Quality Assurance Orientation Program Quality Assurance Cell State

Quality Assurance Orientation Program Quality Assurance Cell, State Health Society, Bihar

Quality Ability of service to satisfy the needs & expectation of users & to meet the purpose for which it is designed. Appraisal of healthcare facility & services in terms of – ü core healthcare services. ü safety & hygiene. ü comfortable atmosphere. ü facilitation when a healthcare seeker visits. ü Ambience.

Perception of Quality may mean different things to different people. � For poor people - Quality in health services means accessibility and availability of services when in need at minimum cost. � For services provider - Quality means timely availability of services with minimum infection rate. � For community as whole- Quality means availability, accessibility, affordability with positive impact in the environment. � For state - Quality means ensuring health care services which is based on the concept of equity, which makes services available, accessible, affordable, and high level of infection control.

Quality Management System �It is an approach which encourages health facilities to analyze the requirement of service user, define the processes and keep the processes under control for consistency. �Identify the gaps in service delivery, trace its root causes & then suggests solution to close this gaps so that its effect is sustainable. �Corrective & preventive measures - Regular review of actions taken & result so that the problem doesn’t occurs again & again, it plans & implement system so that whenever gap emerges it gets resolve at the point of emergence.

ANY SUSTAINABLE CHANGE IN TERMS OF INSTITUTIONALISATION OF QUALITY ASSURANCE (QA) WILL COME FROM WITHIN THE SYSTEM & NOT FROM OUTSIDE. “ITS WE WHO CAN IMPROVE THE QUALITY TO OUR SYSTEM”

Why is quality needed in healthcare system Quality in healthcare is not a matter of choice, it is mandatory, as it can cost life. �Benefit users by ensuring quality of service provision. �Ensure efficient utilization of resources. �Provide for transparency and accountability in the functioning of the healthcare system. �Generate a sense of pride and achievement for the health care providers.

Quality: Is a continuous process that has to be sustained for continual improvement.

State’s focus Area in Quality Assurance � Formation, orientation & regular (monthly) meetings of QA committee. (For FY 2012 -13 FMR code : - B. 15. 2) � Hospital level quality improvement as per standards. (For FY 2012 -13 FMR code : - B. 15. 2+ RKS, Hospital maintenance grant, untied fund, MCH/FP funds, etc. ) � Quality certification of hospitals � Qualitative operationalization of Facility Based Newborn Care Units (NBCC/NBSU/SCNU) {For FY 2012 -13 FMR code : - A. 2. 2. 2}; labour rooms, , Family Planning Corner (FP Corner) � Death review – Especially maternal deaths

QUALITY ASSURANCE COMMITEE -COMPOSITION, ROLES & RESPONSIBILITIES

Formation & strengthening of Quality Assurance Committees State Quality Assurance Committee (Chairperson - Principle secretary – Health, Cochairperson – Executive Director, SHSB) Nodal Person - Regional Program Manager. Supported by R (M&E) Nodal Person - District Program Manager. Supported by DPC Nodal Person - Dy. Superintendent /MOIC. Supported by Hospital Manager / Health Manager Regional Quality Assurance Committee (Chairperson – Regional Deputy Director) District Quality Assurance Committee (Chairperson – Civil Surgeon) Facility level Quality Improvement Group 1. 2. 3. 4. State Quality Assurance Cell: - QA Nodal Officer Consultant –MCH – QA Consultant –FP – QA Quality Assurance Manager

Regional Quality Assurance Committee Functions of RQAC : � Monitoring of health facilities & guiding the District level teams on development of processing for ensuring quality health care services from that facility. � Ensuring adherence of treatment protocols on public health management and to ensure delivery of quality health care services focusing more on the medical colleges, district Hospital and FRUs. � Planning, controlling, management of the medical staff, demography and bio-statistic, management of research in health care, epidemiology and community health and strategic management. � Ensuring proper functioning of the Hospital Management information system and will also ensures and monitor the maintenance of the medical records, as prescribed. � Management of health and related services within the medical colleges/hospital premises to achieve optimal care by providing staff with managerial leadership, experts advice and opinion to aid diagnosis, management and treatment of patients � To provide quality of care through the monitoring and evaluation of services, development of protocols, supervision of staff and continuing education � Review the cases of maternal & infant deaths and report from cases of adverse outcomes/complications in maternal, neonatal health & child health. � To provide technical inputs to the medical colleges/District Hospital/FRUs within the division for improving their functioning.

{ks=h; xq. koÙkk ; dhu uks. My vk. Wf. Qlj & {ks=h; dk; ZØe izca/kd. A dk; ks. Z ds lle; fu"iknu esa {ks=h; M & E Hkh mÙkjnk; h gksaxs. A {ks=h; xq. koÙkk ; dhu uks. My vk. Wf. Qlj ds dk; Z , oa ft. Eesnkfj; k. W %& fu; fer RQAC dk c. SBd le; ls lqfuf’pr djuk@djokuk. A c. SBd dh dk; Zokgh lss izea. My ds l. Hkh ftyksa vk. Sj jk. T; Lok. LF; lfefr dks voxr djuk@djokuk. A � {ks=h; xq. koÙkk ; dhu lfefr dh xfrfof/k; k¡ ; kstuk ds vuqlkj lle; fu"iknu djuk@djokuk. A blds vfrfj. Dr fdlh Hkh izdkj ds QA need based activity dks djokuk. A � ftyk xq. koÙkk ; dhu lfefr (DQAC) dh ekfld c. SBd fu; fer djokus gsrq vko’; d dne m. Bkuk. A � ftyk xq. koÙkk ; dhu lfefr (DQAC) dks vko’; drkuqlkj rduhdh lg; ksx iznku djuk. A � izea. My varx. Zr l. Hkh ftyksa esa py jgs xq. koÙkk ; dhu dk; ZØeksa dh izxfr dk i; Zos{k. k fujh{k. k djuk@djokuk r. Fkk lle; vuqikyu lqfuf’pr djokuk. A � v. Lirkyksa dks FFHI, ISO, b. R; kfn izek. khdj. k ds fy, fuf’pr le; lhek ds vanj r. S; kj djokuk. A � xq. koÙkk lq/kkj dk; ZØeksa dh izxfr gsrq jk. T; o ftyk Lrj ds lk. Fk liasioning djrs gq, Hkk. Sfrd , oa foÙkh; izxfr dks lqfuf’pr djokuk. A � izxfr izfrosnu dks ¼izk: i esa½ fu; fer : Ik ls jk. T; Lok. LF; lfefr dks Hkstuk. A � jk. T; ds }kjk le; ≤ ij ekaxh xb. Z tkudkfj; ksa ; k funs. Z’kks dk lle; vuqikyu djuk@djokuk. A

District Quality Assurance Committee Functions of DQAC: - • Meet once every month. • Develop half yearly action plan of district for quality assurance intervention in the facilities (Based on facility wise planning for infrastructure strengthening and strengthening of services at the facility). • Provide technical and managerial guidance to blocks on the implementation of action plan for improving the quality of services in the facilities disease control programme service delivery in the state. • Monitor the Quality Improvement of programme and track progress based on identified quality indicators at each level e. g. Sub Centres, PHCs, SDHs, District Hospitals and Medical College. Also keep a check whether the facilities are providing the essential service package as per standards and protocols being adhered to. • Review the cases of maternal & infant deaths at facility level and report cases of adverse outcomes/complications. • Collecting information on all hospitalization cases related to complications following sterilization as well as sterilization failure. • Processing all cases of failure, complications requiring hospitalization, and deaths following sterilization for payment of compensation. • Reviewing all static institutions, i. e. government and accredited private / NGOs and selected camps providing sterilization services and safe abortion services, for quality of care as per the standards laid down, and recommending remedial action for institutions not adhering to the standards.

Cont…. • Conducting medical audits from time to time of all maternal & infant deaths and deaths related to sterilization and sending reports to the State QAC office. • Review & monitor the quality of trainings under RHC II/National disease control programmes organized at state & district level and undertake follow-up of selected sample of trainees during field visits. • Review of different community based interventions, implementation of schemes under MNCH. • Plans QAC visits and make necessary preparations for visit to facilities and use the standardized QA Checklists to conduct assessment and debriefs the Medical Officer In-charge of the facility with guidance on what actions needs to be taken. • Compiles findings during the visits at the district level and distributes the District Summary Report and discusses these at the monthly meeting with medical officers. Forward the minutes of the monthly QAC meeting and actions to be taken to the concerned officials; regional and state QAC. • Shares the district visit reports with State Committee on monthly basis and initiates actions based on recommendations from state committee. To address the state level actions, the district has to take the initiation and pursue the state authorities and follow-up. • Keeps a record of follow-up and actions taken so that these can be reviewed on subsequent visits to the facility. • Ensure empanelment of doctors at district level performing sterilization operations & maintain / update their databases.

ftyk xq. koÙkk ; dhu uks. My vk. Wf. Qlj & ftyk dk; ZØe izca/kd. A dk; ks. Z ds lle; fu"iknu esa DPC Hkh mÙkjnk; h gksaxs. A ftyk xq. koÙkk ; dhu uks. My vk. Wf. Qlj ds dk; Z , oa ft. Eesnkfj; k¡ %& � ftyk xq. koÙkk ; dhu lfefr ds c. SBd dks flfoy lt. Zu dh v/; {krk esa iz. R; sd ekg djokuk( c. SBd esa v. Lirkyksa ds xq. koÙkk ; dhu ls lacaf/kr fy; s x; s fu. k. Z; ksa ls l. Hkh v. Lirkyksa ds DS/MOIC dks voxr djokuk. A � ftyk xq. koÙkk ; dhu lfefr dh xfrfof/k; ksa ds ; kstukuqlkj lle; fu"iknu lqfuf’pr djokuk. A blds vfrfj. Dr fdlh Hkh izdkj ds QA need based activity dks djokuk. A � ftyk varx. Zr l. Hkh p; fur v. Lirkyksa ¼ISO, FFHI, b. R; kfn½ esa py jgs dk; ks. Za dh izxfr dk i; Zos{k. k fujh{k. k djuk@djokuk r. Fkk lle; vuqikyu lqfuf’pr djokuk. A � buds vfrfj. Dr ftys ds v. U; l. Hkh v. Lirkyksa (PHC, SDH, RM, DM) esa xq. koÙkk lq/kkj dk; ZØe dks ykxw djus ds fy, ; kstukc} rjhds ls visioning cum gap analysis exercise djokuk] action plan cuokuk r. Fkk mlds vuq: Ik dk; Z djokuk A � v. Lirkyksa dks FFHI, ISO, b. R; kfn izek. khdj. k ds fy, fuf’pr le; lhek ds vanj r. S; kj djokuk. A le; ≤ ij Vhe x. Bu dj v. Lirkyksa ds xq. koÙkk izxfr dk ew. Y; kadu djkuk. A � xq. koÙkk lq/kkj dk; ZØeksa dh izxfr gsrq jk. T; o {ks=h; Lrj ds lk. Fk liasioning djrs gq, Hkk. Sfrd , oa foÙkh; izxfr dks lqfuf’pr djokuk. A � l. Hkh v. Lirkyksa ls izk. Ir izxfr izfrosnu dks lay. Xu dj ftyk Lrj ds izxfr izfrosnu ds lk. Fk jk. T; dks r. Fkk mldh izfrfyfi {ks=h; Lrj ij miy. C/k djkuk. A lk. Fk gh v. Lirkyksa ds xq. koÙkk lq/kkj lacaf/kr Qks. Vks] documentary, testimonial b. R; kfn le; ≤ ij jk. T; dks miy. C/k djokuk. A � jk. T; ds }kjk le; ≤ ij ekaxh xb. Z tkudkfj; ksa ; k funs. Z’kks dk lle; vuqikyu djuk@djokuk. A

ftyk xq. koÙkk ; dhu uks. My vk. Wf. Qlj & ftyk dk; ZØe izca/kd. A dk; ks. Z ds lle; fu"iknu esa DPC Hkh mÙkjnk; h gksaxs. A ftyk xq. koÙkk ; dhu uks. My vk. Wf. Qlj ds dk; Z , oa ft. Eesnkfj; k¡ %& � ftyk xq. koÙkk ; dhu lfefr ds c. SBd dks flfoy lt. Zu dh v/; {krk esa iz. R; sd ekg djokuk( c. SBd esa v. Lirkyksa ds xq. koÙkk ; dhu ls lacaf/kr fy; s x; s fu. k. Z; ksa ls l. Hkh v. Lirkyksa ds DS/MOIC dks voxr djokuk. A � ftyk xq. koÙkk ; dhu lfefr dh xfrfof/k; ksa ds ; kstukuqlkj lle; fu"iknu lqfuf’pr djokuk. A blds vfrfj. Dr fdlh Hkh izdkj ds QA need based activity dks djokuk. A � ftyk varx. Zr l. Hkh p; fur v. Lirkyksa ¼ISO, FFHI, b. R; kfn½ esa py jgs dk; ks. Za dh izxfr dk i; Zos{k. k fujh{k. k djuk@djokuk r. Fkk lle; vuqikyu lqfuf’pr djokuk. A � buds vfrfj. Dr ftys ds v. U; l. Hkh v. Lirkyksa (PHC, SDH, RM, DM) esa xq. koÙkk lq/kkj dk; ZØe dks ykxw djus ds fy, ; kstukc} rjhds ls visioning cum gap analysis exercise djokuk] action plan cuokuk r. Fkk mlds vuq: Ik dk; Z djokuk A � v. Lirkyksa dks FFHI, ISO, b. R; kfn izek. khdj. k ds fy, fuf’pr le; lhek ds vanj r. S; kj djokuk. A le; ≤ ij Vhe x. Bu dj v. Lirkyksa ds xq. koÙkk izxfr dk ew. Y; kadu djkuk. A � xq. koÙkk lq/kkj dk; ZØeksa dh izxfr gsrq jk. T; o {ks=h; Lrj ds lk. Fk liasioning djrs gq, Hkk. Sfrd , oa foÙkh; izxfr dks lqfuf’pr djokuk. A � l. Hkh v. Lirkyksa ls izk. Ir izxfr izfrosnu dks lay. Xu dj ftyk Lrj ds izxfr izfrosnu ds lk. Fk jk. T; dks r. Fkk mldh izfrfyfi {ks=h; Lrj ij miy. C/k djkuk. A lk. Fk gh v. Lirkyksa ds xq. koÙkk lq/kkj lacaf/kr Qks. Vks] documentary, testimonial b. R; kfn le; ≤ ij jk. T; dks miy. C/k djokuk. A � jk. T; ds }kjk le; ≤ ij ekaxh xb. Z tkudkfj; ksa ; k funs. Z’kks dk lle; vuqikyu djuk@djokuk. A

v. Lirky xq. koÙkk ; dhu uks. My vk. Wf. Qlj & v. Lirky v/kh{kd@iz. Hkkjh fpfd. Rlk inkf/kdkjh. A dk; ks. Z ds lle; fu"iknu esa v. Lirky izca/kd@Lok. LF; izca/kd Hkh mÙkjnk; h gksaxs. A v. Lirky xq. koÙkk ; dhu uks. My vk. Wf. Qlj ds dk; Z , oa ft. Eesnkfj; k. W %& • v. Lirky Lrj ij , d xq. koÙkk lq/kkj lfefr dk x. Bu DS/MOIC dh v/; {krk esa djuk@djokuk ftlesa v. Lirky ds inkf/kdkjh@dfe. Z; kas (MO/HM/ANM/Nurses/BAM/LT/VI grade Staff representative b. R; kfn) dh Hkkxhnkjh gks. A • xq. koÙkk lq/kkj lfefr dh c. SBd iz. R; sd ekg djuk@djokuk r. Fkk fy, x, fu. k. Z; ksa ls ftyksa dks voxr djkuk. A • v. Lirky lq/kkj gsrq xfrfof/k; ksa ds ; kstukuqlkj dk; ks. Za dk lle; fu"iknu djuk@djokuk r. Fkk vuqikyu izfrosnu lay. Xu izk: Ik esa iz. R; sd ekg ftyksa dks miy. C/k djkuk. A • iz. R; sd =Sekl Gap Analysis Report dh leh{kk djuk r. Fkk mldks v|ru djuk@djokuk. A • v. Lirky dks FFHI/ISO, b. R; kfn ds fy, r. S; kj djokuk. A

HOSPITAL QUALITY IMPROVEMENT & CERTIFICATION

Approaches for Establishment of QMS in Hospital Visioning, Gap Analysis, Action Plan Development, SOPs, availability of standard documents & guidelines Implementation, Training/capacity building, Report compilation & timely reporting PLAN DO Quality service & better Environment for patient Quality certificate to hospital ACT Corrective & preventive action; redesigning of plans & system etc CHECK Progress monitoring, review of developed action plan, Lags & lacunas in implementation of affecting final outcome

Process of FFHI In Facility � Team building -Formation of Hospital Meeting by Hospital Quality Improvement Group � Visioning Exercise & Problem Bank creation. � Vision statement of health facility / Quality statement. � Gap analysis Self. Assessment � Action Plan Development with Time frame (Prioritizing the gaps, level at which gaps would be addressed, resources/FMR source, responsible person, etc) � Monthly Hospital Quality Improvement Group and RKS Follow up / Monitoring Hospital staff RKS meetings for approval of work and associate line department. Gap Analysis District QA Team Hospital QI group � Implementation of Plan according to activity plan. � Indicator development. � Monitoring & check. � Apprise District QAC on the processes & progress. � Once facility is ready it may apply to DQAC for certification. Corrective steps Action Plan Independent assessment and certification

Process of certification Diagrammatic representation for facility assessment and certification process Submit report with recommendation or non-recommendation for certification visit State Quality Assurance Committee (SQAC) Submit final reports for conducting certification visits Check readiness of facility and request for assessment Regional level Assessment team (RQAC + any nominated member) District Quality Assurance Committee (DQAC) Apply for certification Public Health Facility Forward request to conduct assessment Conduct certification Visit & award quality certificate State Certification Body Check readiness of facility and request for assessment

PHOTO GALLERY- QUALITY ASSURANCE

SDH, Sherghati

PHC, Uchkagaon, Gopalganj

SDH, Danapur

Sadar Hospital, Aurangabad

Quality Poiicy Duty roaster; sitting arrangement at OPD Doctor list OT

Thanks.