This document discusses standards for quality eye care services and infrastructure. It outlines key aspects of quality including professional performance, use of resources, risk management, and patient satisfaction. Key components of quality infrastructure are proper planning, equipment, trained staff, record maintenance, and accreditations. The document also discusses layout and facilities for outpatient departments, inpatient wards, operating theaters, and overall hospital infrastructure and emphasizes the importance of standardized procedures, staff training, and accreditation in ensuring quality of care.

1. Standard Infrastructure
for Quality Eye Care Services
DR. DIVYESH P. SHAH
Sight First Technical Advisor,
MD 322

2. The American Medical Association defines the
quality of care services as “the degree to which
[these] services influence the probability of
optimal patient outcomes.

3. The World Health Organization offers a more
comprehensive definition and divides
quality in four sections :
1 Professional performance
2.Use of resources
3 Risk management
4 Patient satisfaction
‘whole system’

4. Quality Infrastructure
1. Planned OPD, IPD & OT
2. Proper equipments
3. Trained human resources
4. Record maintenance
5. Accreditations

5. Building and Infrastructure :
1. Layout
2. Maintenance
3. Sanitation and Hygiene

6. Layout of facilities
• Amenities OPD FACILITIES
Reception
– Seating
– Consulting rooms: optometrists, opthalmologists
– Investigation rooms
– Speciality clinics - Squint clinic, retinal clinic, glaucoma clinic
etc
– laser and minor procedures room
– Patient counselor
– Canteen
– Banking / ATM
– Medical Shop
– Optical shop
– Parking
– Telephone facility
– Travel Desk

7. OPD

8. Patient waiting hall

11. Hospital Atmosphere
• Ambience
– Clean, Safe environment
– Infection free atmosphere
– Pleasant

12. LAYOUT
• IPD facilities –
- proper OT layout
- pre OT and post OT facilities
- wards and private cabins
- nurses station
- emergency medicines and treatment
facilities
• Store

13. Operation Theatre
• OT complex
• Pre OT
• OT walls and flooring
• Laminar airflow
• Septic OT
• Autoclave room, proper autoclave, scrub
area
• Facilities for patient emergency

14. Wall & Floor

15. Floor and wall construction
• Nonporous material with minimal joint is
recommended for Walls and floors
• Surface should be smooth for better
disinfection.
• Corners should be rounded
• Thorough wiping of walls and floor with
disinfectants is currently preferred to
regular fumigation.

16. Theatre lay out and interior
• Minimum two barriers are recommended
between external air and the Operating
Room.
• Prevent entry of external air to prevent
contamination of inside air.
• No window in the theatre.
• Any surface that may gather dust should be
avoided like fans, cupboards etc. Only
essentials
• Split AC

17. OT Layout

18. Appropriate Technology /
Techniques
• Will it minimize complications
• Will it improve visual outcomes
• Will it enhance productivity
• Will it minimize follow up
• Will it improve satisfaction
“ Technology is a queer thing. It brings you great gifts with one
hand, and it stabs you in the back with the other”

19. Monitoring surgical supplies
• Use the same source
• Periodic QC of the supplies used : irrigating solutions,
viscoelastics, disposables etc
• Check sterility, pH etc
“Most worthwhile achievements are the result of
many little things done in a single direction”

20. Safety Control
• Electricity safety and Power Loss
• Fire Safety
• Biological Hazard
• Reporting of Mishaps/ Just missed events.

21. Systems to Ensure
Efficiency & Quality
• Clinical Protocols
• Standardization of procedures
• Resources - Usage & Balancing
• Staff Training & Discipline
• Documentation Systems

22. Hospital Management software

23. Total Computerization
• Administrative
• Medical records
• Finance and Book keeping

24. Human resources
1. Trained staff
2. Technical Skills
3. Task to skill matching for individual
“you can have the best strategy and best
building in the world, but if you don’t have
the hearts and minds of the people who
work with you, none of it comes to life”

25. Appropriate use of manpower
• Increases out put & Reduces cost
• Maintains quality of skill at high level
• Eliminate non-productive activities
• Increases job satisfaction
“ At the end you bet on people , not on
strategies”

26. Staff Training & Discipline
• Systematic procedure
for training
• Individual skills are
continuously upgraded
by training to reach
acceptable levels
• Motivating the staff to
train others
“Management is nothing more than
motivating people”

27. Standardization of procedures
• Essential to streamline workflow
• Person responsible for each task/process identified
• Expected outcomes quantitatively & qualitatively
well defined
• Clarity is achieved by frequent discussion and re-emphasis

28. ACCREDITION
• NABH
• ISO....

29. What is Accreditation
• Accreditation means Certification of competence in a
specified subject or areas of expertise by external
agencies.
• There are four principal component
1. It is based on written and published standards
2. Reviews are conducted by professional peers
3. The accreditation process is administered by an
independent body
4. The aim of accreditation is to encourage
organizational development.
5. On going process

30. Patient Centered Care

32. Effective philanthropy requires a lot of
time and creativity – the same kind of focus
and skills that building a business requires
-- Bill Gates
THANK YOU
DR DIVYESH P SHAH, TA MD 322

33. Surgical Quality
Surgical Complication rate
XYZ LIONS EYE HOSPITAL
– 2007 1.45%
– 2008 1.24%
– 2009 1.06%
– Surgeons’ performance review

34. Follow up Visual Outcome
Vision
category
PAYING FREE CAMP
NOS. % NOS. % NOS. %
Unaided Visual Outcome
(6/6-6/18) 1706 86.25% 925 52.11% 2207 55.56%
(6/24 - 6/60) 235 11.88% 783 44.11% 1666 41.94%
(<6/60) 37 1.87% 67 3.77% 99 2.49%
NO ENTRY 0 0.00% 0 0.00% 0 0.00%
TOTAL 1978 1775 3972
Best Corrected Visual Outcome
(6/6-6/18) 1914 96.76% 1466 82.59% 3805 95.80%
(6/24 - 6/60) 42 2.12% 303 17.07% 126 3.17%
(<6/60) 22 1.11% 6 0.34% 41 1.03%
NO ENTRY 0 0.00% 0 0.00% 0 0.00%
TOTAL 1978 1775 3972

35. Compliance to Treatment
• Counseling – Providing maximum
information
• Health Education inputs – Audio Visual
aids (Brochures, posters, pamphlets, etc.,)
• Informed decision making
– Risks, complications, benefits, alternative
procedures, guarded prognosis, etc.,

36. Comprehensive Eye Examination
• History
• Visual Acuity/Refraction
• Systemic Examination (BP/Blood sugar)
• IOP
• External torch light examination
• Slit Lamp Examination
• Fundus Examination

37. Non-medical needs

38. Employee safety and Policies

39. To prevent mistakes
• Create culture of safety
• “First do no harm”
• Improve Processes
– Reduce complexity
– Develop reliable processes
– Create independent checks for key
processes
• Make the organization depend on systems and
not on individuals

40. Most of the errors / failures go
unreported…
Due to
 staff fear of reprisal
 lack of adequate systems to report
 limited staff education about safety and report process
and
 lack of computerized surveillance systems
So, So, alleviate alleviate the the fear fear of of reporting reporting through through training
training
and sharing the importance of IR system
and sharing the importance of IR system

41. Hospital Assessment Tool
• Dr. Moses file on Assessment

42. • Safety -
• Patient-Centred - care should be based on individual needs
• Timely - waits and delays in care should be reduced
• Effective - care should be evidence-based
• Efficient – best use of resources and reduced waste
• Equitable - care should be equal for all people irrespective their gender,
economic status, caste, religion, etc

43. Access
Availability
•Core services matching the community needs
•All services under one roof
•Outreach programs
•Open Access system

44. Core result of service:
Patient satisfaction
Handling patient complaints promptly improves
Handling patient complaints promptly improves
satisfaction
satisfaction
• Patient complaint is
everybody’s
responsibility
• Viewing Complaints as
feedback for improvement
• Patient feedback
monitoring