1. Quality Assurance in
Healthcare Delivery;
A MUST for Safety of End
Users
Dr Olufemi Aina
Master TeamSTEPPS Trainer
Aesculapius Healthcare Consultants (AHC)

2. Our GoalsAesculapius Healthcare Consultants (AHC)
• Broaden Patient Safety Knowledge in Nigerian
Hospitals
• Develop Patient Safety Culture in our Hospitals by
deploying TeamSTEPPS Patient Safety Strategies

3.  Healthcare Quality
Assurance
 Entrenching Patient Safety
in our Healthcare System
 Developments in Quality
Assurance
 TeamSTEPPS Patient
Safety Strategies
 Need for Safety
Assessment in Hospitals
 Quality Assurance ensures
Safety

4. Components of Quality Care
Safe
Efficient
Effective
Equitable
Patient Centred
Timely
Thus Safety is the foundation upon which all other aspects of
Quality Care are built.
Institute of Medicine (IOM) considers patient safety
―indistinguishable from the delivery of quality health
care.‖

5. End Users of Healthcare Service
• Patients and Family Members
• Healthcare Provider and its Professionals

6. Quality Assurance is that set of activities that are
carried out to previously Set Standards to
monitor and improve Performance so that the
care provided is as Effective and as Safe as
possible.

7. Quality Assurance in Healthcare
Component of Quality Management that
ensures the Right things are being donebased on Standards and Established Goals.
Systematic Process of checking if a Healthcare
Service is meeting Specified Requirements
Helps reduce waste and unnecessary activities
and improve Service Delivery

8. Quality Assessment Methods
System Performance
 Health Priorities, System
Planning, Financing And
Resource Allocation done
at National Level & Global
Level.
 General Environment Of
The Country, Legislation
& Other Regulatory
Mechanisms, Professional
Recognition and Overall
Quality Management.
Institutional and Clinical
Performance
External Assessment
 ISO, Accreditation,
Licensing, EFQM, Peer
Review
Internal Self-assessment
 Patients Rights, Risk
Management, Clinical
Governance, Clinical
Audit, Performance
Indicators &
Benchmarking

9. Healthcare Quality Assurance Strategies
Comparing Healthcare Quality Improvement Strategies
Object of
Process
Issuing Organization
Standards
Evaluation
Minimum Standards to ensure a
Individual and
Licensure Mandatory Government
Minimum Risk Environment to Health
Organization
and Safety
Certification Voluntary Authorized Body
Components
Regulations to ensure Minimum
Standards, Competence and Onsite Inspection
Organization or ISO 9001 Standards to ensure
Organization to demonstrate
Component Conformance to Industry Standards Services, Technology or Capacity
Usually Non GovernmentalAccreditation Voluntary
Organization
Recognized Tools
Maximum Achievable Level to
Compliance with Published
stimulate Improvement over time Standards and Onsite Evaluation

10. 4 Tenets of Quality Assurance
• Oriented toward meeting the needs and
expectations of the Patients and other Users.
• Focused on systems and processes.
• Use data to analyse service delivery
processes.
• Encourage a team approach to Problem
Solving and Quality Improvement.

11. Developments in Quality Assurance
 1859- Florence Nightingale
introduced the first standards in
nursing care during the Crimean
War
 1966-Avedis Donabedian‗Evaluating the Quality of
Medical Care’
Structure| Process | Outcome
 1913-American College of
Surgeons(ACS)- Minimum
Standards for Hospitals
1998- International Society for
Quality in Healthcare (ISQUA)
ALPHA Program
 1951-Joint Commission- ACS ,
American College of Physicians,
American Hospital Association,
Canadian Medical Association,
American Medical Association
2004-WHO- World Alliance for
Patient Safety

12. Comparing Quality and Safety
Quality
Safety
Degree of the realisation of the
reasons that the Patient has
come to the care hospital e.g.
patient comes to Hospital for
an Operation
Results which are not the
reasons for the Patient coming
e.g. ‘not catching an infection’
and he is implicitly confident he
will not run the risk of this
happening.

13. Need for Safety Assessment
Institute of Medicine Report
Impact of Error:
 44,000–98,000 annual deaths occur
as a result of errors
 Medical errors are the leading cause,
followed by surgical mistakes and
complications
 More Americans die from medical
errors than from breast cancer,
AIDS, or car accidents
 7% of hospital patients experience a
serious medication error
Federal Action:
By 5 years;
 medical errors by
50%,
 nosocomial by
90%; and
eliminate ―neverevents‖ (such as
wrong-site surgery)
Cost associated with medical errors is $8–29 billion annually.

14. Medical Errors Still Claiming
05/18/2005
Many Lives
20/01/2005
By Elizabeth Weise, USA TODAY
As many as 98,000 Americans still die each
year because of medical errors.
Improvements
Hospitals have taken steps
to reduce medical errors
and injuries.
Examples:
The researchers blame the:

Computerized
prescriptions: 81%
decrease in errors.

Including pharmacist in
medical team: 78%
decrease in preventable
drug reactions.

Team training in delivery
of babies: 50% decrease
in harmful outcomes —
such as brain damage —
in premature deliveries.
 Reluctance to admit Errors
Billing System that Reward Errors
Lack of Leadership
Complexity of Health Care Systems
…little progress towards the goal
Leape and Berwick,
JAMA May 2005
Source: Journal of the
American Medical
Association
14

15. WHO- African Region
WHO- African Region
Adverse events
4% to 16% of all hospitalized patients
Developing Countries
estimated 5% to 10% of patients acquire one or more
infections
Risk
2 to 20 times higher than in developed countries.
Sentinel Events
Surgical Care- > 50% of Adverse Events, Unsafe
injections, blood and medicines
African Countries
Mali 18.9%, Tanzania 14.8%, Algeria 9.8%
Drugs
25% of medicines are counterfeit, poly-pharmacy,
inappropriate use of antimicrobials; overuse of
injections, lack of prescription guidelines,
inappropriate self-medication, non-adherence to
dosing regimes.

16. WHO- Patient Safety Practice
• Processes or structures which, when applied, reduce the
probability of adverse events resulting from exposure to
the health-care system across a range of diseases and
procedures.
• Healthcare-associated infection is a global problem with
over 1.4 million people suffering at any given time.
• Medical errors result in numerous preventable injuries and
deaths.
• Inadequate Patient Safety Data in African Region

17. Need for Safety-Personal Experience
• Young NYSC dr. in a GH, many years ago:
ordered IM drugs, nurse uncomfortable, even
though gave lower dose- respiratory arrest,
called and answered promptly.
• Young Father in a PH, Lagos: 2 years ago:
overworked nurse (esp. with reports), set up IV
line, suction didn’t work, sucked manually

18. Entrenching Patient Safety in Our
Healthcare System
 Focus on Patient Safety
Performance Goals in
Hospitals
Accreditation: ensure Sectorwide Quality Assurance System in
Healthcare.
 Reward Patient Safety
Achievement by Hospitals
Forward thinking AGPMPN is
embarking on Patient Safety and
Quality Management Program
 Government to support
Patient Safety Advocacy
Groups
 Patient Safety Forum between
Health Professionals &
Patient Groups
Accreditation standards will
include Patient Safety Standards
and Patient Safety Performance
Goals

19. The Components of a
Patient Safety Program
19

20. Classification of Medical Errors- Near Miss
Near Miss is defined as an act could have harmed the patient but
did not do so as a result of:
• Chance e.g. patient received a contraindicated drug but did not
experience an adverse drug reaction
• Prevention e.g. a potentially lethal over-dose was prescribed,
but a nurse identified the error before administering the
medication
• Mitigation e.g., a lethal drug overdose was administered but
discovered early and countered with an antidote.

21. Classification of Medical Errors- Adverse Events
Adverse Events cause harm to patients—causing a
large number of injury, disability, and death.
Errors of Commission
• Prescribing a medication that has a potentially fatal
interaction with another drug the patient is taking.
Errors of Omission
• Failing to prescribe a medication from which the
patient would likely have benefited, which may pose an
even greater threat to health.

22. Why Do Errors Occur—Some Obstacles
 Workload fluctuations
 Interruptions
 Fatigue
 Multi-tasking
 Failure to follow up
 Poor handoffs
 Not following protocol &
standard operating
procedures
 Poor Leadership
 Breakdown in
Communication
 Breakdown in Teamwork
 Losing track of Objectives
 Excessive professional
courtesy
 Complacency
 High-risk phase
 Task (target) fixation

23. Healthcare System focused on Patient Safety
• Prevents Errors
• Learns From The Errors That Do Occur
• Is Built On A Culture Of Safety that Involves
Health Care Professionals, Organizations, And
Patients.

24. Team Strategies & Tools to Enhance Performance & Patient
Safety
―Initiative based on
evidence derived
from team
performance…lev
eraging
more than 25
years of research
in military,
aviation, nuclear
power, business
and industry…to
acquire team
competencies‖

25. Quality Assurance ensures Safety by
assessing:
Adverse Event
Reporting
Adverse Event
Prevention
Patient Safety Culture
Communication and
Feedback
Leadership Support of
Patient Safety
Patient Involvement
in Care
Adverse Event
Analysis
Environment of Care

26. Accreditation Standards
 Hospital has a Patient
Safety Program
 Hospital Risk
Management Program
 Specific Prevention
Programs
 Transfusion Safety
Program
Procedures for identifying
Patients Correctly
Conducts Periodic Patient
Safety Training
Effective Communication
Techniques
Ensures Safety of HighAlert Medications

27. Accreditation Standards
 Ensures Correct-Site,
Correct-Procedure, CorrectPatient Surgery
 Conducts Risk Management
& Infection Prevention for
Healthcare Professionals
 Procedures for reducing
Health Care–Associated
Infections
 Hospital has Procedures for
handling, storage,
preparation & distribution of
foodstuffs
 Hand Hygiene Standards
 Ensures Radiation Safety
 Reduce Patient Harm
Resulting from Falls
 Ensures Injection Safety

28. The AGPMPN Quality Program
Components of the AGPMPN Quality Program
are :
• Patient Safety
• Staff Safety
• Quality Management
• Performance Excellence

29. Goals of The AGPMPN Quality Program
• First Professional Group to deploy an intensive Quality
Management and Patient Safety Program across board
• Influence all Healthcare Professionals and Service Delivery in
Nigeria.
• Build capacity for transformation across the entire AGPMPN
Membership with Peer Monitoring and Performance Management.
• Become Point of reference in Health in Nigeria and Africa as a
whole.
• Activate Paradigm Change in Nigerian Healthcare

30. Thank You