QUALITY QUALITY What is in Health Care ?

QUALITY as defined by CUSTOMERS Internal & External QUALITY as defined by CUSTOMERS Internal & External

1985 Scott Report Recommend to establish the Hospital Authority as a statutory body to transform the management of public hospitals in Hong Kong

The HA Reform

Manages 44 public hospitals Staff force nearly 50,000 Recurrent budget HK$30 billion In-patients 1.2 million A & E attendances 2.6 million Specialist out patient attendances 9.5 million Public spending on health 2.7% GDP Market share in secondary & tertiary care 94% Manages 44 public hospitals Staff force nearly 50,000 Recurrent budget HK$30 billion In-patients 1.2 million A & E attendances 2.6 million Specialist out patient attendances 9.5 million Public spending on health 2.7% GDP Market share in secondary & tertiary care 94% The HA Reform

Daily hospital charge below US$9 Including: Meals Nursing care Medical Intervention Drugs Including: Meals Nursing care Medical Intervention Drugs

HA Ordinance To advise the Government of the needs of the public for hospital services To provide hospital services of the highest possible standard within the resources obtainable To advise the Government of the needs of the public for hospital services To provide hospital services of the highest possible standard within the resources obtainable

Mission Statement

1993 HA’s Year of QUALITY

Defining the customer context of quality Developing the philosophy of quality Integrating quality improvement into organizational systems and processes Focusing on clinical quality improvement Defining the customer context of quality Developing the philosophy of quality Integrating quality improvement into organizational systems and processes Focusing on clinical quality improvement Quality in the HA Context

“What constitutes the healthcare product that the organization is supposed to produce?” “What constitutes the healthcare product that the organization is supposed to produce?” Quality as Defined by Customer

Needs of Patients

Access and convenience Decent environment and hygiene Staff attitude and empathy Information and explanations Respect for dignity and rights Channels for feedback and complaints Access and convenience Decent environment and hygiene Staff attitude and empathy Information and explanations Respect for dignity and rights Channels for feedback and complaints Quality Aspects Important to Patients

Elimination of camp beds Reduction of overcrowding Environmental improvement Building new hospitals Elimination of camp beds Reduction of overcrowding Environmental improvement Building new hospitals Quality Improvement in Early Years

Promulgate Patients’ Charter Introducing Customer Concepts Communication courses

3-tiered Complaints Management Structure

Internal Customers

Extension of the Customer Concept

Organizational Philosophy on Quality “Quality Patient Centered Care through Teamwork” Core Value

Prevention and System Approach QC ==> QA ==> TQM QC ==> QA ==> TQM Focusing on prevention No blame culture

Promoting a Quality Culture Quality involves everybody All hospital staff are healthcare workers Patients’ participation Optimize existing resources Adopting Preventive and System approach Spirit of CQI even with no additional resources Quality involves everybody All hospital staff are healthcare workers Patients’ participation Optimize existing resources Adopting Preventive and System approach Spirit of CQI even with no additional resources

Continuous Quality Improvement Cultivate an attitude of constant improvement Critical re-look to eliminate non-value added work Prevention of errors Do the right things right, first time and every time Quality Tools - BPR, 5-S Cultivate an attitude of constant improvement Critical re-look to eliminate non-value added work Prevention of errors Do the right things right, first time and every time Quality Tools - BPR, 5-S

Structure for Assuring Quality

Clear Lines of Accountability

Accountability at Department Level

Internal and external task forces to do quality audits on clinical and non-clinical areas Structure

HA’s Annual Planning Process A key management tool to: Align value and directions Demonstrate public accountability Manage quality improvement Tie in with resource allocation exercise A key management tool to: Align value and directions Demonstrate public accountability Manage quality improvement Tie in with resource allocation exercise

Annual Planning Process

Resources Planning

Outcome Focused Planning

50 Areas of Quality Standards

Perspectives of Annual Planning

HA is the Mark in Hong Kong CQI versus Accreditation

Donobedian model of Structure, Process and Outcome Improving Clinical Quality

Inverse Pyramid Concept

Hospital Quality Improvement Committees Promotes quality awareness Representative from all departments Trains and aligns methodology Monitors feedback and evaluation Promotes quality awareness Representative from all departments Trains and aligns methodology Monitors feedback and evaluation

CQI Methodology

Process of developing alignment, trust and leadership Engage clinicians to look at the bigger picture Territory-wide service rationalization Consensus on improvement programs and outcome Cross-hospital clinical audits Pooling resources in specialist training Process of developing alignment, trust and leadership Engage clinicians to look at the bigger picture Territory-wide service rationalization Consensus on improvement programs and outcome Cross-hospital clinical audits Pooling resources in specialist training Clinical Specialty Coodinating Committees

Process: Discussion and sharing Consensus building Planning for quality improvement Process: Discussion and sharing Consensus building Planning for quality improvement Improving Clinical Quality Means: Clinical guidelines Protocols Clinical audits Means: Clinical guidelines Protocols Clinical audits Good Practice Good Practice + + = =

Web-based IT Infrastructure

Champions in Evidence-based Medicine Electronic Knowledge Gateway (eKG) Publication of Champions in Evidence-based Medicine Electronic Knowledge Gateway (eKG) Publication of Knowledge Management

Central Drug Advisory Committee Hospital Drug Advisory Committees Striking a balance between Innovation and Risk HA Mechanism for Safe Introduction of New Procedures (HAMSINP) Central Drug Advisory Committee Hospital Drug Advisory Committees Striking a balance between Innovation and Risk HA Mechanism for Safe Introduction of New Procedures (HAMSINP) Central Mechanisms on Clinical Effectiveness

Ethics Committees Clinical Ethics Research Ethics

Risk Management Strategy Systematic environmental scanning Appraisal of risks in all aspects of clinical and non-clinical areas Part of CQI philosophy Systematic environmental scanning Appraisal of risks in all aspects of clinical and non-clinical areas Part of CQI philosophy

Quality in Healthcare a Journey of Lifelong Learning