13th and 14th October 2011
Safety, Standards and Customer Service
….. sharing healthcare best practices
2011 Conference Report N O 8 M A R I N E R O A D A P A P A L A G O S , N I G E R I A
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Conference Report The Society for Quality in Healthcare in Nigeria held its 3rd conference at the Royal Tropicana Hotel, 13, Waziri Ibrahim Crescent, off Elsie Femi Pearce, off Adeola Odeku Street, Victoria Island, Lagos on the 13th and 14th of October 2011. The theme for the Conference was Safety, Standards and Customer Service. The conference attracted over 300 attendees from diverse sectors in Nigeria, especially the Healthcare Sector which saw medical practitioners, nurses, researchers, students, government delegates from both Federal and State Ministries of Health as well as members of the society. The conference provided a platform for selected speakers, local and international, to share best practices within their institutions and the opportunity for lively debate on issues relating to healthcare quality. It also provided a library of information and contact persons for those looking to possibly adopt some of the practices show cased. The first day of the conference had 3 scientific sessions with a total of 5 presentations and 3 presentations by representatives of Member hospitals – Shell Producing Development Company and Lagoon Hospitals. The Society is particularly grateful to Dr. Mohammed Ali-‐Pate, the Honorable Minister of State for Health, who sent a representative to give the opening address for the conference in the person of Professor Akin Osibogun and the Executive Secretary, NHIS, Dr. Dogo Mohammed, represented by Dr. Abdulrahman Sambo, who gave the keynote speech on the Importance of Standards in a Demand Driven Health Insurance System. This objective of this year’s conference was to
1. 2. 3. 4.
Emphasize the importance of Safety as an essential dimension of quality in healthcare Define structures and processes that must be available to guarantee patient safety Show a link between customer service and the mission, vision goals, and culture of an organization Advocacy and membership drive for the Society for Quality in Healthcare in Nigeria
Welcome remarks were also given by Mrs. Njide Ndili, the Secretary of the Society and member of the conference organizing committee and Prof. E. A. Elebute, the founder and President of the society.
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Conference Programme of activities Thursday, 13th of October 2011 Time
Activity
Co-coordinator
8:30 – 9:30 am
Arrival and Registration of Guests
Ms. Ema Oche
9:30 – 9:40 am
Introduction of Guests & Update on the Society
9:40 – 10:00 am
Welcome Remarks
10:00 – 10:30 am
Opening Ceremony & Address
10:30 – 11:15 am
Keynote: Importance of Standards in a Demand Driven Health Insurance System
Mrs. Njide Ndili Secretary SQHN and member Programmes Committee Professor Ade Elebute Chairman, SQHN Dr. Muhammed Ali-Pate Hon. Minister of State for Health Mr. Dogo Muhammed mni fss Executive Secretary, NHIS
11.15-11.30am
Tea break
Opening Session
11:30 – 12:15 pm The National Health Bill and the impact on the Quality Agenda 12:15 -12.45 pm
Quality Improvement at the Shell Hospital, Warri
12:45 – 1:15 pm
Attaining the Gold Standard in Nosocomial Infection Control
1:15 – 1:45 pm
JCI – The Lagoon Hospitals Journey to Accreditation
1:45 – 2:45 pm
Lunch
2:45 –3:15 pm
Dr. Olutoyin Abitoye
The Use of Standard Clinical Core Measures in Comparing Hospital Quality Standards in the United States: A case for a similar strategy in future health care delivery in Nigeria.
3:15 – 3:45 pm
Dr House or Dr Welby -‐ where did we miss it?
Dr. Christy Okoroma Consultant Cardiologist, Department of Paediatrics, Lagos University Teaching Hospital
3:45 –4:15 pm
Questions & Answers
4:15 – 4:45 pm
Wrap up
Drs. Mosuro, Akintola & Osakwe Shell Hospital, Warri Dr. Alexander Dimoko Consultant General Surgeon, Shell I A Hospital, Ogunu, Warri Dr. Olujimi Coker Lagoon Hospitals
Virtua Medical Group, USA
Rapporteur
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Professor Emmanuel Otolorin Country Director, JHPIEGO
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Keynote Speaker – Mr. MBW Dogo Mohammed, Executive Secretary/CEO from the National Health Insurance Scheme Topic: Importance of Standards in a Demand Driven Health Insurance System • •
•
Mr. Dogo-‐Mohammed began his presentation by commending the effort of the Society for Quality In Healthcare in Nigeria by saying that the theme of this year’s conference (Safety, Standards and Customer Service) is aptly titled, as it a reflection of the reality that service to the customer is key to the growth and sustainability of health insurance industry in Nigeria. According to Mr. Dogo-‐Mohammed, standards are not only desirable but also important in the health insurance system, which is demand driven. The basic function of health insurance can be summarized as provision of access to care with financial risk protection, within which are 3 core sub-‐components: • • •
Collection of funds Pooling of funds Purchasing of services
All forms of insurance perform these functions, and since there is no universally acceptable “best practice” mechanism or system, each country adopts a system that fits its socio-‐economic, political and cultural environment. There is however some deciding factors for achieving successful implementation of social health insurance, and they are: • •
Size of the informal sector and labor market Socio-‐economic status of the people and level of income
The NHIS has developed a blueprint for the implementation of community based Social Health Insurance Programme, which is at the verge of being flagged off in 37 pilot, sites all across Nigeria. He went on to discuss the challenges encountered in the implementation of the Programme and how they were overcome. He also stated that although the NHIS started off as the implementing agency of the Formal Sector Health Insurance Programme, the role has gradually evolved to that of regulation (Protecting consumers and the promotion of public health objectives of equity, affordability and access to qualitative health services) of the industry in line with the law setting up the organization. The main stakeholders (HMOs and Healthcare facilities) are taking over the implementation. He stressed that quality of care cannot be measures unless there is something to measure with, and this is known as standards. Standards are the vehicle by which the general concept and attributes of quality are translated to actual measurements, and the attainment of standards forms the basis for accreditation of the facility and the determinants of its quality. These standards address issues of who can sell insurance, who can be covered, what should be covered, how providers of healthcare facilities should be paid and how the prices can be set.
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Health care infrastructure Design of the insurance scheme (including its administration, provider payment mechanism, quality assurance process, and level of solidarity within the society. Support by government (to guide and regulate a process of compulsory health insurance for all)
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Speaker 1 – Professor Emmanuel Otolorin – FRCOG Country Director JHPIEGO-‐ Nigeria Topic: The National Health Bill and its Impact on the Quality Agenda control of use of blood, blood products, tissue and gametes in humans; regulations and miscellaneous provisions; He also went on to identify the partners in the National Health System (NHS) and they are: 1. Federal Ministry of Health (FMOH) 2. State Ministries of Health (SMOH) in the every State and the Federal Capital Territory (FCT) 3. Parastatals under the federal and state ministries of health 4. All LGA’s 5. Ward Health Committees (WHCs) 6. Village Health Committees (VHCs) 7. Private Health care providers 8. Traditional and alternative health care providers The presentation was outlined in 3 stages namely: • Challenges to quality of care in Nigeria He further explained Section 10 which states the • An overview of the National Health Bill establishment of National Primary HealthCare • The way forward Development Fund, also referred to as “the Fund” which shall be financed from the consolidated fund of He started his presentation by stating that there are the Federation (not less than 2 % of its value), by many barriers to accessing Health services in Nigeria grants from international donor partners and funds some of which are: from any other source. The Fund should be disbursed • overcrowding in hospitals which usually leads by: facility improvements, Human Resources for to long turn-‐around time, stock out of Health, essential drugs and Basic minimum package of medical supplies and drugs, dissatisfaction, health services. The following bodies shall be overworked health workers responsible for disbursing the funds: • Poor emergency preparedness • National Primary Health Care Development • Inadequate supervision which results in Agency (NPHCDA) shall disburse through State medical negligence and increased risks of Primary Health Boards for distribution to Local adverse events. Government Health Authorities • Low standards and unsafe practices which are • State Primary Health Care Development highly prevalent Agency (SPHCDA) • Inappropriate waste disposal • LGHA • Lack of security Professor Otolorin also went through other important He continued by explaining the role of the National sections of the National Health Bill and concluded his Health Bill in Nigeria by explaining the different parts presentation by identifying the next steps to be taken of the Bill. Part I – Part VII of the National Health Bill with emphasis that the 2015 MDG deadline is very which range from the responsibility for health and much around the corner. He advocated for the eligibility for health services and establishment of Nations president to sign the National Health Bill National Health System; Health establishment and immediately to resolve the issues within the health technologies; rights and duties of users and sector. healthcare personnel; national health research and information system; human resources for health; Page 5 of 17
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Speaker 2 – Dr. Carmen Audera-‐Lopez from WHO Patient Safety Topic: WHO Patient Safety Programme and the gaps (poor handling of emergency, interventions ill defined, monitoring unavailable, inadequate staff knowledge). 10 domains in order of relevance in developing countries are given as: 1. Health care associated infections (HCAI) 2. Preventable adverse drug events 3. Adverse events in mother and/or baby related to prenatal, labor and postnatal care period 4. Adverse events due to surgical and anesthetic care 5. Adverse events related to wrong and/or late Dr. Audera-‐Lopez introduced her topic by defining diagnosis patient safety as the absence of avoidable harm to 6. Adverse events related to injection practices patients during the process of healthcare, the 7. Adverse events related to unsafe use of blood reduction of risk of unnecessary harm associated with and blood products health care to an acceptable minimum. (An 8. Adverse events related to medical device use acceptable minimum is a collective notion of given 9. Patients falls and injuries due to falls current knowledge, available resources and the 10. Pressure ulcers context through which care was delivered) The following risks to patient safety were also She identified 2 types of problems: identified • Problems related to commission • Poor test follow-‐up • Problems related to omission • Misdiagnosis • Poor safety culture Data shows that every year, tens of millions of • Inadequate use of protocols patients worldwide suffer disabling injuries or death • Organizational/system failures due to unsafe medical care, and one in 10 patients is • Poor health system accountability harmed while receiving hospital care, usually caused • Poor patient identification by a range of errors. Dr. Audera-‐Lopez went on to • Poor training of healthcare staff explain adverse events in health care in developed • Workload pressures and developing countries using the following as a • Stress and fatigue of health care staff basis for comparison; Sir Liam Donaldson, the Former Chief Medical Officer, 1. Health Care Associated Infections UK said the Patient safety problem also affects the 2. Unsafe surgery lives of doctors, nurses and other healthcare staff who 3. Blood safety become the ‘second victims’ in a chain of events. 4. Injection safety 5. Counterfeit drugs She further said the mission of patient safety is to coordinate, facilitate and accelerate patient safety She went on to quote a statement by Dr. Lucian Leape improvements around the world. She identified 10 that human beings make mistakes because the useful strategies for safer care and gave data and systems and processes they work in are poorly statistics to buttress the importance of safe practices designed. The Swiss Cheese Model was used as an in health care. example having 2 sides: Defenses (Risk management plan, Clinical policy, essential equipment, skilled staff) Page 6 of 17
The Patient Safety Situation in Africa • •
•
• • •
• •
• •
•
Most countries lack national policies and plans on safe and quality health-‐care practices Inappropriate funding of healthcare systems and unavailability of critical support systems, strategies, tools and guidelines Weak health care delivery systems, poor management capacity and under-‐equipped health facilities Overuse, underuse or misuse of medicines Lack of adequate infection control within healthcare facilities Unsafe surgical care as very few countries use the safe surgery save lives check-‐list recommended by WHO Risk infection from blood borne pathogens for healthcare workers Shortage of human resources, low level of staff preparedness and lack of continuing medical education Lack of partnership involving patients and civil society in improving patient safety Inadequate data on patient safety issues
•
• •
C hallenge in implementing of blood safety Inability to understand patient safety as a new concept, or as a priority when the health systems are faced with other pressing health issues Blame culture Fatality mentality…”things are like this here”
The WHO Patient Safety Programme is proposing the following: Simple solutions that make a change (hand washing, checklists, protocols, standard procedures, local solutions) Change in Patient Safety Culture (communication, leadership, learning from errors, commitment) Integration of patient safety into all aspects of Health care (patient safety as a cross cutting issue) Integration of patient safety into training curricula of health professionals
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Speaker 3 – Drs. O Mosuro, O. Ohiosimuan, R. Akintola and N. Osakwe from Shell IA Hospital, Ogunu Topic: Quality Improvement at the Shell Hospital, Warri 2010, the Hospital was awarded a Certificate of Accreditation for 27 elements of the Hospital Services. This was possible through the QA/QIP Strategies which include: • Awareness lectures • Individual tasks and targets for yearly assessment • Development of a written guideline for implementation of QA and QI process • Defined roles and responsibilities (organization chart) • Training in the use of IT tools (excel, PowerPoint) and PDSA cycle Dr. Olufemi Mosuro began the presentation by stating Areas for improvement were identified by the focus of the Shell Health Plan (which is to “protect • Gap analysis of status quo against identified and preserve the health of staff ensuring a healthy goals workforce) and the objective-‐ to deliver effective and • Quality Data collection process quality Health strategies and services in order to • Data analysis and reporting optimize the health of the stakeholders (employees, • Audits dependants, contractors and neighbors). • Tools and training to use these tools He identified critical success factors The benefit derived from using the above processes • Quality of staff include: • Quality of infrastructure and equipment • Improvement in team work • High quality drugs and consumables • Better focus on work processes and outcomes • Ready access to quality information, whilst as well as on appropriate skills and maintaining confidentiality competences • Quality of procedures and controls • Ownership of hospital processes by the grass • Timely emergency response capabilities root • Visible management commitment and • Continuous improvement of services and adequate funding outcomes • Good communication processes in place • Faster response to quality issues • Externally assures quality of service He went on to give a history of the Shell IA Hospital. Before the year 2000, there were Health and Safety Challenges faced in the process include: audits, Site and facility inspections, audits and TQM • Erratic IT Tool – which encouraged manual process, external clinical audits every 2 years. By data collection 2005, the UK IHC (SAQ) was used to access the quality • Inadequate budget for learning and of care offered. In 2007, In-‐House quality development improvement programs were initiated with the • Business continuity challenges partogram in labour review. In May 2008, Shell IA Hospital enrolled in the COHSASA (ISQua) quality improvement and accreditation program, and by
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Speaker 4 – Dr. Alexander Dimoko, Consultant Surgeon from Shell IA Hospital, Ogunu Topic: Attaining the Gold Standard in Nosocomial Infection Control
The objective is to achieve a zero percent Hospital infection rate through the following: • Hand washing campaign • Theatre procedure guide • Wound care protocols • Hospital antibiotic policy • Increased critical area surveillance • HAP Compliance audits • Collation of data from the wards on surgical infections, pneumonia and UTI on a monthly basis and calculation of hospital infection rate every quarter. He further explained the policies and protocols available in the Hospital with data. The achieved objectives are: 1. Attainment and maintenance of Nosocomial infection rate of zero 2. Reduced duration of hospital stay 3. Reduced expenditure on dressings, antibiotics and other drugs He concluded by saying that the control of Nosocomial infections requires an integrated approach driven by a functional infection control unit, and anchored on global best practices. A low rate of Nosocomial infection can be achieved in all hospitals, and cost implications of this effort is usually quite modest. Also, hand washing is the single most important intervention which can be instituted at very little cost.
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Speaker 5 – Dr. Olujimi Coker, Chief of Surgery & Group Clinical Adviser from Lagoon Hospitals Topic: JCI-‐ The Lagoon Hospitals Experience
Dr. Coker began his presentation by explaining the vision and mission of Lagoon Hospitals as well as the I CARE Culture, which the Hospitals had imbibed. He explained Accreditation to be a process where an independent entity assess the health care organization to determine if it meets a set of requirements designed to improve safety and quality of care; voluntary or mandatory; has standards usually regarded as optimal and achievable; has effective quality evaluation and management tools. The Hospital considered 3 types of accreditation • International Standard Organization (ISO 9000) • Kings Fund • Joint Commission International (JCI) -‐ which it eventually went for. He explained that for Lagoon Hospitals, the Road to Accreditation began in 2004 with collaborations from Apollo Hospitals of India, to the decision in 2005 to achieve internationally recognized quality
accreditation, the set up of the Quality improvement department (with trainings, baseline assessment of standards), audit of the hospital facilities, policies and procedures in 2006 as well as mock audit about 6/12 months before accreditation, repeat assessment of JCI Standards in 2007 and structural modification of the hospital as well as organization-‐wide training sessions. In 2008, there were monthly progress reports, upgrade of the hospitals facilities to meet international standards, inclusion of safety features and hand hygiene, staff engagement (regular poster campaigns on group standards, the creation of Dr. J C Isaac, and weekly quizzes on knowledge of JCI Standards with prizes which were featured in the HYNews bi-‐monthly Newsletter for the Hygeia Group). By 2010, we had a JCI Mock survey for over 3 days where it was agreed that the hospitals were ready. The accreditation survey started on the 26th of October 2010 and the preliminary result was out in December 2010 and we had 45 citations out of 1033 standards. By April 19th and 20th, 2011, we had passed all standards and gotten the JCI Accreditation. There were major challenges along the way such as: • Team work and enhanced communication • Development and adherence to standard operating procedures • Delivery of care as an integrated team • Transition from a “physician-‐centered” care to a “patient-‐centered” care • Acceptance of the idea of continuous performance evaluation
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Speaker 6 – Dr. Olutoyin Abitoye from Virtua Medical Group Topic: The Use of Standardized Clinical Core Measures in Comparing Hospital Standards in the United States: A case for a similar strategy in future health delivery in Nigeria
Dr. Abitoye identified the objectives of the study as: • Introduce the methods of using core measures to compare quality of health care US hospitals provide • Have knowledge of certain basic clinical, hospital practice requirements referred to as the standards of care in US hospitals • Understand the advantages of adopting process of care measures that can be used to compare hospital quality • Understand the need for Nigeria to have a body similar to the Joint Commission or the Agency for Healthcare Research and Quality (AHRQ) in the US or the National Institute of Health and Clinical Excellence (NICE) in the UK He explained Core measures to be quality measures hospitals report to for Medicare and Medicaid services to compare hospital quality standards in the US with the goal of improving healthcare quality. Core measures are also used to report how often patients with specific conditions receive care that are scientifically proven and evidence based. He also explained quality in healthcare to be the degree to which health services for individuals increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Dr. Abitoye moved on by giving the Core Measure Sets (Acute Myocardial Infarction, Heart Failure, Pneumonia, Surgical Care, Children’s Asthma Care, Venous Thromboembolism, stroke), which he backed up with statistics and data, obtained from
medical records and transmitted to CMS and Joint Commission. Benefits of core measures in comparing hospital quality • Increasing the drive by hospitals to improve quality in healthcare • Improving health outcomes • Improving adherence to medical practice based on standard of care and evidence-‐based medicine. • Stimulating improvements of internal process mechanisms of hospitals • Serves as a means of constantly educating healthcare providers on standards of care and evidence-‐based medicine • Reduces costs of healthcare The disadvantages • Gaming: when hospitals invent methods to circumvent care processes to achieve high scores • Focus of care on assessed conditions alone thereby reducing the attention on other disease conditions • Cream skimming: when hospitals invent ways of not admitting sick patients that can potentially reduce their scores. Adopting the Process in Nigeria This can be done if the following are put in place: • The establishment of a national body similar to the Joint Commission that can accredit and certify all hospitals in Nigeria • A tertiary hospitals commission that can focus on tertiary hospitals alone • The public display of names of certified hospitals in a national registry. • Institutions will be subject to audits by the body with sanctions /severe fines to fraudulent hospitals • Constant involvement of all stakeholders (general public, healthcare providers, patients and the government) • Constant communication of the goal of the program to improve quality in health care • Periodic assessment of the program and its revision when and where applicable.
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Speaker 6 – Dr. Christy Okoromah – Associate Professor, Dept. of Paediatrics, College of Medicine, University of Lagos Topic: Dr. Welby or Dr. House? Medical Professionalism the Vanishing Core Competency Ten broad/ generic core competencies identifies were: 1. Medical knowledge 2. Professionalism 3. Communication and interpersonal skills 4. Practice-‐based learning and professional development 5. System-‐based practice 6. Population health/health systems 7. Leadership and management skills 8. Interdisciplinary collaboration 9. Research and scholarship 10. Patient care Dr. Okoromah began her presentation by defining Medical Education and relating it to the quality if Dr. Okoromah went on to define medical Healthcare. She stressed that poorly trained medical professionalism as the “adherence to ethical practice doctors practice medicine poorly and ultimately principles, including but not restricted to: contribute to the dismal national health indices. honesty/integrity, confidentiality, moral reasoning She went ahead to define the conceptual frameworks and respect privileges and codes of conduct. that are very critical to Medical Training Programs and Why is Medical Professionalism Vanishing? said that the design and redesign of training programs • Lack of a consensus definition with is serious research and must be based on the measurable elements, limiting the teaching & following: assessment of medical professionalism • Best available evidence • Outdated training programs/curricula in • Best theoretical/Educational models medical schools • Current global trends in medical education • Outdated education strategies • Rigorous process • Compartmentalized training with little or no integration She made the session interactive by asking the • Poor learning environment (infrastructure & participants to: training resources) 1. List 5 broad core competencies critical for • Faculty development (inadequately prepared physicians in the 21st century medical teachers/role models) 2. Compare the list with neighbors and report • Disconnect between the written and hidden commonalities and differences curricula (Environment, practices, role models, mentors)
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Friday 14th of October 2011
Time
Activity
Co-coordinator
9:30 – 10:00 am
Safety and Cost Correlations in Diagnostics
Dr. Wole Edwin Executive Director, Quality & Regulatory Affairs, Quest Diagnostics Incorporated Dr. Carmen Audera-Lopez Patient Safety Programme, WHO
10:00 – 10:30 am Patient Safety 10:30 – 11:00 pm Tea Break 11:00 – 12:00 am The SafeCare Initiative – Implications for Quality Improvement Outcomes 12:00 – 12:30 pm The May Clinics Experience 12:30 – 1:00 pm
Questions and Answers
1:00 – 1:15pm
Presentation of Plaques
1:15 – 2:15 pm
Lunch
2:15 – 3:30 pm
Annual General Meeting
All Members of SQHN
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Professor Tobias Rinke de Wit Director Advocacy, Technology and Research, PharmAccess Foundation Mr. Abisola Aworinde Executive Director, May Clinics Ltd.
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Speaker 7 –Mr. Wole Edwin from Quest Diagnostics Incorporated Topic: The Role of Diagnostics as a Driver of Standards, Patient Safety & Cost
Mr. Edwin begins by saying that Healthcare is a right for all citizens, and every one (including the Government, physicians, healthcare workers and providers, insurance providers and even citizens) has a role to play in it. He went ahead to explain that in the past, patient diagnosing was based on trial and error and this lead to premature death for some people. Currently, patients receive more accurate treatment by diagnosing precisely leading to a reduction in the untimely and unnecessary death of patients. This has also led to improved life expectancy, reduced healthcare costs, use of only needed drugs, thus boosting drug resistance and safety of the patient. He said diagnosis is when the physician knows what is normal and can measure the patient’s current condition against those norms, the physician can then determine the patient’s particular departure from homeostasis and the degree of departure with the help of a medical diagnostic test. He went on to explain clearly the following terms: Medical diagnostic tests, medical screening, medical evaluation and who should perform the diagnosis.
5 reasons for a diagnostic test are: • To establish a diagnosis in symptomatic patients • To screen for disease in asymptomatic patients • To provide prognostic information in patients with established disease • To monitor therapy by either benefits or side effects • To confirm that a person is free from a disease. He further went on to identify the reality of the Nigerian healthcare system in the world. Nigeria ranks as the 7th most populated country with a population of 158 million people; our life expectancy is 47.2 years and 70% of Nigerians live below the poverty line, to mention a few. Based on the data presented, something needs to happen fast in the country in terms of • Giving appropriate diagnosis • Appropriate therapy must be administered • Proper monitoring must be done Characteristics of a good diagnostic test include • Test specificity • Test accuracy • Equipment reliability, maintainability ad ease of use The role of Government in all of this • Regulate all laboratories and ensure that standards are followed, laboratories under go accreditation and training is continuous. • Regulate medical devices, and ensure they comply to set standards • Regulate health insurance companies • Establish universal healthcare programs • Ensure adherence to regulations and enforce the law
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Speaker 8 – Professor Tobias Rinke de Wit from PharmAccess Foundation Topic: Committing Healthcare Providers To Quality Improvement: Working Towards Safecare Tanzania and Kenya by subsidizing health insurance premiums of target groups and improving quality healthcare provision by performance-‐based financing. In Nigeria, the HIF targets Market women, ICT workers, Farmers in Kwara North and Central. Since 2007, the assessment of Healthcare providers is done by using a tool (on Track) that quantifies according to assets, processes and skills depending on the type of service required in a facility, or by a team of professionals (doctors, laboratory technicians, IT personnel as well as quality managers. Questions are grouped in different modules to facilitate assessing and reporting. Continuous quality improvement is encouraged through staffing and training, Professor Tobias began by explaining the Health documentation of guidelines maintenance, Insurance Fund, HIF, which is a not-‐for-‐profit infrastructure equipment and the use of assets, skills Foundation founded in 2007 by the Dutch Government, and processes. Professor Tobias went on to explain the World Bank and USAID, to support programs in Nigeria, (On Track) setup and how it works in Nigeria. The way forward African healthcare systems are stuck in a vicious cycle of low demand and supply, access to basic healthcare among the poor is low in quality (relational, technical, functional and organizational quality), but can be improved by the following: 1. Purchase of assets and supplies 2. Training of staff and implementation of continuous education processes 3. Implementation of standard operating procedures 4. Implementation of safe systems and processes 5. Local and long distance technical assistance 6. External quality control and proficiency testing The impact of Quality can be seen from the following: • Appropriateness – the right care at the right time for the right patient • Access – willingness to pay, trust and availability • Transparency – benchmarking and accountability • Cost effectiveness – sustainability of quality improvement Safecare is very important because 1. Patients know where to go at all times and this increases revenue for private providers as well 2. Healthcare providers can have better access to loans, insurers and patients 3. Banks can provide loans based on quality plans and can rely on external validation 4. Donors can allocate their funds to opportunities and monitor results easily 5. The Government can have a basis for a legal framework to monitor and regulate the healthcare industry 6. Insurers can chose or reward better performing providers. Page 15 of 17
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Speaker 9 – Mr. Abisola Aworinde from May Clinics Ltd. Topic: The May Clinics Experience: The importance of Accreditation to the improvement of quality in healthcare practices
Mr. Aworinde began his presentation with the Vision and Mission Statements of May Clinics Ltd., and how the aim of improving quality meant providing better service. An overview of the service sector and the key challenges was conducted over a 24-‐month period to try to identify the sources of pressure for change within and outside the organization. Recommendations were made to enable employees work better as well as how the plan will be implemented and evaluated over time. There was a need to have an external body to evaluate the clinic and give concrete feedback on services and facilities in line with international standards, hence the entry of PharmAccess in association with Hygeia Community Health Plan. We were given a detailed report about our service delivery and every member of staff was carried along to achieve the objective. The guidelines helped improve patronage, revenue and positive feedback from customers and patients. The initiative aligned with our corporate mission and vision and added an opportunity to be a major player in the healthcare industry in Nigeria. Advantages of the PharmAccess M&E • The provision of a framework to help create and implement systems and processes that improve operational effectiveness
Improved communication and collaboration with internal and external stakeholders
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Strengthened team effectiveness
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Credibility and commitment to quality and accountability
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Decrease liability costs
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Mitigates risk of adverse events
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Sustained improvement in quality and organizational performance
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Promotes the sharing of policies, procedures and best practice among health care organizations
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Promotes the understanding of how each person’s job contributes to the organization’s mission and services
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Improves patients health outcomes
COHSASA’s guidelines showed very clearly how to capitalize on our strengths and work on our weaknesses. We were able to create a quality department to ensure the creation and maintenance of quality products and services, as well as collect data that will be helpful in forecasting and formulating policies and procedures. May Clinics Ltd currently invest in IT Infrastructure to aid in data collection and easy communication. Training and employee development has become an integral part of the organizations culture, and all staff are involved in decision making processes Mr. Aworinde concluded by saying that • Patients will choose the hospital where they are least likely to suffer adverse outcomes. • Accreditation improves patient services, so the standards that a facility is assessed against should be patient centered • Accreditation is much more than a marketing tool and shows how an organization works and how patient and staff risks can be minimized • Accreditation is in the ability of the process to alter the culture of a healthcare setting into one of continual improvement in quality.
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•
Overview of Presentations S/N SPEAKERS 1 Dr. Dogo Mohammed 2
ORGANIZATION National Health Insurance Scheme JHPIEGO Nigeria
4
Professor Emmanuel Otolorin Dr. Carmen Audera-‐ Lopez Dr. Olufemi Mosuro
5
Dr. Alexander Dimoko
Shell Hospital
6 7
Dr. Olujimi Coker Dr. Olutoyin Abitoye
Lagoon Hospitals Virtua Medical Group
8
Dr. Christy Okoromah
3
9 10 11
World Health Organization Shell IA Hospital, Ogunu
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TOPIC Importance of Standards in a Demand Driven Health Insurance System The National Health Bill and its Impact on the Quality Agenda WHO Patient Safety Programme Quality Improvement at the Shell Hospital Warri Attaining the Gold Standard in Nosocomial Infection Control JCI-‐ The Lagoon Hospitals Experience The Use of Standardized Clinical Core Measures in Comparing Hospital Standards in the US: A Case for a Similar Strategy in Future Health Delivery in Nigeria Dr. House or Dr. Welby – Where did we miss it?
Lagos University Teaching Hospital Mr. Wole Edwin Quest Diagnostics The Role of Diagnostics as a Driver of Incorporated Standards, Patient safety and Cost Professor Tobias Rinke de PharmAccess Foundation Committing Healthcare Providers to Quality Wit Improvement: Working towards Safecare Mr. Abisola Aworinde May Clinics Ltd. The May Clinic Experience: The Impact of Accreditation to the Improvement of Quality in Healthcare Practices.
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