Performance Improvement Program At Ain Shams University Hospitals

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???Performance Improvement ProgramAt Ain Shams
University Hospitals

• By
• Prof. Mahi Al-Tehewy

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Justification 

• Quality of service delivery has become an
  important focus of attention for every one
  employed in health care.
• The national health reform policies in Egypt
  elaborated the pressing need and demand for a
  highly recognized quality improvement.
• This has led Ain Shams University leaders to
  adopt a program to improve service delivery at
  Ain shams University hospitals.

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• Accordingly, we reviewed the local quality
  initiatives and experiences and studied different
  quality approaches available to learn lessons.
• Then we conducted situational analysis to
  formulate the basis for selecting strategic
  directions and Q policies

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Background

• ASUHs are consisted of 4 hospitals of totally
  2780 beds.
• The oldest hospital had been established in 1931
  and has been exposed to several trials of
  renovation.
• There are about half million patients attending
  the outpatients clinics annually.
• ???About 85 thousands patients admitted annually,
  most of them are very poor people.
• 30 thousands surgical interference are done
  annually
• In addition, there are three specialized centers,
  the first for mental health, the second for
  oncology and the third for clinical toxicology.

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Objectives of situational analysis

• Determine QI strategies policies at ASUHs
• Identify requirements for QI implementation.

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Method

• SWOT analysis was used as a simple tool for
  situational analysis of the internal and external
  environment of ASUHs.
• Three-day workshop was done and attended by
  representatives of all stakeholders of healthcare
  (provided at ASUHs)
• The workshop was facilitated by national quality
  experts.

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Results of Situational AnalysisI- Strengths

• Strong Leadership commitment
• High technology
• Manpower

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Situational AnalysisI- Strengths

• Manpower
• Highly qualified and competent staff
• Increasing interest in quality improvement among
  hospital leaders and some members of the medical
  staff
• Presence of qualified persons capable of leading
  quality improvement programs

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Situational AnalysisII- Weakness

• Manpower
• Poor culture of quality
• Some health leaders underestimate the value of
  quality and are skeptical about feasibility and
  effectiveness of its approaches in improving
  health services
• Poor spirit of team work
• High resistance to change
• Few qualified human resources in quality

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Situational AnalysisII- Weakness

• Undergraduate and postgraduate medical studies
  are lacking components about healthcare quality
  concepts and approaches
• Training needs in healthcare quality are not
  clearly identified

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Situational AnalysisII- Weakness (cont.)

• Organization
• Deeply rooted bureaucratic administrative
  approaches
• Poor inter and intra-sectoral coordination
• Dual role being educational and service
  institutions (unclear organization)
• Lack of managerial skills at all levels
• Job descriptions are not available for all
  members of health teams. Moreover, what are
  available are not properly communicated between
  health team

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Situational AnalysisII- Weakness (cont.)

• Supply and Finance
• Rules and regulation of incentives do not support
  quality improvement activities.
• Bureaucracy of financing and methods of
  dispensing
• Poor salaries of physicians and other members of
  health team
• Preparing budget is not depending on real needs
• Mal distribution of some resources
• Scanty fund posts for quality

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Situational AnalysisII- Weakness (cont.)

• Poor maintenance
• Poor monitoring system
• Poor information system
• Poor infrastructure
• The problem of sustainability of activities

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Situational AnalysisIII Opportunities

• Political commitment
• National standards for general hospitals are
  available now
• Establishment of HSQ unit at Faculty of Medicine
  in 1999
• Starting establishment of the Center of
  Educational Quality and Accreditation at Ain
  Shams University

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Situational AnalysisIII Opportunities (cont.)

• Many parties are interested in quality (national
  and international)
• Availability of evidence based practice
  guidelines at no cost
• Availability of quality measures and quality
  improvement projects at no cost

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Situational AnalysisIV Threats

• Global Layer
• Unstable exchange rate for foreign currency
• Globalization of the health sector by January
  2005 will develop free market of healthcare, new
  competitive providers, firms or organizations for
  accreditation, unstudied rush of local facilities
  to be accredited by international organization

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• TRIPS (Trade related aspects of intellectual
  property rights) will affect, drug market and
  medical supplies
• The current legislations, or policies are
  un-sufficient to protect the local healthcare
  market.
• Vision of the authorities regarding how to face
  current and future threats is poorly communicated.

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Situational AnalysisIV Threats (cont.)

• Lack of quality culture
• Lack of data culture
• Low expectation of clients is considered as a
  threat to achieve optimum level of quality

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Situational AnalysisIV Threats (cont.)

• Adjacent Layer
• - Powerful highly skilled professional
  international competitors are starting invading
  healthcare market in Egypt
• - Potential competitors are expected from
  everywhere for the big Egyptian market
• - Monopoly in the field of medical supplies and
  drugs especially after application of TRIPS

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Strategic Goals

• Ensure quality of healthcare delivered in ASUHs
• Building up capacities for quality at all levels
• Create and communicate culture of quality in
  ASUHs
• Satisfy the needs and expectations of healthcare
  providers and consumers
• Intra-sectoral coordination between different
  departments

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Strategic Direction

• Intensive strategies
• Service development
• Market development
• Defensive strategies
• Joining with others
• Right sizing and down sizing
• Decentralization
• Diversification (low cost providers)

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Come to the challenge

• End of
• The First and Easy part

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Performance Improvement Program

• Goal
• Improving performance and quality of service
  delivery at ASUHs

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Objectives

• 1- Developing a sustainable system for managing
  quality
• 2-  Improving effectiveness and efficiency of
  the service 
• 3- Containment of Resources
• 4-  Satisfaction of internal and external
  customers  

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Methodology

• 1- Building up structure for quality
• Higher Quality Council
• Hospital Quality Committee
• Quality Coordinator
• Relevant Committees
• Starting date Jan. 2004

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Structure of quality
Higher QC
Central Q Manager
Q Committee
Q Committee
Q Committee
Q Committee
Hospital Q coordinator
Hospital Q coordinator
Hospital Q coordinator
Hospital Q coordinator
Relevant Committees
Relevant Committees
Relevant Committees
Relevant Committees
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Methodology (cont.)

• 2- Setting Standards
• Task Force Group
• A group of experts (headed by the head of
  technical office) in different hospital functions
  formulated to review available national and
  international standards to adopt, adapt, clarify,
  and end up with well-defined quality standards
  for all functions of the hospital.

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Methodology (cont.)

• 3- Training of QC of Al-Demerdash and Maternity
  Hospitals (28th Feb.-2nd March)

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Methodology (cont.)

• 3- Communicate standards
• 4- Awareness of all employees

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• 5- Quality awareness among high and middle-level
  leaders
• (Sonesta Hotel, 15th March)

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Methodology (cont.)

• 6- Pilot study
• Implementation of QM at one hospital
• Comprehensive Initial Assessment (guided by the
  settled standards)
• (20-24th March)

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CSS.D
Observation and interview
CSS.D
Observation and interview
CSS.D
CSS.D
CSS.D
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Methodology (cont.)

• Q I Plan
• Priority assessment
• Establish the projects for improvement
• Diagnose the cause
• Remedy the cause
• Hold the gain (monitoring system)
• - Plan of action

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