  • General Description of the Framework The National QA Framework was designed to incorporate the general concepts of quality health care Fourmula1 reform agenda covering the six dimensions of quality health service. The overall objective of quality health service i.e. health status improvement and client satisfaction. While poverty reduction or financial risk protection may be an indirect effect of improved health status, this was not considered as one of the ultimate goal of quality health service because there are so many factors that have more direct effect on this other than health services. The first level (of the framework) represents the different stakeholders with interest in the health service provision like the health care providers, public and private financing institutions that focuses on health care and DOH and other government agencies like LGU. The next layer is adopted from the Fourmula1 framework with impact on the six dimensions of quality care i.e. effectiveness, safety, access, equity, efficiency, and responsiveness.
  • IRR Rule IX – states the objective of the QA in NHIP
  • The commitment to quality begins with management, to ensure support for the deployment of activities towards this commitment. It is up to the hospital leadership to allow, let alone encourage, the development of a CQI culture in their hospital.
  • Data from hereon came from BPASS. These are the average percentage of compliance of ALL hospitals in the 7 performance areas. Data as of November 2010
  • IRR Rule IX – states the objective of the QA in NHIP
  • Transcript of "Institutionalizing Quality standards In Health care"

    1. 1. Shirley B. Domingo, MD, MPH Vice President PRO NCR & Rizal 1
    2. 2. “ The Noblest Search is the Search for Excellence.” Lyndon B. Johnson
    3. 3. Legal Mandate• R.A. 7875 (as amended by R.A. 9241) Sec. 37. Quality Assurance …health care providers shall take part in programs of quality assurance, utilization review, and technology assessment …• IRR Rule IX, PhilHealth shall… – Implement a QAP applicable to all HCPs for delivery of health services – Ensure that health services are of quality necessary to achieve the desired health outcomes and member satisfaction
    4. 4. 4 Coverage Accreditation Premiums Payment VALUE Health care QUALITYRelationship bet. Phil Health, the health care providers and its members.
    5. 5. Minimal threshold standards Inspection - “find what’s wrong” Focus on inputsImprovement of Process and Outcomes Continuous quality improvement Self-assessment and demonstrating achievements
    6. 6. Rationale for Benchbook Standards• Legal mandate• Existing standards do not promote quality improvement culture among hospitals• Need to influence provider behavior to increase likelihood of better outcomes at affordable costs- member protection• Tougher competition (Provider)• Frequent medical errors- safety issues lawsuits!• Rising demand and costs, limited health expenditures/resources - efficiency• Concern with variation in health care practice, outcomes and costs• Patient satisfaction
    7. 7. Relative Performance of Government and Private Government Hospitals PrivateLeadership and ManagementMost could present an assessment of their Difficulty identifying proof of assessment ofperformance. Annual activities and targets are their performance/ not always documentedwell documentedPatient CareProcurement policies for drugs are not readily Procurement policies for drugs are readilyavailable (local government) availableHuman Resource ManagementRecruitment, selection, and hiring policies are Most have these policiesusually not available (local government)Safe Practice and EnvironmentPreventive and corrective maintenance services L3 and hospitals usually have good safetyare not readily available which may be a result of programs compared to governmentdelayed procurement of services as these hospitals. Personnel responsible ofservices were not assured from vendor when the maintaining security and conduct ofequipment was purchased. preventive and corrective maintenance of equipment are always available
    8. 8. Government vs Private
    9. 9. National Performance
    10. 10. Implementing a Quality Assurance Program• Accreditation• HTA• Peer Review• Feedback Mechanism• Performance Monitoring – Utilization Review – Outcomes Assessment• Medical evaluation of claims/PNDF• Program Review/Formulation of policies
    11. 11. Providers being accredited by PhilHealth:• Professionals • Institutions – Hospitals – Physicians – Rural health units/ health – Dentists centers (RHU) – Midwives – Ambulatory surgical clinics (ASC) – Maternity clinics – TB-DOTS centers – Free-standing dialysis centers – OUTPATIENT MALARIA PROVIDER (OMP)
    12. 12. 14
    13. 13. Performance Area Standards Criteria Indicators Core n=78 n=141 n=239 Indicators n=51Patient Rights 6 14 19 1Patient Care 30 75 112 15Leadership & 6 4 14 3MgtHR Mgt 8 19 27 2Info Mgt 5 11 15 3Safe Practice 16 16 40 25Improving 7 2 12 2Performance
    14. 14. Benchbook Awards
    15. 15. Patient Rights & Organizational EthicsGoal:• To improve patient outcomes by respecting patients’ rights and ethically relating with patients and other organizationsIndicators: Policies and procedures for patient’s needs for confidentiality,privacy, security, religious counselling Policies and procedures to resolve patient’s complaints Policies to resole ethical issues arising from patient care
    16. 16. Patient CareGoals:• The organization is accessible to the community that it aims to serve• The entry processes meet patient needs and are supported by effective systems and a suitable environmentIndicators:• Presence of services addressing most common diseases of the community
    17. 17. Patient CareGoals:• Comprehensive assessment of every patient enables the planning and delivery of patient care• The health care team develops in partnership with the patients a coordinated plan of care with goals• Care is delivered to ensure the best possible outcomes for the patientIndicator:• Policies and procedures regarding preoperative and pre anesthetic assessment• Quality control of the diagnostic examination
    18. 18. Patient CareGoals:• The health care team routinely and systematically evaluates and improves the effectiveness and efficiency of care delivered to patients• Care is coordinated between the organization and other health care providers in the community to ensure that the needs of the patient are continuously met (Discharge)Indicator:• Multidisciplinary team in the formulation of adopted clinical protocols
    19. 19. Leadership & ManagementGoals:• The organization is effectively and efficiently governed and managed according to its values and goals to ensure that care produces the desired health outcomes, and is responsive to patients’ and community needs• The organization ensures that services provided by external contractors meet appropriate standardsIndicators:• Presence of staff satisfaction survey• Policies and procedures are known to all levels of the work force.
    20. 20. Human Resource ManagementGoals:• The organization provides the right number and mix of competent staff to meet the needs of its internal and external customers and to achieve its goals (Planning)Indicators:• Policies and procedures to orient new employees and hospital policies• New personnel are adequately supervised
    21. 21. Human Resource ManagementGoals:• Recruitment , selection and appointment of staff comply with statutory requirements and are consistent with the organization’s human resource policies• A comprehensive program of staff training and development meets individual and organizational needsIndicator:• Recruitment and selections are consistent with organizational policies
    22. 22. Information ManagementGoals:• Collection and aggregation of data are done for patient care, management of services, education and research• Integrity, safety, access and security of records are maintained and statutory requirements are met (Records managementIndicator:• Proof that charts are checked for completeness and accuracyPolicy on record storage, safekeeping, retention and disposal
    23. 23. Safe Practice & EnvironmentGoals:• Patients, staff and other individuals within the organization are provided a safe, functional and effective environment of care• A comprehensive maintenance program ensures a clean and safe environmentIndicator:• Safe and efficient use of medical equipment according to specifications.
    24. 24. Safe Practice & EnvironmentGoals:• Risks of acquisition and transmission of infections among patients, employees, physicians and other personnel, visitors and trainees are identified and reduced• The provision of equipment and supplies supports the organization’s roleIndicators:• Presence of an infection control program• Procedure of isolation of nosocomial infections
    25. 25. Safe Practice & EnvironmentGoals:• The organization demonstrates its commitment to environmental issues by considering and implementing strategies to achieve environmental sustainability (Energy and waste management)Indicator:• Procedures on waste disposal involving the reuse, reduction and recycling
    26. 26. Improving PerformanceGoals:• The organization continuously and systematically improves its performance by invariably doing the right thing the right way the first time and meeting the needs of its internal and external clientsIndicators:• Presence of quality improvement programs• CPGs
    27. 27. Benchbook Self-Assessment Process & Accreditation 29
    28. 28. Minimum Requirement for Accreditation Compliance to 100% of CORE indicators ANDCenter 60% Compliance to each of the following: • Patient’s Rights and Organizationalof EthicsSafety • Patient Care • Safe Practice and Environment 30
    29. 29. Compliance to 100% of CORE indicators AND 75% Compliance to each of the following: •Patient’s Rights and Organizational EthicsCenter •Patient Careof •Safe Practice and Environment •Leadership and ManagementQuality •Human Resource Management •Information Management 31
    30. 30. Compliance to 100% of CORE indicators ANDCenter of 90% Compliance to each of the 7Excellence performance areas 32
    31. 31. What if we cannot meet the minimum requirements? Compliance to 70% of CORE indicators AND 50% Compliance to each of the following:Provisional • Patient’s Rights and Organizational Ethics,Accreditation • Safe Practice and Environment • Patient Care Failure to meet cut off for provisionalDenial accreditation 33
    32. 32. Frequently hard to comply indicators/ evidences1. Patient’s Rights and Organizational Ethics• Per validation, patients are seldom informed of their rights and responsibilities• Policy on patient and family education and their involvement in care decision-making• Monitoring reports related to patient or family education program/policy• Policies and procedures that address patients needs for communication• Provision of mechanisms to respect privacy (e.g. partition between patient beds especially in government hospitals) 34
    33. 33. Frequently hard to comply indicators/ evidences1. Patient’s Rights and Organizational Ethics• Policies and procedures on codes of professional conduct. Some have copies of statutory standards such as the following but have no issuance adopting them: – Codes of professional standards (PRC, PMA, PNA, PAMET, CSC, DOLE, etc) – Patient detention (RA 9434) and – Anti-deposit law (RA 8344) – Sexual harassment law (RA 7877)• Presence of programs on improving staff awareness on codes of professional conduct and other statutory standards• Policies and procedures on monitoring compliance to codes of professional conduct relevant to their respective discipline• Presence of an Ethics Committee 35
    34. 34. Frequently hard to comply indicators/ evidences1. Patient Care• Policies and procedures on patient waiting time• Monitoring and evaluation reports on patient waiting time• Policies and procedures on informing patients for any cause of delay in the delivery of services• Some patients admitted or their families are not appropriately informed by authorized qualified personnel of their disease, condition or disability, its severity, likely prognosis, benefits and possible adverse effects of various treatment options and the likely costs of treatment• Patients and/or their families are seldom informed of the need and availability of resources to continue care after discharge 36
    35. 35. Frequently hard to comply indicators/ evidences1. Patient Care• Comprehensive history and PE within 24 hours from admission• Doctors’ progress notes done regularly• Policies and procedures for the standard performance, monitoring and quality control of diagnostic examinations• Adopted/developed protocols, CPGs or pathways containing: – goals to be achieved – services to be provided – patient education strategies to be implemented – time frames to be met– resources to be used 37
    36. 36. Frequently hard to comply indicators/ evidences1. Patient Care• Policies and procedures on implementation/compliance to clinical pathways• Charts with clinical pathway-covered conditions.• Policies and procedures on duplicate assessments and treatments performed by trainees• Monitoring reports in compliance to policies and procedures on duplicate assessments and treatments• Policies and procedures promoting interactive, appropriate and relevant educational programs for patients 38
    37. 37. Frequently hard to comply indicators/ evidences1. Patient Care• Policies and procedures regarding selection and procurement of medical devices and equipment based on organization’s case mix, staff expertise, service capability, scientific evidence and government policies• Patient chart from medical records, look at the discharge orders. It should contain all of the following: – May go home order – Home medications (if applicable) – Follow up visits/schedule – Home care/advise 39
    38. 38. Frequently hard to comply indicators/ evidences1. Leadership and Management• Analysis, conclusion and recommendation based on staff satisfaction survey• Proof that policies and procedures are reviewed and revised as necessary5. Human Resource Management• Training needs assessment system• End-of-training assessment report9. Information Management• Lack of qualified staff involved in data definition, generation, collection and aggregation (no training on medical record management)• Charts are often incomplete 40
    39. 39. Frequently hard to comply indicators/ evidences1. Safe Practice and Environment• Not all operating manuals of equipment are present• Existence of safety programs and/or management plans for hospital safety• Proper waste segregation and labeling of waste receptacles• Policies and procedures on risk identification, assessment and control, security risks, use of personal protective equipment, etc.• Risk assessment reports• Preventive and corrective maintenance logbook for equipment 41
    40. 40. Frequently hard to comply indicators/ evidences1. Safe Practice and Environment• Procurement policy and plan for equipment which considers the following: – intended use – cost benefits – infection control – safety – waste creation and disposal – Storage• Late issuance of pertinent licenses/permits by respective agencies (e.g. ECC, Fire safety permit, including PNRI) 42
    41. 41. Frequently hard to comply indicators/ evidences1. Improving Performance• Presence, Implementation and evaluation of quality improvement programs• Implementation of CPGs (development or adoption)• Proof of better services and patient outcomes• Implementation of patient satisfaction survey (including analysis) 43
    42. 42. Feedback and Experiences during hospital surveyPositive• Hospitals appreciate standards set by Benchbook, standards are for the benefit of their facility• Hospitals find implementation of quality framework helpful• Although compliance to Benchbook requires exertion of much effort by hospitals, in the end, they recognize that the things they have done are actually needed to improve their hospital operations• Many hospital administrators claim that the process of crafting policies and procedures and documentation of monitoring and evaluation, among others, helps them in their work as hospital administrators• Surveyors appreciate it more if hospitals tag their documents based on the indicators of the Benchbook• Once the preliminary results are presented to the hospital management, the latter is very much eager to comply with their deficiencies the soonest time possible 44
    43. 43. Accreditation Reforms• Third Party Accreditation – Delegate accreditation functions exclusive of the decision- making function to duly recognized third party accreditation agencies• On-line Application for Accreditation• Preferred Provider Scheme/ Contracting – No out of pocket payment for PHIC members, provider will be granted faster claims processing
    44. 44. New Accreditation Schemes• Strong collaboration with Licensing of the DOH - Core indicators to be adopted by licensing - Licensed hospitals shall be automatically accredited as Center of Safety but has to sign a performance commitment with Philhealth• All government hospitals to be automatically accredited
    45. 45. “Excellent firms don’t believe in excellence- only in constant improvement and constant change.” Tom Peters
    46. 46. 48
    47. 47. WARRANTIES OF ACCREDITATIONRepresentation of eligibilitiesCompliance to pertinent laws/rules &regulations/policies/administrative orders and issuesClinical servicesConduct of clinical services, records, preparations ofclaims and undertakings of participation in the NHIPManagement Information SystemAdministrative investigations/regularsurveys.domiciliary visitations on the conduct of op-erations in the exercise of the privilege ofaccreditation. 49
    48. 48. Benchbook Indicators• Developed through consultative meetings• Stakeholders suggested indicators for each standard and criteria• Stakeholders agreed to set some indicators as CORE indicators• Survey tool which contains CORE indicators pilot tested in 2008• Revision of some indicators and listing/delisting of CORE indicators
    49. 49. How does Benchbook measure against the principles underlying ISQua Standards?• Leadership through effective planning, governance and management• Customer focus to meet the needs of internal and external customers, both existing and potential• Organizational performance through the management of processes and outcomes and the transparency of decision-making• Continuous quality improvement based on innovation, evidence, best practice and evaluation to better meet the needs of customers• Valuing people by appropriately selecting, training and appraising personnel and maintaining good relationships• Safety by providing safe work environments and complying with statutory requirements.Source: http://www.isqua.org/Accreditations.aspx?men=29
    50. 50. Trends of Health Expenditure by Source of Funds 100,000 90,000 National 80,000 70,000 LocalIn Million Pesos 60,000 Social health insurance 50,000 Out-of-Pocket 40,000 Other private 30,000 20,000 10,000 0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Years Source: Philippine National Health Account
    51. 51. Quality Dimensions• Safety• Efficiency• Appropriateness• Accessibility• Effectiveness• Consumer Participation
    52. 52. Warranties of Accreditation, Institutions they recognize the authority of PhilHealth to any inspection or investigation accept the program of quality assurance, payment mechanism and utilization review of the NHIP shall guarantee safe, adequate, and standard medical care its personnel shall adhere to a strict Code of Ethics they agree to adhere to practice guidelines or protocols, peer reviews and other QA activities
    53. 53. The Quality Problem is Large U.S. Healthcare Is DANGEROUS REGULATED ULTRA-SAFE Hazardous: (>1/1000) (<1/100K) 100,000 HealthCare • 7% of patients Driving suffer a medication error 10,000 Total lives lost per year • Every patient 1,000 admitted to an ICU Scheduled suffers adverse Airlines event 100 Mountain Chemical European • 44,000- 98,000 Climbing Manufacturing Railroads 10 deaths Bungee Chartered Nuclear Jumping Flights Power 1 • $50 billion in total 1 10 100 1,000 10,000 100,000 1,000,000 10,000,000 costs Number of encounters for each fatality BackSource: Leape, Lucian
    54. 54. Legal Mandate• IRR Rule IX, PhilHealth shall… – Implement a Quality Assurance Program applicable to all Health Care Providers for delivery of health services – Ensure that health services are of quality necessary to achieve the desired health outcomes and member satisfaction
    55. 55. PhilHealth’s MissionTo ensure adequate financial access of every Filipino to QUALITY HEALTH SERVICES through the effective and efficient administration of the National Health Insurance Program
    56. 56. Minimal threshold standards Inspection - “find what’s wrong” Focus on inputsImprovement of Process and Outcomes Continuous quality improvement Self-assessment and demonstrating achievements
    57. 57. Calls for improvement of systems and processes, focuses on customer orientation, collection and assessment of relevant performance data, andtimely action on the results of these data.
    58. 58. History of the Benchbook StandardsBenchbook Requirement Full 2nd year ofon of CQI Program Implementation implementationPerformance for of Benchbook as Review ofImprovement accreditation Standard for standards,of Health of hospitals Accreditation indicators andServices was -PC 12 s 2006 evidencespublished 2011 2010 2007 2004
    59. 59. 7 Areas of Benchbook Standards• Patient Rights and Organizational Ethics• Patient Care• Leadership and Management• Human Resource Management• Information Management• Safe Practice and Environment• Improving Performance
    60. 60. Commitment to QualityBegins with management … • ensures support for the deployment of activities • it is up to the hospital leadership to allow, let alone encourage, the development of a CQI culture in their hospital.
    61. 61. Benchbook Awards
    62. 62. Relative Performance of Government and Private Government Hospitals PrivateLeadership and ManagementMost could present an assessment of their Difficulty identifying proof of assessment ofperformance. Annual activities and targets are their performance/ not always documentedwell documentedPatient CareProcurement policies for drugs are not readily Procurement policies for drugs are readilyavailable (local government) availableHuman Resource ManagementRecruitment, selection, and hiring policies are Most have these policiesusually not available (local government)Safe Practice and EnvironmentPreventive and corrective maintenance services L3 and hospitals usually have good safetyare not readily available which may be a result of programs compared to governmentdelayed procurement of services as these hospitals. Personnel responsible ofservices were not assured from vendor when the maintaining security and conduct ofequipment was purchased. preventive and corrective maintenance of equipment are always available
    63. 63. Government vs Private
    64. 64. National Performance
    65. 65. “Excellent firms don’t believe in excellence- only in constant improvement and constant change.” Tom Peters
    66. 66. Background:Universal Health Bawat Pilipino miyembro,Care Bawat miyembro protektado, Kalusugan natin segurado.General • Automatic accreditation of all gov’tAppropriations health care providers effective April 1,Act of 2012 (RA 201210155) • Subject to the guidelines to be issued by DBM, DOH and PhilHealthDOH AO • Automatic accreditation of all licensed2011-0020: hospitals as Centers of SafetyStreamlining of • Benchbook core indicatorsLicensure and incorporated in DOH licensingAccreditation of standards 71Hospitals • Subject to “appropriate rules and
    67. 67. Streamlining of Licensure and Accreditation• Published January 14, 2012, Philippine Star• Effective January 29, 2012• But will only apply to licensed hospitals if the licensure standards already incorporated the 51 core indicators of the Benchbook standards for hospitals• Status: DOH is still finalizing the survey tool
    68. 68. Third Party Accreditation:COQ/ COE Directions ImplementationRecognition of • Recognize • No pre-Accreditation of accreditation accreditationHospitals granted issued by ISQua survey of hospitalsby International accredited accredited by organizations for internationalAccrediting Centers of Quality organizationsOrganizations and Excellence •Non-withholding of necessary/essential services to patients applicable to licensed service capability. •Compliance to policies on the implementation of case rate and/or “no balance billing” (if applicable). •No Writ of Execution issued against the applicant provider by PhilHealth three (3) years prior to application of accreditation. •No negative monitoring findings, e.g., irrational drug use, over/underutilization of services, etc, that remain uncorrected for the year preceding the applicable period.
    69. 69. Automatic Accreditation of Government• HCPs Primary Care Benefit Provider (PCB): health units, outpatient clinics of Levels 2, 3, and 4 DOH licensed hospitals, L1 hospitals with a L2 laboratory and licensed radiology service referral facilities with physician as certified by PHIC or CHDs• MCP + NCP Provider: facilities certified BEmONC with NS• Anti-TB DOTS Providers: health units/DOH-licensed hospitals that are certified as DOTS Facilities• Outpatient Malaria Package (OMP) Provider: certified by DOH• Outpatient Animal Bite Benefit (OABB) Provider: certified by DOH• Other facilities: such as, but not limited to, Ambulatory Surgical Clinics, Free-standing Dialysis Clinics, etc.• Other service providers as identified by the Corporation• All government – employed health care providers, duly licensed by the Professional Regulatory Commission shall be deemed accredited, if applicable as a professional provider of applicable PHIC benefit.
    70. 70. “Automatic Accreditation”• No more pre-accreditation survey will be conducted by PHIC• Automatic accreditation is only for entry, all HCPs shall be subject to Corporate rules and regulations• Exclusion: – Hospitals applying as Centers of Quality and Excellence – Some Outpatient Benefit Package Providers: mostly private
    71. 71. Regular Process EligibleRegistration Survey Deliberation PC to Participat e•SubmitPDR Issue SC/A Sign•Pay Fee PAS Notice/I C PC D Subject to Corporate Rules and Regulations
    72. 72. Thank you!
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