Hospital Committees are regular standing committees prescribed by regulatory agencies and deemed necessary by hospital administration in formulating policies, coordinating and monitoring hospital-wide activities that are considered critical in the delivery of quality health care services.
These are in contrast to ad hoc committees, department and unit committees.
Hospital Committees are regular standing committees prescribed by regulatory agencies and deemed necessary by hospital administration in formulating policies, coordinating and monitoring hospital-wide activities that are considered critical in the delivery of quality health care services.
These are in contrast to ad hoc committees, department and unit committees.
MEDICAL AUDIT
Evaluation of data, documents, and resources to check performance of systems meets specified standards
PRESCRIPTION MONITORING, ADR, DRUG RELATED PROBLEMS, staff safety, data,defining standards,
collecting data,
identifying areas for improvement,
making necessary changes
back round to defining new standards.
Safety Facility Management
Protecting the safety of our employees and the environment is a core value within Facilities Management. We will not be satisfied until our workplaces are safe from hazards, our employees are injury-free, our services are safe, and our commitment and record of protecting the environment are unmatched.
MEDICAL AUDIT
Evaluation of data, documents, and resources to check performance of systems meets specified standards
PRESCRIPTION MONITORING, ADR, DRUG RELATED PROBLEMS, staff safety, data,defining standards,
collecting data,
identifying areas for improvement,
making necessary changes
back round to defining new standards.
Safety Facility Management
Protecting the safety of our employees and the environment is a core value within Facilities Management. We will not be satisfied until our workplaces are safe from hazards, our employees are injury-free, our services are safe, and our commitment and record of protecting the environment are unmatched.
quality assurance slides include components, models, approaches, cycle of quality assurance is included in the slides.
the slide gives a brief ides regarding all the points and gives a comprehensive picture of the topic.
NABH is an institutional member of the International Society for Quality in Health Care (ISQUA). ISQUA is an international body which grants approval to Accreditation Bodies in the area of healthcare as mark of equivalence of accreditation program of member countries.
ISQua Accreditation of NABH Standard , India
International Society for Quality in Healthcare (ISQua) has accredited “Standards for Hospitals” developed by National Accreditation Board for Hospitals & Healthcare Providers (NABH, India ). The approval of ISQua authenticates that NABH standards are in consonance with the global benchmarks set by ISQua. The hospitals accredited by NABH will have international recognition This will provide boost to medical tourism.
International Society for Quality in Health Care (ISQua ) is an international body which grants approval to Accreditation Bodies in the area of healthcare as mark of equivalence of accreditation program of member countries.
So far hospital standards of only 11 countries viz. Australia , Canada , Egypt , Hong Kong , Ireland , Japan , Jordan , Kyrgyz Republic , South Africa , Taiwan , United Kingdom were accredited by ISQua. India becomes the 12 th country to join in this group.
Quality assurance is a way of preventing mistakes and defects in manufactured products and avoiding problems when delivering products or services to customers; which ISO 9000 defines as "part of quality management focused on providing confidence that quality requirements will be fulfilled".
what is the future of Pi Network currency.DOT TECH
The future of the Pi cryptocurrency is uncertain, and its success will depend on several factors. Pi is a relatively new cryptocurrency that aims to be user-friendly and accessible to a wide audience. Here are a few key considerations for its future:
Message: @Pi_vendor_247 on telegram if u want to sell PI COINS.
1. Mainnet Launch: As of my last knowledge update in January 2022, Pi was still in the testnet phase. Its success will depend on a successful transition to a mainnet, where actual transactions can take place.
2. User Adoption: Pi's success will be closely tied to user adoption. The more users who join the network and actively participate, the stronger the ecosystem can become.
3. Utility and Use Cases: For a cryptocurrency to thrive, it must offer utility and practical use cases. The Pi team has talked about various applications, including peer-to-peer transactions, smart contracts, and more. The development and implementation of these features will be essential.
4. Regulatory Environment: The regulatory environment for cryptocurrencies is evolving globally. How Pi navigates and complies with regulations in various jurisdictions will significantly impact its future.
5. Technology Development: The Pi network must continue to develop and improve its technology, security, and scalability to compete with established cryptocurrencies.
6. Community Engagement: The Pi community plays a critical role in its future. Engaged users can help build trust and grow the network.
7. Monetization and Sustainability: The Pi team's monetization strategy, such as fees, partnerships, or other revenue sources, will affect its long-term sustainability.
It's essential to approach Pi or any new cryptocurrency with caution and conduct due diligence. Cryptocurrency investments involve risks, and potential rewards can be uncertain. The success and future of Pi will depend on the collective efforts of its team, community, and the broader cryptocurrency market dynamics. It's advisable to stay updated on Pi's development and follow any updates from the official Pi Network website or announcements from the team.
Empowering the Unbanked: The Vital Role of NBFCs in Promoting Financial Inclu...Vighnesh Shashtri
In India, financial inclusion remains a critical challenge, with a significant portion of the population still unbanked. Non-Banking Financial Companies (NBFCs) have emerged as key players in bridging this gap by providing financial services to those often overlooked by traditional banking institutions. This article delves into how NBFCs are fostering financial inclusion and empowering the unbanked.
Currently pi network is not tradable on binance or any other exchange because we are still in the enclosed mainnet.
Right now the only way to sell pi coins is by trading with a verified merchant.
What is a pi merchant?
A pi merchant is someone verified by pi network team and allowed to barter pi coins for goods and services.
Since pi network is not doing any pre-sale The only way exchanges like binance/huobi or crypto whales can get pi is by buying from miners. And a merchant stands in between the exchanges and the miners.
I will leave the telegram contact of my personal pi merchant. I and my friends has traded more than 6000pi coins successfully
Tele-gram
@Pi_vendor_247
what is the best method to sell pi coins in 2024DOT TECH
The best way to sell your pi coins safely is trading with an exchange..but since pi is not launched in any exchange, and second option is through a VERIFIED pi merchant.
Who is a pi merchant?
A pi merchant is someone who buys pi coins from miners and pioneers and resell them to Investors looking forward to hold massive amounts before mainnet launch in 2026.
I will leave the telegram contact of my personal pi merchant to trade pi coins with.
@Pi_vendor_247
Latino Buying Power - May 2024 Presentation for Latino CaucusDanay Escanaverino
Unlock the potential of Latino Buying Power with this in-depth SlideShare presentation. Explore how the Latino consumer market is transforming the American economy, driven by their significant buying power, entrepreneurial contributions, and growing influence across various sectors.
**Key Sections Covered:**
1. **Economic Impact:** Understand the profound economic impact of Latino consumers on the U.S. economy. Discover how their increasing purchasing power is fueling growth in key industries and contributing to national economic prosperity.
2. **Buying Power:** Dive into detailed analyses of Latino buying power, including its growth trends, key drivers, and projections for the future. Learn how this influential group’s spending habits are shaping market dynamics and creating opportunities for businesses.
3. **Entrepreneurial Contributions:** Explore the entrepreneurial spirit within the Latino community. Examine how Latino-owned businesses are thriving and contributing to job creation, innovation, and economic diversification.
4. **Workforce Statistics:** Gain insights into the role of Latino workers in the American labor market. Review statistics on employment rates, occupational distribution, and the economic contributions of Latino professionals across various industries.
5. **Media Consumption:** Understand the media consumption habits of Latino audiences. Discover their preferences for digital platforms, television, radio, and social media. Learn how these consumption patterns are influencing advertising strategies and media content.
6. **Education:** Examine the educational achievements and challenges within the Latino community. Review statistics on enrollment, graduation rates, and fields of study. Understand the implications of education on economic mobility and workforce readiness.
7. **Home Ownership:** Explore trends in Latino home ownership. Understand the factors driving home buying decisions, the challenges faced by Latino homeowners, and the impact of home ownership on community stability and economic growth.
This SlideShare provides valuable insights for marketers, business owners, policymakers, and anyone interested in the economic influence of the Latino community. By understanding the various facets of Latino buying power, you can effectively engage with this dynamic and growing market segment.
Equip yourself with the knowledge to leverage Latino buying power, tap into their entrepreneurial spirit, and connect with their unique cultural and consumer preferences. Drive your business success by embracing the economic potential of Latino consumers.
**Keywords:** Latino buying power, economic impact, entrepreneurial contributions, workforce statistics, media consumption, education, home ownership, Latino market, Hispanic buying power, Latino purchasing power.
how to sell pi coins in all Africa Countries.DOT TECH
Yes. You can sell your pi network for other cryptocurrencies like Bitcoin, usdt , Ethereum and other currencies And this is done easily with the help from a pi merchant.
What is a pi merchant ?
Since pi is not launched yet in any exchange. The only way you can sell right now is through merchants.
A verified Pi merchant is someone who buys pi network coins from miners and resell them to investors looking forward to hold massive quantities of pi coins before mainnet launch in 2026.
I will leave the telegram contact of my personal pi merchant to trade with.
@Pi_vendor_247
Poonawalla Fincorp and IndusInd Bank Introduce New Co-Branded Credit Cardnickysharmasucks
The unveiling of the IndusInd Bank Poonawalla Fincorp eLITE RuPay Platinum Credit Card marks a notable milestone in the Indian financial landscape, showcasing a successful partnership between two leading institutions, Poonawalla Fincorp and IndusInd Bank. This co-branded credit card not only offers users a plethora of benefits but also reflects a commitment to innovation and adaptation. With a focus on providing value-driven and customer-centric solutions, this launch represents more than just a new product—it signifies a step towards redefining the banking experience for millions. Promising convenience, rewards, and a touch of luxury in everyday financial transactions, this collaboration aims to cater to the evolving needs of customers and set new standards in the industry.
how to sell pi coins on Bitmart crypto exchangeDOT TECH
Yes. Pi network coins can be exchanged but not on bitmart exchange. Because pi network is still in the enclosed mainnet. The only way pioneers are able to trade pi coins is by reselling the pi coins to pi verified merchants.
A verified merchant is someone who buys pi network coins and resell it to exchanges looking forward to hold till mainnet launch.
I will leave the telegram contact of my personal pi merchant to trade with.
@Pi_vendor_247
how to sell pi coins effectively (from 50 - 100k pi)DOT TECH
Anywhere in the world, including Africa, America, and Europe, you can sell Pi Network Coins online and receive cash through online payment options.
Pi has not yet been launched on any exchange because we are currently using the confined Mainnet. The planned launch date for Pi is June 28, 2026.
Reselling to investors who want to hold until the mainnet launch in 2026 is currently the sole way to sell.
Consequently, right now. All you need to do is select the right pi network provider.
Who is a pi merchant?
An individual who buys coins from miners on the pi network and resells them to investors hoping to hang onto them until the mainnet is launched is known as a pi merchant.
debuts.
I'll provide you the Telegram username
@Pi_vendor_247
how to swap pi coins to foreign currency withdrawable.DOT TECH
As of my last update, Pi is still in the testing phase and is not tradable on any exchanges.
However, Pi Network has announced plans to launch its Testnet and Mainnet in the future, which may include listing Pi on exchanges.
The current method for selling pi coins involves exchanging them with a pi vendor who purchases pi coins for investment reasons.
If you want to sell your pi coins, reach out to a pi vendor and sell them to anyone looking to sell pi coins from any country around the globe.
Below is the contact information for my personal pi vendor.
Telegram: @Pi_vendor_247
If you are looking for a pi coin investor. Then look no further because I have the right one he is a pi vendor (he buy and resell to whales in China). I met him on a crypto conference and ever since I and my friends have sold more than 10k pi coins to him And he bought all and still want more. I will drop his telegram handle below just send him a message.
@Pi_vendor_247
US Economic Outlook - Being Decided - M Capital Group August 2021.pdfpchutichetpong
The U.S. economy is continuing its impressive recovery from the COVID-19 pandemic and not slowing down despite re-occurring bumps. The U.S. savings rate reached its highest ever recorded level at 34% in April 2020 and Americans seem ready to spend. The sectors that had been hurt the most by the pandemic specifically reduced consumer spending, like retail, leisure, hospitality, and travel, are now experiencing massive growth in revenue and job openings.
Could this growth lead to a “Roaring Twenties”? As quickly as the U.S. economy contracted, experiencing a 9.1% drop in economic output relative to the business cycle in Q2 2020, the largest in recorded history, it has rebounded beyond expectations. This surprising growth seems to be fueled by the U.S. government’s aggressive fiscal and monetary policies, and an increase in consumer spending as mobility restrictions are lifted. Unemployment rates between June 2020 and June 2021 decreased by 5.2%, while the demand for labor is increasing, coupled with increasing wages to incentivize Americans to rejoin the labor force. Schools and businesses are expected to fully reopen soon. In parallel, vaccination rates across the country and the world continue to rise, with full vaccination rates of 50% and 14.8% respectively.
However, it is not completely smooth sailing from here. According to M Capital Group, the main risks that threaten the continued growth of the U.S. economy are inflation, unsettled trade relations, and another wave of Covid-19 mutations that could shut down the world again. Have we learned from the past year of COVID-19 and adapted our economy accordingly?
“In order for the U.S. economy to continue growing, whether there is another wave or not, the U.S. needs to focus on diversifying supply chains, supporting business investment, and maintaining consumer spending,” says Grace Feeley, a research analyst at M Capital Group.
While the economic indicators are positive, the risks are coming closer to manifesting and threatening such growth. The new variants spreading throughout the world, Delta, Lambda, and Gamma, are vaccine-resistant and muddy the predictions made about the economy and health of the country. These variants bring back the feeling of uncertainty that has wreaked havoc not only on the stock market but the mindset of people around the world. MCG provides unique insight on how to mitigate these risks to possibly ensure a bright economic future.
how can i use my minded pi coins I need some funds.DOT TECH
If you are interested in selling your pi coins, i have a verified pi merchant, who buys pi coins and resell them to exchanges looking forward to hold till mainnet launch.
Because the core team has announced that pi network will not be doing any pre-sale. The only way exchanges like huobi, bitmart and hotbit can get pi is by buying from miners.
Now a merchant stands in between these exchanges and the miners. As a link to make transactions smooth. Because right now in the enclosed mainnet you can't sell pi coins your self. You need the help of a merchant,
i will leave the telegram contact of my personal pi merchant below. 👇 I and my friends has traded more than 3000pi coins with him successfully.
@Pi_vendor_247
Turin Startup Ecosystem 2024 - Ricerca sulle Startup e il Sistema dell'Innov...Quotidiano Piemontese
Turin Startup Ecosystem 2024
Una ricerca de il Club degli Investitori, in collaborazione con ToTeM Torino Tech Map e con il supporto della ESCP Business School e di Growth Capital
2. “ The Noblest Search is the
Search for Excellence.”
Lyndon B. Johnson
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
Coverage
Accreditation
Premiums
Payment
VALUE
Health care
QUALITY
Relationship bet. Phil Health, the health care providers and
its members.
5. Minimal threshold standards
Inspection - “find what’s wrong”
Focus on inputs
Improvement of Process and Outcomes
Continuous quality improvement
Self-assessment and demonstrating
achievements
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. Relative Performance of Government and Private
Government Hospitals Private
Leadership and Management
Most could present an assessment of their Difficulty identifying proof of assessment of
performance. Annual activities and targets are their performance/ not always documented
well documented
Patient Care
Procurement policies for drugs are not readily Procurement policies for drugs are readily
available (local government) available
Human Resource Management
Recruitment, selection, and hiring policies are Most have these policies
usually not available (local government)
Safe Practice and Environment
Preventive and corrective maintenance services L3 and hospitals usually have good safety
are not readily available which may be a result of programs compared to government
delayed procurement of services as these hospitals. Personnel responsible of
services were not assured from vendor when the maintaining security and conduct of
equipment was purchased. preventive and corrective maintenance of
equipment are always available
17. Patient Rights & Organizational
Ethics
Goal:
• To improve patient outcomes by respecting patients’ rights and
ethically relating with patients and other organizations
Indicators:
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
18. Patient Care
Goals:
• 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 environment
Indicators:
• Presence of services addressing most common diseases of the
community
19. Patient Care
Goals:
• 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
patient
Indicator:
• Policies and procedures regarding preoperative and pre anesthetic
assessment
• Quality control of the diagnostic examination
20. Patient Care
Goals:
• 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
21. Leadership & Management
Goals:
• 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 standards
Indicators:
• Presence of staff satisfaction survey
• Policies and procedures are known to all levels of the work force.
22. Human Resource Management
Goals:
• 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
23. Human Resource Management
Goals:
• 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 needs
Indicator:
• Recruitment and selections are consistent with organizational
policies
24. Information Management
Goals:
• 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 management
Indicator:
• Proof that charts are checked for completeness and
accuracyPolicy on record storage, safekeeping,
retention and disposal
25. Safe Practice & Environment
Goals:
• 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 environment
Indicator:
• Safe and efficient use of medical equipment according to
specifications.
26. Safe Practice & Environment
Goals:
• 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 role
Indicators:
• Presence of an infection control program
• Procedure of isolation of nosocomial infections
27. Safe Practice & Environment
Goals:
• 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
28. Improving Performance
Goals:
• 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 clients
Indicators:
• Presence of quality improvement programs
• CPGs
30. Minimum Requirement for Accreditation
Compliance to 100% of CORE indicators
AND
Center 60% Compliance to each of the following:
• Patient’s Rights and Organizational
of Ethics
Safety • Patient Care
• Safe Practice and Environment
30
31. Compliance to 100% of CORE indicators
AND
75% Compliance to each of the following:
•Patient’s Rights and Organizational Ethics
Center •Patient Care
of •Safe Practice and Environment
•Leadership and Management
Quality •Human Resource Management
•Information Management
31
32. Compliance to 100% of CORE indicators
AND
Center of
90% Compliance to each of the 7
Excellence
performance
areas
32
33. 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 provisional
Denial accreditation
33
34. Frequently hard to comply indicators/ evidences
1. 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
35. Frequently hard to comply indicators/ evidences
1. 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
36. Frequently hard to comply indicators/ evidences
1. 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
37. Frequently hard to comply indicators/ evidences
1. 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
38. Frequently hard to comply indicators/ evidences
1. 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
39. Frequently hard to comply indicators/ evidences
1. 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
40. Frequently hard to comply indicators/ evidences
1. Leadership and Management
• Analysis, conclusion and recommendation based on staff satisfaction
survey
• Proof that policies and procedures are reviewed and revised as
necessary
5. Human Resource Management
• Training needs assessment system
• End-of-training assessment report
9. 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
41. Frequently hard to comply indicators/ evidences
1. 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
42. Frequently hard to comply indicators/ evidences
1. 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
43. Frequently hard to comply indicators/ evidences
1. 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
44. Feedback and Experiences during hospital survey
Positive
• 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
45. 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
46. 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
47. “Excellent firms don’t believe in
excellence- only in constant
improvement and constant
change.”
Tom Peters
49. 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 of
claims and undertakings of participation in the NHIP
Management Information System
Administrative investigations/regular
surveys.domiciliary visitations on the conduct of op-
erations in the exercise of the privilege of
accreditation.
49
50. 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
51. 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
52. Trends of Health Expenditure
by Source of Funds
100,000
90,000
National
80,000
70,000 Local
In 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
54. 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
55. 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
Back
Source: Leape, Lucian
56.
57. 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
58. PhilHealth’s Mission
To ensure adequate financial access of
every Filipino to QUALITY HEALTH
SERVICES through the effective and
efficient administration of the National
Health Insurance Program
59. Minimal threshold standards
Inspection - “find what’s wrong”
Focus on inputs
Improvement of Process and Outcomes
Continuous quality improvement
Self-assessment and demonstrating
achievements
60. Calls for improvement of
systems and processes,
focuses on customer
orientation, collection and
assessment of relevant
performance data, and
timely action on the results
of these data.
61. History of the Benchbook
Standards
Benchbook Requirement Full 2nd year of
on of CQI Program Implementation implementation
Performance for of Benchbook as Review of
Improvement accreditation Standard for standards,
of Health of hospitals Accreditation indicators and
Services was -PC 12 s 2006 evidences
published
2011
2010
2007
2004
62. 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
63. Commitment to Quality
Begins 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.
65. Relative Performance of Government and Private
Government Hospitals Private
Leadership and Management
Most could present an assessment of their Difficulty identifying proof of assessment of
performance. Annual activities and targets are their performance/ not always documented
well documented
Patient Care
Procurement policies for drugs are not readily Procurement policies for drugs are readily
available (local government) available
Human Resource Management
Recruitment, selection, and hiring policies are Most have these policies
usually not available (local government)
Safe Practice and Environment
Preventive and corrective maintenance services L3 and hospitals usually have good safety
are not readily available which may be a result of programs compared to government
delayed procurement of services as these hospitals. Personnel responsible of
services were not assured from vendor when the maintaining security and conduct of
equipment was purchased. preventive and corrective maintenance of
equipment are always available
70. “Excellent firms don’t believe in
excellence- only in constant
improvement and constant
change.”
Tom Peters
71. Background:
Universal Health Bawat Pilipino miyembro,
Care Bawat miyembro protektado,
Kalusugan natin segurado.
General • Automatic accreditation of all gov’t
Appropriations health care providers effective April 1,
Act of 2012 (RA 2012
10155) • Subject to the guidelines to be issued
by DBM, DOH and PhilHealth
DOH AO • Automatic accreditation of all licensed
2011-0020: hospitals as Centers of Safety
Streamlining of • Benchbook core indicators
Licensure and incorporated in DOH licensing
Accreditation of standards 71
Hospitals • Subject to “appropriate rules and
72. 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
73. Third Party Accreditation:COQ/
COE
Directions Implementation
Recognition of • Recognize • No pre-
Accreditation of accreditation accreditation
Hospitals granted issued by ISQua survey of hospitals
by International accredited accredited by
organizations for international
Accrediting
Centers of Quality organizations
Organizations
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.
74. 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.
75. “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
76. Regular Process
Eligible
Registration Survey Deliberation PC to
Participat
e
•Submit
PDR Issue
SC/A Sign
•Pay Fee PAS Notice/I
C PC
D
Subject to
Corporate
Rules and
Regulations
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