1. Introducing Quality Management in District Hospitals in Tanga Region First Experiences from Korogwe District Hospital

2. Improving Patient Care – a strategic framework for Tanzanian Hospitals Goal: To improve the health and well-being of all Tanzanians with a focus on those most at risk and to encourage the health system to be more responsive to the needs of the people Purpose: To provide access for all Tanzanians to good quality, equitable and affordable hospital services

3. Why? Public dissatisfied with services Efficiency and effectiveness of services low Poor value for money Low motivation and morale amongst health workers Weaknesses in management Inadequate quality control

4. Some objectives in the framework Strengthen management systems and capability in the Ministry and Hospitals Improving quality and effectiveness of clinical care, e.g.: –Introduction of peer hospital appraisal –Establishment of evidence-based protocols, standards, guidelines and benchmarks –Introduction of internal and external clinical audits of patient care Ensure financial sustainability of hospital services

5. Quality Assurance Guidelines for health workers Introduces HWs to: –concept of quality and quality assurance –Quality control –Professional standards –Package of minimum essential health interventions –Team work –Management skills –Communication skills –Data collection and use

6. Activities in Tanga Region QM activities established aimed at Dispensaries and Health Centres: –Supervision checklist –Ranking and scoring of HFs –Public awarding of best performing HFs Next step: inclusion of Hospitals in QM activities

7. 5 important Principles of QM Client orientation - satisfaction Focus on improving systems and processes Decisions based on (good) data All staff members are involved and responsible for quality of services = TEAM WORK important Commitment to continuous improvement

8. Quality Management Triangle Defining Quality Measuring Quality Improving Quality

9. 3 key conditions required to succeed with quality improvement activities Management is committed to meet staff needs Empowerment and support of staff to initiate and implement changes in terms of –Decision-making –Access to resources Adequate infrastructure for service delivery

10. Adequate infrastructure Adequate buildings and working space Necessary equipments always available and functioning Necessary medications and medical supplies always available

11. Situation at District Hospital Availability of equipments : –Basic equipments available but not always in sufficient number –Some essential equipments missing Availability of drugs and medical supplies : –Stock- outs still occurred from time to time for various reasons State of buildings etc: –old electrical and water system –old buildings –Some wards overcrowded Inadequate staffing levels and staff mix

12. Getting ready…1 Strengthening the Hospital Committees

13. Getting ready …2 Raise availability of drugs and medical supplies: –Support of pharmacy –Review logistics system Purchase of equipments as planned in CCHP 2003

14. Introduction to QM - 1 Initial 2 day seminar for clinical and nursing in-charges of the hospital: –Meaning of quality –Basic principles of quality management –Introduction to quality improvement cycle using a practical example

15. Introduction to QM – 2 5 day workshop organised by Ministry of Health Participants: Hospital Matron and 1 Nurse Topics: –COPE Methodology –Quality Measuring Tool –Cost Analysis –Clinical Monitoring –Supervision

16. Quality Circles Definitions: A group of health workers who form a group to identify and solve specific quality problems at their workplace Peer Review: a group of health professionals, e.g clinical officers who review case management together in order to improve / maintain quality of services

17. Kamati ya ubora wa huduma Appointed by the hospital management team Multi-disciplinary Members: –MO I/c –Matron –1 Clinical Officer –1 Health Officer –1 Nurse / Midwife –1 Medical Attendant

18. Tasks of the Hospital Quality Committee Establish a Comprehensive quality plan for the Hospital in close cooperation with departments Initiate, coordinate and support Quality Groups in the various hospital departments To give advice to Quality Groups for developing their action plans Support implementation of action plans of the Quality Groups Motivation and appraisal of Quality Groups Feedback to Hospital Management Team

19. First Activities of HQC All departments of the hospital were asked to compile a list of quality problems Review of the list by the Hospital Quality Committee Provide feedback to the departments and support departments for the analysis of problems and design of solutions

20. Planned activities Establish quality circles in all departments Train more staff with QM skills Work on the problems with each department

21. Results Quality is a topic in the hospital

22. Quality Activities initiated by staff of Maternity ward Improvement of dispensing of medications: –Problem identified in recording –Development of a dispensing sheet Prevention of prolonged labour of Prime Gravida: –Problem identified in interpreting partograph and initiating appropriate action –Development of a flow chart

23. 3 pillars of Quality Management Defining Quality Measuring Quality Improving Quality

24. Data management Data collection: –Patient records –Financial records –Inventories etc. Data analysis Feedback and use of data

25. Patient records Information about: –Patient –Symptoms and diagnosis –Investigations –Treatment given gives information about quality of care