Advanced Healthcare Technology Management Workshop Mombasa, Kenya — 9-12 August 2006 Quality Management & HT Baset Khalaf Tshwane University of Technology

What is Quality in Health Care? “The Right People Doing the Right Thing (at the Right Time).” Deming The Right Thing = Highest Quality Care  Defined by the USA National Institutes of Health  A measure or indicator of the degree to which health care is expected to increase the likelihood of desired health outcomes and is consistent with established standards of health care.

Measure & Improve Quality through  Appropriate quality culture & quality improvement (QI) infrastructure  Prioritized QI initiatives based on disease burden, best practice & broad relevance  Appropriate QI indicators & tools  Performance feedback  Evidence-based medicine & CE practices

Quality Improvement cont.  All healthcare services must be delivered accurately and correctly  Such indicated services must be delivered at the right time  Avoid Healthcare services that not helpful to the patient  Avoid services that not reasonably cost-effective  Avoid Safety hazards and errors that harm patients and employees  The patient’s unique needs and preferences are respected.

Principles of Quality Culture & QI Infrastructure  Leadership : unity of purpose, create environment for people to become fully involved, achieve objectives  Factual approach to decision making : based on logical analysis, manage what you can measure  Involvement of people : enable their ability for the organization’s benefits  Customer focus : know your clients, their current & future needs, strive to exceed their expectations  Process approach : resources & activities are managed as a process; accuracy-staff effectiveness-cost reduction  Systems approach to management : system of interrelated processes for a given objective

Principles of Healthcare Delivery  Prevention of harmful events extends resources life  Reduce inappropriate variation in diagnosis & treatment  Patient must be the center of HC delivery  Those who know how to must lead the improvement process  Multi-disciplinary teams is the right approach for most efficient QI  Measure-feedback and intervene  Good management practice: medicine-lab- equipment

Typical QI indicators used in HTM PM  Type/number of devices scheduled for service  Type/number devices inspected  Type/number of devices that failed an inspection  Type/number: on-demand service  Type/number found with physical damage  Type/number of no problem found  Type/number serviced more than once in 7-days  Type/number involved in incident  Type/number requiring abnormal labor or parts  Inspections failed  No inspection-equipment not located or in use

Typical QI indicators used in HTM Repair  Downtime (uptime)  Specific equipment failure  Number of repairs  Average time per repair  Downtime due to repairs  Repair turnaround time  Response time for repairs  Repeat repairs  Repairs delayed due to parts order  Downtime due to parts order  Mean time to repair

Typical QI indicators used in HTM Users 1. User-related problems 2. % user errors associated with high risk devices 3. Number of user errors 4. Number of repairs caused by user misuse/abuse 5. Frequency repairs by user errors 6. Frequency user errors on same shift/ same unit Miscellaneous 1. Complaints 2. Incident investigations 3. Equipment Recalls

Quality Assurance Focused Approach, Binseng Wang, USA 2000  Program components 1. Equipment Acquisition 2. Inspection and Maintenance 3. Staff Management & Quality Improvement 4. Quality Compliance 5. Regulatory Compliance

QA-focused Approach  Program components 1,2,& 3 are covered in other presentations  Quality Monitoring 1. At service center, separate staff inspects equipment scheduled & random 2. At branches, central staff inspects and reports to senior management 3. Overdue inspection reports are provided monthly 4. Customer complaints are aggregated centrally 5. Each technician’s service reports reviewed for accuracy & completeness

QA-focused Approach, cont.  Regulatory Compliance 1. Medical device recall info is collected, analyzed & followed up 2. Medical device tracking reports acquisition of tracked devices to OEM 3. Device incident reporting includes investigation of every equipment-related death or serious injury 4. Upcoming regulations are continually watched

Limited Resources Does Not Mean Limited Quality  Examples from “Soft Side of Technology”: Leadership, Truth, and Team Focus  Leadership and Staff Commitment  Use of Best Available Medical Evidence  Right People with Right Training  Recognizing Importance of Local Empowerment

Practical Quality  Work Smarter Not Harder (and using less money and other resources) Examples  Centralized versus Distributed Facilities and Services  Centralized versus Bulk Acquisition of Supplies  Standardization in HT purchase

Quality and You How to be ready for future change  Be a leader others will want to follow  Act responsibly and professionally  Improve yourself – make a plan of action  Learn from your colleagues

EHTP Links Quality & Technology Link between resources and delivery of quality care is achieved by identifying all HT resources needed to provide well-delineated health interventions Issues Addressed by EHTP  How to enhance Provider Performance  What are the best Clinical Interventions for your population  How do you best manage existing (or new) health resources  Allows CE practitioners & health planners to potentially conduct optimal HT planning

References  Clinical Engineering Handbook 1. Thomas Judd 2. Andrei Issakov 3. Peter Heimann

Advanced Healthcare Technology Management Workshop Mombasa, Kenya — 9-12 August 2006 Quality Management & HT Questions? Comments?