1. Performance Based Financing at Hospital - Process of Care Quality Assessment July 11, 2013 James Sorsor, Foday Kanneh Shun Mabuchi

2. HSSP provides a set of management tools for hospital management 1 Quantity Checklist Process of Care Quality Checklist Management and Structural Checklist Assessment/Monitoring PBF Bonus Calculation Tool Financing Business/Operation Plan Health Worker Bonus Allocation Use of Finance Focus of this presentation

3. Process of care is an important part of quality 2 24% of Total Quality Score Overview of Quality Checklists for Hospitals

4. Hospital will be reviewed by 14 checklist to assess the process of care in hospitals 3

5. Process of care quality will be assessed every quarter 4 Process of Care Quality Assessment Process Find relevant patients from register (e.g., “Malaria” patient for Malaria checklist) Record names and patient numbers Request health workers to bring charts Team of minimum 2 verifiers from LMDC will compare charts and guides/checklists 2 charts (tentative) for all 14 checklists will be reviewed quarterly Total scores will be calculated as % for each checklist LMDC will enter average % for each checklist in Bonus Calculation Tool

6. Acquired score (%) of each checklist will be linked to quarterly performance bonus to the hospital (1/2) 5 Aggregate Score Calculation Weight defined by importance Total 60pt are allocated by weight 1 2 Assessment results (%) 3 “Point Allocation” * “Actual %” 4

7. Acquired score (%) of each checklist will be linked to quarterly performance bonus to the hospital (2/2) 6 Quality Bonus Calculation Process Total aggregated process of care score 1 “Actual Points”/ “Max points” 2 40% of Total max quality bonuses 3

8. Hospital SMT and QI team should use the checklist results for continuous quality improvement 7 2 Find major gaps in scores 3 Look into the actual checklists to see what are wrong 4 Plan specific activities to improve the low-score checklists in operational plan 1 Review scores of all checklists

9. QI team and LMDC coach will motivate health workers to improve key indicators through tracking and coaching (2/2) 8 Weekly/daily chart review Monthly management and structural checklist review 1 Self-Assessment 2 Post scores on a wall Provide detailed feedback to staff Tracking and Feedback 3 Support improvement activities (e.g., standardize chart, waste disposal, cleaning) Training on the treatment protocol and chart writing …… Support to Improvement Activities

10. Exercise – Review medical records with the Process of Care checklist 9 Look into a patient chart Identify the relevant checklist for the chart Score the chart based on the guide Calculate the percentage (%) score Discuss with your group One person present the group’s answers to the questions below Process Discussion Questions What is the overall percentage (%) score? What are the issues in the patient chart? What does a hospital management and staff need to do to improve the score of the chart?