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Rabab Diab, RN, MSN, CPHQHCAC, Deputy CEO, Director of Education & Consultation
MEDHEALTH Cairo 2014 Thursday, 13 March 2014
Human Resources: The Essential Ingredient for a Culture of Quality
Outline
• Introduction • Healthcare Human Resources in Jordan• Quality and Patient Safety Challenges • Standards for Human Resources Management• Competency based practice• Conclusion
Outlines
• Introduction • Healthcare Human Resources in Jordan• Quality and Patient Safety Challenges • Standards for Human Resources Management• Competency based practice• Conclusion
Research has been showing that human resources are very essential in developing and sustaining any quality practices in the health sector
• Most of literatures have showed the importance of human resources management on developing the quality of healthcare service (Yu, 2007; Michael, 2009; Patrick, 2011)
• Incentives and providing motivation and use system of bonuses by competencies improve the performance of individuals working in hospitals (McKinnies, 2011)
• Training courses for workers in the hospitals in the area of the dimensions of medical service quality, and to deepen the quality concept between the staff and to achieve the quality dimensions at the best degree (Diab, 2012).
• Perceived safety climate in the relationship of high performance human resources and organizational performance is confirmed.
• The finding suggests that organizational emphasis on safety issues contributes to establishing effective high performance human resources and driving organizational performance (Chan and Mak (2012))
Especially in developing countries or young health care systems, there are many challenges to having and retaining human resources that embrace quality
• Supply of trained Health Professionals in local market
• Insufficient and ineffective professional institutions
• No structured career guidance.
• Brain drain of skilled individuals.
• Inappropriate placement and distribution of work
• Lack of continuous capacity building
• No embracing of latest technologies
• Weak laws and regulations (and / or their enforcement) to ensure continuous medical education
• No real HUMAN RESOURCES systems – everything still is a personnel management world
Outlines
• Introduction • Healthcare Human Resources in Jordan• Quality and Patient Safety Challenges • Standards for Human Resources Management• Competency based practice• Conclusion
Human Resources in Jordan have different strengths but face several challenges
Strengths Strengths
Established graduate and post graduate education programs
Qualified Healthcare professionals
Good health out come indictors in terms of communicable diseases, infant and maternal health
Challenges Challenges
Lack of leadership competency
Lack of established human resources management programs
Lack of regulations
No policies, procedures, clinical guidelines
Lack of credentialing and privileging system for medical staff
No relicensing system
No mandatory continuous education
No medical liability laws
Although the numbers in Jordan are relatively sustainable….
0
10
20
30
40
50
60
70
14.9
28.3
8.9 6.1
25.617.9
35.4
19
6.2
20.5
9.42.8
15 12.219.3
2
Physicians/10,000 Population2005 – 2012
Bahrain
Egypt
Iran
Iraq
Jordan
KuwaitLe
bLib
ya Mor
Oman
Saudi ..
.
Sudan
Syria
Tunisia
UAE
yemen
0
10
20
30
40
50
60
70
38.635.2
14.1
40.545.5
22.3
68
8.9
44.9
21
8.4
18.6
32.840.9
6.8
Nursing and Midwifery/10,000 Population2005 – 2012
0
10
20
30
40
50
60
70
1.5 4.2 1.59
3.5
13.36
0.8 2.3 2.3 0.27.9
2.9 4.30.2
Dentists /10,000 Population2005 – 2012
Bahrain
Egypt
Iran
Iraq
Jordan
Kuwait
Lebanon
Libya
Moro
ccoOman
Saudi A
rabia
Sudan
Syria
Tunisia
UAE
yemen
0
10
20
30
40
50
60
70
2.5
16.7
2 1.7
21.4
3
12.33.6 2.7 4.4
0.6 0.18.1
3 5.90.4
Pharmacists /10,000 Population2005 – 2012
…Jordan still faces similar challenges for the retention of skilled and patient centered resources
Lack of proactive measures
• No On The Job Training Programs
• Still no Compensation alignment:
• No Career Growth for Professionals
• No Competency based Pay
• Limited professional training institutes,
• Lack of uniform and Structured Programs
• No Licensing body, No accreditation and no affiliation of these programs
Outlines
• Introduction • Healthcare Human Resources in Jordan• Quality and Patient Safety Challenges • Standards for Human Resources Management• Competency based practice• Conclusion
chemical exposure
Lack of radiation safety
Absence of basic hygiene
Lack of privacy
No fire safety procedures and systems
Untrained staff on basic resuscitation
Lack of leadership competencies
Lack of medical staff management systems
Competency of healthcare providers
No documented policies, procedures, plans,
No clinical guidelines
Not in compliance with laws and regulations regarding fire safety, radiation safety, staff qualifications, and medication management processes.
Lack of qualified staff in quality management , risk management, and infection prevention and control
Reporting culture
Additionally, Quality and Patient safety still faces many challenges in Jordan
12
Developin
g standard
s
Building
Capacity
But to address both challenges “quality issues and human resources challenges” Jordan adopted a two prong approach
Outlines
• Introduction • Healthcare Human Resources in Jordan• Quality and Patient Safety Challenges • Standards for Human Resources Management• Competency based practice• Conclusion
14
Each hospital leader’s job description identifies qualifications that include formal training and experience in health management.
Quality improvement, patient safety and risk management are part of that training.
The leaders have documented formal leadership training within the past two years.
Accreditation standards support the provision of qualified personnel: Leadership!
Leadership competencies
Managing
projects and
programs
Leading organizations
Managing self
and people
15
The quality improvement coordinator has knowledge in risk management methodologies.
The quality improvement coordinator completes continuing education activities at least annually to increase knowledge regarding current quality improvement practices and risk management
The standards also require quality improvement coordinator who coordinates QI activities
Quality Plannin
g
Quality Measurement
Quality Improvement
Manage Change
16
The hospital has a risk management coordinator who meets the qualifications outlined in a job description, which includes:
1. Attendance in formal risk managementtraining course or
2. Risk management certificationThe qualifications are met within one year of assuming the position of the risk management coordinator
The risk management coordinator completes continuing education activities at least annually to increase knowledge regarding current quality improvement practices and risk management.
The risk management coordinator participates in training staff on risk management measures.
The standards require a qualified risk management coordinator who coordinates risk management
Risk managemen
t process and program
Safety culture
Patient safety
17
There is at least one qualified nurse, or professional in related field, who coordinates the infection prevention and control activities.
The IPC Preventionist is responsible for the surveillance, data gathering, aggregation and analysis of IPC data.
Infection prevention certification
The IPC Preventionist in the related field has knowledge in quality improvement and risk management methodologies.
The IPC Preventionist completes continuing education activities at least annually to increase knowledge regarding current ICP practices, quality, and risk management.
And the standards also stipulate a qualified nurse, or professional to coordinate the infection prevention and control activities
Microbiology Adult
Learning
Surveillance
Quality Managemen
t
Program manageme
nt
Risk managemen
t
18
For example, the tailored certification courses introduce concepts of continuous education while ensuring applicability to the field
practicum
Portfolio assignments Mentorship program
Class room Training Each course consists of different modules The class room training ranges between 6 – 12
days
Pre course Selection criteria Pre course readings and assessment
Certification
Complete Assignments Pass certification Exam
Recertification every 2 years
Recertification
19
There are several opportunities in place for human resources development crucial to the quality journey
Enabling Services
Certification coursesCertification courses
Workshops and Trainings
Workshops and Trainings
Knowledge TransferKnowledge Transfer
Not just academic, includespractical and hands on
Rich yearly schedules
Walkthroughs and1 to 1 consulting , coaching and mentoring
Outlines
• Introduction • Healthcare Human Resources in Jordan• Quality and Patient Safety Challenges • Standards for Human Resources Management• Competency based practice• Conclusion
21
Individuals qualified to perform health care are defined in a policy, according to specific patient populations, e.g. emergency, pediatric, ICU.
Only those individuals permitted by license, certification and/or competency-based testing perform healthcare procedures.
Staff members demonstrate competency in managing patients within their area of work.
Additionally, standards specify that at all times qualified individuals provide health care services in timely and efficient manner.
Additionally, in Jordan, we are trying to promote and push for competence based practice as it clearly supports quality improvement
22
DefinitionDefinition
Competency- based practice (CBP) is that it focuses on the ability of healthcare provider to provide safe, consistent care to patients when their performance is measured against valid, reliable and objective evaluation criteria.
AdvantagesAdvantages
Establish recognition for the practice
Establish minimum standards in practice
Establish quality training programs
Establish criteria for evaluation of practice
Establish commitment to good practice
23
Competency-based performance improvement frame work is a very straight forward and goal oriented approach feeding into quality improvement requirements
Need analysis, assessment, and planning
Competency model development
Education modules planning
Learning intervention design and development
Evaluation
Strategic goals, objectives, and business plans
External environment
Internal environment
24
The concepts and methods for developing competency based framework are supportive of quality improvement practices
Competency AssessmentCompetency Assessment
Competencies should be…
Ongoing
Systematic
Demonstrable ( capable of being demonstrated)
Improved
Addressing age-specific issues(if applicable)
Competency ContinuumCompetency Continuum
Competencies should be assessed when
• An individual is hired• During their orientation period
to the position• Throughout employment as
the requirements of the job and needs of the organization change.
Dynamic competencies should exist that address each period separately.
25
CBP is continuum with ongoing work, and new education programs need to be developed to address development and changes in healthcare field.
Ongoing WorkOngoing Work
Ongoing competency assessment is NOT annual re-assessment of the initial competencies for the job.
Ongoing competency assessment is a dynamic process that is based on the ever-changing needs required to carry out the organization’s mission and goals.
Ongoing competencies will be different than the initial competencies identified for the job.
Educational ProgramEducational Program
New procedures
New equipment
Maintenance of current competencies
Improve Performance
Outlines
• Introduction • Healthcare Human Resources in Jordan• Quality and Patient Safety Challenges • Standards for Human Resources Management• Competency based practice• Conclusion
27
To address Human resources challenges , interventions need to be introduced on the organizations level, as well as changes in the policy level.
Human resources management is an integral part of quality culture
Established continuous education programs and certification courses one of the key elements in addressing human resources challenges
Advocate for changes in laws, regulations that mandate continuous education to maintain licenses
Policy Change
Post Graduate
Citification Courses
Established Education Programs
based on CBP
Human Resources
Management Programs
28
Questions and Comments
28
29
Thank You