This document discusses quality assurance in healthcare. It defines quality from different perspectives including the provider, manager, and client. It outlines 10 key steps in the quality assurance process: 1) Planning, 2) Developing guidelines and standards, 3) Communicating standards, 4) Monitoring quality, 5) Identifying problems, 6) Defining problems, 7) Choosing a team, 8) Analyzing problems, 9) Developing solutions, and 10) Implementing and evaluating improvements. It also discusses indicators for monitoring quality assurance like infection prevention, referral systems, and client satisfaction. Overall, the document provides an overview of the concepts, approaches, and factors involved in ensuring quality in healthcare.
The Basics of Monitoring, Evaluation and Supervision of Health Services in NepalDeepak Karki
This presentation has made to health workers who have more than two decades of experience of managing/implementing public health programs in Nepal, especially at district level and below.
This is just a short & simplified slide made easy for undergraduate level . Important things have been highlighted. Before classifying system,I felt that few terms have to be described, so I have put few extra slides in the beginning.
The Basics of Monitoring, Evaluation and Supervision of Health Services in NepalDeepak Karki
This presentation has made to health workers who have more than two decades of experience of managing/implementing public health programs in Nepal, especially at district level and below.
This is just a short & simplified slide made easy for undergraduate level . Important things have been highlighted. Before classifying system,I felt that few terms have to be described, so I have put few extra slides in the beginning.
A health system, also sometimes referred to as health care system or as healthcare system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.
There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. Implicitly, nations must design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary healthcare and public health measures.In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious organizations, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often evolutionary rather than revolutionary.
Current co-ordination mechanism of health system in NepalPrakashRajSharma
Coordination is the process of linking together the activities of various departments & people to achieve unity of action and harmonization of efforts for attaining organizational goals.
It is a planned collaboration of two or more persons, departments, programs or organizations who are concern with achieving a common goal.
In Nepal, Coordination in Health Sector occurs in three levels:
1. Coordination at Federal Level
2. Coordination at Provincial Level
3. Coordination at Local Level
This National Strategic Roadmap on Health workforce Provides comprehensive guidance to the federal, provincial and local levels on Health, Health education. HRH strategy envisions to ensure equitable distribution and availability of quality health workforce as per the country health service system to ensure universal health coverage. This strategy provides guidance to the government at all levels in the federal context to fulfill the constitutional right for the access to health services by each citizen through effective management of the health workforce.
A health system, also sometimes referred to as health care system or as healthcare system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.
There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. Implicitly, nations must design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary healthcare and public health measures.In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious organizations, or other co-ordinated bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often evolutionary rather than revolutionary.
Current co-ordination mechanism of health system in NepalPrakashRajSharma
Coordination is the process of linking together the activities of various departments & people to achieve unity of action and harmonization of efforts for attaining organizational goals.
It is a planned collaboration of two or more persons, departments, programs or organizations who are concern with achieving a common goal.
In Nepal, Coordination in Health Sector occurs in three levels:
1. Coordination at Federal Level
2. Coordination at Provincial Level
3. Coordination at Local Level
This National Strategic Roadmap on Health workforce Provides comprehensive guidance to the federal, provincial and local levels on Health, Health education. HRH strategy envisions to ensure equitable distribution and availability of quality health workforce as per the country health service system to ensure universal health coverage. This strategy provides guidance to the government at all levels in the federal context to fulfill the constitutional right for the access to health services by each citizen through effective management of the health workforce.
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.
Quality assurance is one of the important topic for our Nursing field this is important for M.Sc. Nursing Final Year students for the subject of management that will also help to all nurses either in the filed of clinical as well as education
quality assurance are the major topic related to Nursing as well as all health care department that are usefull to improve the quality of health care quality assurance models are important to assess the productivity of the services that are usefull in advance nursing care practices
Climate change is an acute threat to global development and efforts to end poverty. Without urgent action, climate impacts could push an additional 100 million people into poverty by 2030.
2016 was the hottest year since record-keeping began, and in November 2016 the UN announced that global temperatures have risen 1.2 degrees Celsius above pre-industrial levels.
The impact of extreme natural disasters is equivalent to a $520 billion loss in annual consumption, and forces some 26 million people into poverty each year.
(Source: World Bank, 2016)
BIO= Life
DIVERSITY= Variety, Difference
Richness and variety of life on earth
Biological Diversity, Raymond F. Dasmann in 1968.
Term biodiversity was coined in 1985, W.G. Rosen in 1985.
Charles Darwin: All species were linked in a single great phylogeny, or tree of life, and that all could be traced back to a presumed single original species at some distant time in the geological past.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
1. QUALITY ASSURANCE IN HEALTH
CARE
NABIN LAMICHHANE
Purbanchal University
lamichhanenabin@gmail.com
2. What is Quality?
Quality of care must be defined
in the light of the provider’s
technical standards and
patient’s expectations. While no
single definition of health
service quality applies in all
situations.
3. QUALITY
The quality of technical care consists in the
application of medical science and technology
in a way that maximizes its benefits to health
without correspondingly increasing its risks.
The degree of quality is, therefore, the extent
to which the care provided is expected to
achieve the most favorable balance of risks
and benefits.
- Avedis Donabedian, M.D., 1980
4. QUALITY
...proper performance (according to
standards) of interventions that are known to
be safe, that are affordable to the society in
question, and that have the ability to produce
an impact on mortality, morbidity, disability,
and malnutrition.
- M.I. Roemer and C. Montoya Aguilar, WHO,
19883
5. The most comprehensive
and perhaps the simplest
definition of quality is that
used by advocates of total
quality management:
“Doing the right thing right,
right away..”
6. Perspectives on the Meaning of
Quality
•The Client
•The Health Service
Provider
•The Health Care Manager
7. DIMENSIONS OF QUALITY
• Quality is a comprehensive and multifaceted
concept.
• These dimensions of quality are a useful
framework that helps health teams to define
and analyze their problems and to measure
the extent to which they are meeting
program standards
8.
9. QUALITY ASSURANCE
• Various definitions and Concepts
“All the arrangement and activities that are
meant to safeguard, maintain and promote
quality of care.”
- Dr Donabedian
10. “a systematic process of closing the gap
between actual performance and the
desirable outcomes…..”
- Drs. Ruelas and Frenk (Mexico)
11. Four Tenets of QA
• Quality Assurance is oriented toward meeting
the needs and expectations of the patient and
the community.
• Quality assurance focuses on systems and
processes.
• Quality assurance uses data to analyze service
delivery processes.
• Quality assurance encourages a team
approach to problem solving and quality
improvement.
12. The Quality Assurance Process
• PRICOR Project developed a simple, practical approach
to quality improvement that was applied in Africa, Asia,
and Latin America.
• WHO has promoted a QA paradigm developed by
Hannu Vuori that has been applied in selected
international settings.
• Some U.S. models include the quality assurance cycle
used by Palmer in ambulatory care settings; the 10-
step process developed by the Joint Commission on
Accreditation of Health Care Organizations; and CQI
which applies total quality management to health
services.
13. QAP's (Quality Assurance Process)
1. Planning for quality assurance
2. Developing guidelines and setting standards
3. Communicating standards and specifications
4. Monitoring quality
5. Identifying problems and selecting opportunities for
improvement
6. Defining the problem operationally
7. Choosing a team
8. Analyzing and studying the problem to identify its root
causes
9. Developing solutions and actions for improvement
10. Implementing and evaluating quality improvement
efforts
14.
15. Step 1:Planning for Quality Assurance
• First step
• Review of the organization’s scope of care to
determine high-priority, high-volume, or problem-
prone services.
16. Step 2: Setting Standards and Specifications
• Practice guidelines, sometimes called clinical protocols or
practice parameters, define how clinical processes such as
antenatal care are carried out.
• Administrative procedures, sometimes called standard
operating procedures, define routine nonclinical processes.
• Specifications usually pertain to product characteristics or
material inputs such as drugs or technical equipment related
to health service delivery.
• Performance standards are specific criteria used to measure
the outcome of service delivery and the activities that support
it.
17. 3. Communicating Guidelines and Standards
• Will ensure that each health worker, supervisor, manager, and
support person understands what is expected of him or her.
• More important if ongoing training and supervision have been
weak or if guidelines and procedures have recently changed.
• A dialogue about guidelines and standards can take place in
the context of supervision, training, or other channels.
• Activities that communicate guidelines and standards include
developing job descriptions, translating performance
guidelines into job aids, developing and conducting training
programs, holding formal conferences or informal
presentations about new procedures, providing on-the-job
training through supervisory activities, and informing
providers of changes in protocols through administrative
announcements.
18. 4. Monitoring Quality
• Routine collection and review of data.
• Assess whether program norms are being followed or
whether outcomes are improved
• By monitoring key indicators, managers and supervisors can
determine whether the services delivered follow the
prescribed practices and achieve the desired results.
• Processes
– Selecting indicators
– Setting thresholds
– Selecting information sources
– Designing a system for collecting and compiling data
– Implementing the monitoring activities
19. 5. Identifying Problems and Selecting Opportunities for
Improvement
• Suggestions from health workers, performing system process
analyses, reviewing patient feedback or complaints, and
generating ideas through brainstorming or other group
techniques.
• Employing a participatory approach
20. 6. Defining the Problem
• A gap between actual performance and
performance as prescribed by guidelines and
standards.
• Clearly state where the problem begins and
ends, and how to recognize when the problem
is solved.
21. 7. Choosing a Team
• Assign a small team to address the specific problem.
• Analyze the problem, develop a quality improvement
plan, and implement and evaluate the quality
improvement effort.
• Team should comprise those who are involved with,
contribute inputs or resources to, and/or benefit
from the activity or activities in which the problem
occurs.
22.
23. 8. Analyzing and Studying the Problem to Identify the Root
Cause
• Achieving a meaningful and sustainable quality improvement
effort depends on understanding the problem and its root
causes.
• complexity of health service delivery, clearly identifying root
causes requires systematic, in-depth analysis.
• Analytical tools such as system modeling, flow charting, and
cause-and-effect diagrams can be used to analyze a process or
problem.
24.
25.
26. 9. Developing Solutions and Actions
for Quality Improvement
• The problem-solving team should now be ready to develop and
evaluate potential solutions. Unless the procedure in question is the
sole responsibility of an individual, developing solutions should be a
team effort. It may be necessary to involve personnel responsible
for processes related to the root cause.
• A solution may be very straightforward: it may be as simple as
reminding staff about clinical guidelines through supervision or
focused in-service training. Solutions may also take the form of job
aids such as wall charts and checklists. They become part of the
process that provides information and checks at the point of service
delivery, thereby reducing error or variation. Often, solutions and
improvements are rooted in management systems related to
supervision, training, and logistics.
27. 10. Implementing and Evaluating
Quality Improvement Efforts
• The team must determine the necessary resources and time
frame and decide who will be responsible for implementation.
It must also decide whether implementation should begin
with a pilot test in a limited area or should be launched on a
larger scale. A pilot project is merited if the solution requires
substantial resources or if there is considerable uncertainty
about the solution’s potential effectiveness.
• The team should select indicators to evaluate whether the
solution was implemented correctly and whether it resolved
the problem it was designed to address
28. QA in NEAL
• In Nepal importance of QA in health care was felt in 1990s
and Nepal Medical Standard of Contraceptive was prepared
in 1991.
• In 1993 with restructuring of MoH a QA cell was
established under the Health institutions and Manpower
Division, DOHS.
• In the same year a quality care management center was
established under the Family Health Division, DOHS.
• Quality assurance programs are also carried out by the
National Public Health Laboratory, Department of Drug
Administration and by National Health programs such as TB
Control, Leprosy Control etc.
29. Standard Guidelines for Different Types of Health Services and Health Institutions
• Those private health institutions and health
organization who had registered and got permission to
open according to the recent policies and rules beside
that, those health organization should have
compulsory maintain and completed the pre
requisition and standard decided by MOH and take
approval letter. After these formalities they are allow
to running and implementing the program.
• Standards and pre-requisition should have to manage
and maintain according to the nature and level of
health organization and institution
30. Roles and Functions of QA Section
• Develop/design national QA system both for public and
private sector health programs and institutions.
• Draft necessary regulatory framework and get it promulgated
and develop related rules for its implementation.
• Monitor /supervise the quality of health care services
provided by both public and private sectors and provide
feedback accordingly.
• Facilitate program divisions and health institutions in
developing and health institutions in developing standards,
guidelines and service protocols for specific health services
including social inclusion and health care waste management.
• Coordinate with NHTC and other concerned agencies for
conducting orientation / training on QA.
31. Roles and Functions of QA Section
• Coordinate with NHEICC and other concerned agencies for
conducting awareness program on consumer’s right and
responsibilities to quality health services.
• Conduct / support studies and research activities to improve quality
health service.
• Coordinate and liaise with private health sector service and health
human resources training institutions.
• Monitor quality of care and human resources of both public and
private sector institutions.
• Liaise with QA Steering Committee at MoHP and QA Working
Committee at district level.
• Collect QA activity reports conducted by program divisions, health
institutions and other agencies review and analyze QA reports and
provide feedback to concerned agencies.
32. Importance of Q/A in Health care:
• Improve the health status of the population.
• Ensure the right of the people to access quality health
services.
• Meet consumers need expectations.
• Maximize utilization of resources and reduce cost.
• Ensure effective and efficient utilization of limited
resources.
• Standardize health care services and reduce variation.
• Ensure safety and minimize risk
• Fulfill the ethical and professional duty of health
professional.
33. The hindering factors:-
• Lack of policy, plan, and unclear strategy.
• Weak leadership
• Corruption and transparency issues
• Poor skill
• Lack/adequacy of resources
• No unity and integrity
• Lack of trust
• Misuse of authority
• Different perceptions with in leaders and
workers.
34. Role of GoN
• Policy formation based upon the appropriate environment,
feasibility and resources.
• Orientation to all the related personnel on programming
and intervening change.
• Proper allocation and utilization of resources.
• Decentralization of authority for actions.
• Distributions of work with accountability.
• Continued supervision, monitoring and evaluation of the
quality assurance program utilizing appropriate indicators.
• Encourage for simple operational research activities and
interventions of its recommendation for getting good result
(best outcome)
35. Professionals and Individual roles:
• Regulation
• Healthy competition
• Continue education
• Continue quality improvement
• Health care standards
• Follow, develop, protocols, gudielines.
• Develop and implementation of service process and
care method.
• Job aids.
• Conduct research for better implementation and
outcome.
36. Monitoring Indicators of Quality Assurance in health care service
management:
• Indicators are very much important to monitor
the health care services either hospital or in
community health settings.
• Hence there is need to develop the simple and
specifically designed indicators, which can be
easily understood by all health personnel.
• Then establish the simple, easy and feasible
mechanism for regular monitoring of the
quality assurance in health service.
37. Indicators:
• Percentage of need based services provided by trained health
personnel
• Maintain infection prevention activities.
• Management for risk cases and referral system.
• Percentage of client satisfaction and acceptance of health services.
• Proper system of co-ordination and communication.
• Provision and system of guidance and counseling.
• Motivation of service providers and their work satisfaction.
• Positive views of general public on service and care providers.
• Public relation system.
• Hazardous physical facilities
38. Indicators:
• Follow-up system.
• System of teamwork activities with effective leadership.
• Objectives of health services should be in written form and types of
health service.
• Clear and well defined hierarchical level of organizational chart.
• J/D of all related personnel.
• Policy, administration and protocol, procedure Manuel.
• Master rotation plan of staffing.
• Plan of appraisal of health personnel and evaluation format system.
• Develop Health Committees.
• Facilities and accessible of equipments and supplies.
• Records and reporting system.
39. Indicators:
• Facilities for staffs;
- Health
-Career development program
-Physical facilities, security from hazards
-In-service education.