2. QUALITY QUALITY What is in Health Care ?

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

7. 1985 Scott Report Recommend to establish the Hospital Authority as a statutory body to transform the management of public hospitals in Hong Kong

8. The HA Reform

9. 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

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

11. 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

12. Mission Statement

13. 1993 HA’s Year of QUALITY

15. 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

16. “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

17. Needs of Patients

18. 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

19. 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

20. Promulgate Patients’ Charter Introducing Customer Concepts Communication courses

21. 3-tiered Complaints Management Structure

22. Internal Customers

23. Extension of the Customer Concept

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

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

26. 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

27. 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

28. Structure for Assuring Quality

29. Clear Lines of Accountability

30. Accountability at Department Level

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

32. 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

33. Annual Planning Process

34. Resources Planning

35. Outcome Focused Planning

36. 50 Areas of Quality Standards

37. Perspectives of Annual Planning

38. HA is the Mark in Hong Kong CQI versus Accreditation

39. Donobedian model of Structure, Process and Outcome Improving Clinical Quality

40. Inverse Pyramid Concept

41. 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

42. CQI Methodology

43. 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

44. 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 + + = =

45. Web-based IT Infrastructure

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

48. 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

49. Ethics Committees Clinical Ethics Research Ethics

50. 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

51. Quality in Healthcare a Journey of Lifelong Learning