Quality is degree to which health services for individuals and populations increase the likelihood of desired health outcomes (quality principles),are consistent with current professional knowledge (professional competency),and meet the expectations of healthcare users (the marketplace)

1. Quality and Safety
in
patient care delivery

2. Outline
• Quality
• Quality Dimensions
• Patient Care Delivery Processes
• Patient Care Delivery Process in Equip 6 – ACHS Accreditation
• Reflections from study visits

3. Outline
• Quality
• Quality Dimensions
• Patient Care Delivery Processes
• Patient Care Delivery Process in Equip 6 – ACHS Accreditation
• Reflections from study visits

4. What is QUALITY?
• Quality is
• degree to which health services for individuals and populations increase the
likelihood of desired health outcomes (quality principles),
• are consistent with current professional knowledge (professional competency),
• and meet the expectations of healthcare users (the marketplace)
Buttell, P.,Hendler, R., & Daley, J. (2008). Quality in healthcare: concepts and practice. The business of
healthcare, 3, 61-95.
• Therefore quality has 3 components i.e.
• Increasing desired health outcomes,
• Meeting customer expectations and
• Consistent with the current professional knowledge.
Thalidomide Story

5. What is QUALITY?
Current
Professional
Knowledge
(Need)
Desired
Health
Outcomes
(Supply)
Customer’s
Expectations
(Demand &
Wants)
Meeting
Customer
Expectations
Consistent with
the Professional
Knowledge
Patient with a
Chest Pain

6. Increasing desired healthoutcomes
• How do we know that our desired health outcomes are
• Increasing and
• Reaching Desired Level ……………?
Current
Professional
Knowledge
(Need)
Desired
Health
Outcomes
(Supply)
Customer’s
Expectations
(Demand &
Wants)

7. Standard
• Professionally (or humanly) agreed
• Level of performance
• For a particular
setting which is
• Desirable
• Achievable
• Measurable

8. Increasing desired health
outcomes
• How do we know that our health outcomes are
• Increasing and
• Reaching Desired Level ……………?
• Accreditation: Public recognition of achievement by a health care organization,of
requirements of national health care standards.
• The status obtained by an organization after a successful third party external
evaluation by a recognized body to assess whether an organization meets applicable
per-determined and published standards

9. Standards are Evaluated byIndicators
• A variable or parameter
• that can measure changes in a phenomenon
• directly or indirectly
• in a
• Valid,
• Objective,
• Sensitive and
• Specific way
Waiting Time as a Measure of Quality

10. Valid, Objective, Specific, Sensitive
Indicators
Colombo - Katharagama
False Positive = Not Specific
False Negative =
Not Sensitive

11. Outline
• Quality
• Quality Dimensions
• Patient Care Delivery Processes
• Patient Care Delivery Process in Equip 6 – ACHS Accreditation
• Reflections from study visits

12. Dimensions of Quality
•S – Safe
•T – Timely
•E – Efficient
•E – Effective
•E – Equitable
•P – Patient Centered

13. S – Safety  PatientSafety
• Patient Safety is “the prevention of errors and adverse effects
to patients associated with health care”
– World Health Organization
• Patient Safety is “the prevention of harm to patients.”
– Institute of Medicine
• Patient Safety is “the freedom from accidental or preventable injuries
produced by medical care.”
– Agency for Healthcare Research and Quality (AHRQ) – USA
Avoiding injuries to patients
from the care that is
intended to help them

14. T – Timely
• Reducing waits and sometimes harmful delays for both who receive
and those who give care
• Timeliness in health care is the system’s capacity to provide care
quickly after a need is recognized. (Healthy People 2020).
– Agency for Healthcare Research and Quality (AHRQ) – USA

15. E – Efficiency andEffectiveness
• Efficient – Maximum Performance (output) from available, limited resources
(Doing things CORRECTLY)
• Effective – Maximum useful output form available limited resources
(Doing a CORRECT thing)
Efficiency
Avoiding waste,
including waste
of equipment,
supplies, ideas
and energy
Effective
Providing services based
on scientific knowledgeto
all who could benefit and
refraining from providing
services to those not
likely to benefit

16. E – Equity, Equality andReality
Equity – Providing care that does not vary in
quality because of personal characteristics

17. P – PatientCenteredness
• Providing care that is respectful of, and responsive to individual
patient preferences, needs and values ensuring that patient values
guide all clinical decisions.
• Patient- and family-centered care is an approach to the planning,
delivery, and evaluation of health care that is grounded in mutually
beneficial partnerships among health care providers, patients,and
families.
• http://www.ipfcc.org/pdf/CoreConcepts.pdf

18. Guiding Principles of
Patient- and Family-centred Care
• “The needs of the patient come first,”
– Priority for the patient
• “Every patient is the only patient,”
– Uniqueness of every patient
• “Nothing about me without me”
– Participatory decision making with the patient
Dignity and
Respect
Information
Sharing
Participation
Collaboration

19. Outline
• Quality
• Quality Dimensions
• Patient Care Delivery Processes
• Patient Care Delivery Process in Equip 6 – ACHS Accreditation
• Reflections from study visits

20. Optimal Care Delivery Process:
• Optimal health and personal care requires following universally
acknowledged methods to identify and address complexissues.
• It starts with collecting enough relevant information
 enabling pertinent, individualized care plans andinterventions.
• Process steps
1. Recognition/Assessment,
2. Cause Identification/Diagnosis,
3. Management/Treatment, and
4. Monitoring

23. Benefits of a Optimal Care DeliveryProcess
• A consistent, correct care delivery process facilitates care that meets all of the desirable
quality attributes as identified by the Institute of Medicine: STEEP  safe, effective,
efficient, patient-centered, timely, and equitable.
• Use of a systematic care delivery process reduces guess work and helps increase the
likelihood that correct, safe care will be given,
• It contributes to improved care quality, customer satisfaction, regulatory compliance,
and financial performance, and reduced legal liability.
• Adherence to the care delivery process enables rational medication use that maximizes
effectiveness, minimizes risks and complications, and facilitates regulatory compliance
• A proper care delivery process helps fill the critical gap between assessment and care
planning.
• It provides a significant basis for process and outcome qualityindicators

24. Outline
• Quality
• Quality Dimensions
• Patient Care Delivery Processes
• Patient Care Delivery Process in Equip 6 – ACHSAccreditation
• Reflections from study visits

25. 1.1 Continuity of CareStandard
• Consumers / patients are provided with safe, high quality care
throughout the care delivery process.
• The intent of the Continuity of Care standard is to ensure that
organizations provide high quality care and a caring
environment to the consumer / patient at all times.
• They should do this:
1. From the time that the consumer / patient enters
the healthcare organization or service
2. Through to when the consumer / patient is discharged or
transferred to another organization / service; and
3. During any ongoing care they provide after discharge.

27. Care Planning Process –Components
• Admission of Patients
• Identify and Manage
Emergencies
• Transfer of Care and
Clinical Handover
• Discharge of Patients
• End of Life Care

28. Safe, High Quality Care throughout the Care Delivery Process

29. ACHS Accreditation

30. • Conducted
• Documented
• Involved
• coordinated• Guidelines
• Processes
• Systems • Evaluated

31. Outline
• Quality
• Quality Dimensions
• Patient Care Delivery Processes
• Patient Care Delivery Process in Equip 6 – ACHS Accreditation
• Reflections from study visits

32. Reflections
1 Assessment ensures current and ongoing needs of the patient are identified.
• Assessments are done and documented wheneverpracticable
• No guidelines, systems and processes and Poor documentation
• 1.1.2 Care is planned and delivered in collaboration with the patient and, when relevant,
the care giver to achieve the best possible outcomes.
• Not done – No evidence based Policies, guidelines, systems andprocesses
• 1.1.3 Patients are informed of the consent process, and they understand and provide
consent.
• Consent is taken from the patient (may be in primitive forms; e.g.: RubberStamps)
• Which is acceptable and it may be taken at whatever the place prior to theprocedure
• But whether informed and understand the consent is in doubt
• No Policies / guidelines / formats addressing consent which are consistent with relevant
legislation, standards, guidelines and/or codes of practice, and are readilyavailable

33. Reflections
• 1.1.4 Effective Systems for Managing Medical Emergencies
• In Accidents and Emergency Departments
• Guidelines / observation charts are available
• Prompt attention was given
• Response plans and instructions are displayed
• Need identifications
were done promptly
• Care planning was done
promptly and effectively
• Training on CPR done
• No mechanisms to
identify and care for
deteriorating patients

34. Reflections
• 1.1.5 Processes for clinical handover, transfer of care and discharge address the needs of
the consumer / patient for ongoing care
• Receiving and sending the patients to and from Operating Theatres, a standard checklist /
formats was used.
• During the changing of shifts of nurses, notes were exchanged on the handing andtaking
over book.
• Investigations are pasted at a specific place in BHT for easy reference.
• During the transfers, colour coding stickers are used to indicate the urgency and transfer
form is filled in duplicate.
• During the discharge detailed discharge summary or diagnosis card is issued with
prescription for medications and patients are educated on the follow upplan.
• At the same time, staffs are appropriately handling care for terminally-illpatients.
• Standard guidelines and processes to be developed for transfer of care between units
• Applying surgical safety checklist to each and every patient

35. Reflection
• 1.1.8 The health record ensures comprehensive and accurate information is
collaboratively gathered, recorded and used in care delivery
• Manual form of information gathering is available, but not comprehensive andaccurate
• Trainings on Medical Records Management is done, but not doneregularly.
• Poor documentation (even in the writtenform).
• No Policies / guidelines addressing health recorddocumentation.
• Patients do not have a health record with a recognized uniqueidentifier.
• Security of medical records is not maintained properly, creating privacy andconfidentiality
issues. Not only authorized persons have access torecords.
• Need of Electronic Health Records  Is the SINGLE solution for achieving thisstandard