BPH 4th year Roles and responsibilities of quality health care HSM

1. Role and responsibilities of GoN in QA in
Health Care
Ankita Kunwar
Bph 4th year
HSM

2. Scope of work of different level of
QA in Nepal
• Two type of organization level for implement
quality assurance effectively
1. QA Steering Committee at Ministerial level
2. QA Working Committee at District level

3. Scope of Work of QA Steering Committee at the
Ministry of Health and Population
• Regulate overall QA activities carried out by public, private
and NGO sectors;
• Provide necessary directives/guidelines to QA Coordination
Committee at DoHS for effective implementation of quality of
care programmes/activities;
• Formulate and / or update national QA Policy and Strategy for
sustained improvement in the quality of overall health
services;
• Approve, research activities to be conducted for the
improvement of quality of health services;

4. Scope of Work: QA Working Committee at District
• Carry out QA activities as per instructions and guidelines
provided by QA Section of DoHS
• Ensure availability and use of services standards and protocols
at different health facilities of public, private and NGO sectors
within the district;
• Review and monitor the quality of health care services
provided by public, private and NGO sector health facilities;
• Conduct medical audit at district hospitals, private nursing
home and NGO hospitals in the district and give feedback for
quality improvement;

5. • Plan and implement QA activities for improving the quality of
health care services in the district;
• Supervise and support to QA activities of health facilities in
district and provide feedback;
• Coordinate with district level private and NGO sector health
facilities for facilitating the implementation of QA activities;
• Report to QA Section of Department of Health Services and
give recommendations and suggestions for improving the
quality of health services;
(GoN, MoH and P, 2064 Policy on Quality Assurance in Health
Care Services )

6. Role of health professionals
• The health workforce is essential to the delivery of
safe and high-quality health care.
• Improvement to the system can be achieved when
the health workforce actively participates in
organizational processes, safety systems,
improvement initiatives, and is trained in the roles
and services for which they are accountable.

7. • The clinical workforce can make health systems safer
and more effective if they:
- understand their broad responsibility for safety and
quality in health care
- follow safety and quality procedures
- supervise and educate other members of the
workforce
- participate in the review of performance procedures
individually, or as part of a team.

8. • Although the codes of conduct for the different
professional groups all vary to some extent, broadly
speaking all registered healthcare professionals
must:
• ensure that patient safety and patient interests are
top
• take action to protect patient safety, including
reporting concerns about patient safety / the actions
of colleagues where necessary
• protect confidentiality where any concerns are
raised.

9. Role of Clients/ patients
• A client is the one who uses our services. There are two
types of clients of a health care facility: internal clients and
external clients.
• internal clients - As health staff, we also become internal
clients when we receive services from other health staff at
one time or the other
• external clients- The external clients are the patients,
relatives of patients and anybody who seeks the services
from the facility.

10. The key roles of clients in QA include the
following:
• Definers of quality- Clients are in the best position to
tell us their expectations and what quality means to
them.
• Evaluators of quality- We can call on our clients to
assist us in assessing quality through periodic
satisfaction surveys, client complaints and staff-client
durbars.
• Co-producers of quality-Our external clients must
not only be seen as users of service but also as
partners who are helping us to provide quality health
care for them

11. • Informants on quality-They provide information on
what they experience during the process of care and
what the results of care are.
• Contributors to Quality Practice-When clients are
educated or informed on health matters they can
contribute to decision making in our facilities.
• Reformers of health services-Through the above
contributions, clients play important role in
promoting changes in our health care delivery.

12. Barriers of quality health services
• The health system environment
• The health system infrastructure
• Cost of services
• Socio/cultural constraints
• Service user's perception regarding medical care
• Language and education
• Trust by users in health care providers and procedures
• Service provider's attitudes and skills
• Lack of assertiveness and low self-esteem by users
• Lack of information/knowledge of available health services in
community
• monitoring quality of care;
• comparing and ranking performance of facilities
• providing technical support to regional QA teams;
• mobilizing resources for quality assurance.

13. Category Themes
Patient related factors Patient socio-demographic variables
Patient cooperation
Type of patient illness
Provider related factors Provider socio-demographic variables
Provider competency
Provider motivation and satisfaction
Environmental factors Healthcare system
Resources and facilities
Leadership and management
Collaboration and partnership developmen
Factors influencing the quality of healthcare

14. • Socioeconomics plays an important role in a family's decision
to seek medical assistance The uncertainty regarding the
ability to pay for medical cost may discourage one to seeking
medical help. For example, cost and prices of services,
transport cost, wages of quality of staff, price of quality of
drugs and other consumables.
• Waiting for a long period e.g. two or three-month doctor’s
appointment, facing long lines, and long hours discourages
individuals seeking healthcare services.

15. • Language and literacy can be a barrier to healthcare. Lack of
information on available health care choice/providers, the
embarrassment of sharing personal information or admitting
ones lacks of reading and writing skills can be a barrier to
entering a medical facility.
• Community's culture, attitudes and norms plays a significant
role in healthcare barriers through negative perceptions or
fears regarding medical care. For example, culturally, patients
may have difficulty with a doctor of the opposite. Another
cultural barrier to medical services is an individual’s religious
belief.

16. • Lack of assertiveness and low self-esteem by users from
among the poor, which increased the difficulty of accessing
services.
• The effect of non-financial barriers, such as lack of health
awareness, apparent unfelt need or lack of opportunity
(defined as exclusion from social and health providers) are
important hindering factors to assure of quality improvement
of health services.

17. • Trust plays a major role in seeking medical attention. Lack of
trust by users in health care providers, making people
reluctant to use the respective services.
• Staff absenteeism, limited opening hours that do not allow
for dealing with emergencies or working times are not
convenient for patients, especially working people.
• Negative experiences with medical staff may influence
patients to postpone medical attention. For example
unwelcoming staff attitude or poor interpersonal skills as well
as complex billing systems at hospitals play barrier in quality of
care.

18. Issues and challenges in quality of
health care
• Inequity due to mal distribution of scarce health resources
• Shortage of trained personnel and skewed distribution
• Increasing expenditure in health
• Expansion of health business in health center
• Continuity of services
• Quality assessment, techniques and tools
• Monitoring and reporting system