QUALITYQUALITYWhat isWhat is

in Health Care ?in Health Care ?

QUALITYas defined by

CUSTOMERSInternal & External

QUALITYas defined by

CUSTOMERSInternal & External

1985 Scott Report1985 Scott Report

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

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

The HA ReformThe 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 ReformThe HA Reform

Daily hospital charge below US$9Daily hospital charge below US$9

Including:• Meals• Nursing care• Medical

Intervention• Drugs

Including:• Meals• Nursing care• Medical

Intervention• Drugs

HA OrdinanceHA 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 StatementMission Statement

19931993HA’s Year of QUALITYHA’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 ContextQuality in the HA Context

“What constitutes the healthcare productthat the organization

is supposed to produce?”

“What constitutes the healthcare productthat the organization

is supposed to produce?”

Quality as Defined by CustomerQuality as Defined by Customer

Needs of PatientsNeeds 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 PatientsQuality 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 YearsQuality Improvement in Early Years

• Promulgate Patients’ Charter• Promulgate Patients’ Charter

Introducing Customer ConceptsIntroducing Customer Concepts

• Communication courses • Communication courses

3-tiered Complaints Management Structure3-tiered Complaints Management Structure

Internal CustomersInternal Customers

Extension of the Customer ConceptExtension of the Customer Concept

Organizational Philosophy on QualityOrganizational Philosophy on Quality

“Quality Patient Centered Care through Teamwork”

“Quality Patient Centered Care through Teamwork”

Core Value Core Value

Prevention and System ApproachPrevention and System Approach

QC ==> QA ==> TQMQC ==> QA ==> TQM

Focusing on preventionNo blame culture

Focusing on preventionNo blame culture

Promoting a Quality CulturePromoting 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 ImprovementContinuous 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 Structure for Assuring Quality

Clear Lines of Accountability Clear Lines of Accountability

Accountability at Department Level Accountability at Department Level

Internal and external task forces to do quality audits on clinical

and non-clinical areas

Internal and external task forces to do quality audits on clinical

and non-clinical areas

Structure Structure

HA’s Annual Planning ProcessHA’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 ProcessAnnual Planning Process

Resources PlanningResources Planning

Outcome Focused PlanningOutcome Focused Planning

50 Areas of Quality Standards50 Areas of Quality Standards

Systems are in place to ensure cost-effective use of drugs andsafety of drug administration

Reference Standard

(i) To ensure cost-effective use of drugs, a hospital formulary review system isin place, as measured by

¥ s% of pharmacological class of drugs reviewed in each quarter

¥ t number of new drug entities added in the hospital in each quarter

¥ u number of drug entities deleted in each quarter

¥ v number of cost-effective drug utilisation programmes performed,e.g. through multi-disciplinary approach as directed by DrugTherapeutic Committee, including e.g. prescribing guidelines,treatment protocols

(ii) To achieve safety use in drug administration, to report on x% Compliance tothe Recommendations checklist of the Drug Administration Report 2000edition

(iii) Programmes are implemented to review and improve patient compliancelevel to drug therapy

Perspectives of Annual Planning

Perspectives of Annual Planning

HA is the Mark in Hong KongHA is the Mark in Hong Kong

CQI versus AccreditationCQI versus Accreditation

Donobedian model of Structure, Process and

Outcome

Donobedian model of Structure, Process and

Outcome

Improving Clinical QualityImproving Clinical Quality

Inverse Pyramid ConceptInverse Pyramid Concept

Hospital Quality Improvement CommitteesHospital 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 MethodologyCQI 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 CommitteesClinical 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 QualityImproving Clinical Quality

Means:• Clinical guidelines• Protocols• Clinical audits

Means:• Clinical guidelines• Protocols• Clinical audits

Good

Practice

Good

Practice++ ==

Web-based IT InfrastructureWeb-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 ManagementKnowledge Management

Qualityfilteredresources

Level Ie-journals

Internalknowledgecapture

Interactiveparticipation

Multi-facetaccess

Auto alerts

Crystal in Paediatrics

• 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 EffectivenessCentral Mechanisms on Clinical Effectiveness

Ethics CommitteesEthics Committees

Clinical EthicsClinical Ethics Research EthicsResearch Ethics

Risk Management StrategyRisk 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 Healthcarea Journey of Lifelong LearningQuality in Healthcarea Journey of Lifelong Learning