Standard Infrastructurefor Quality Eye Care Services

DR. DIVYESH P. SHAH

Sight First Technical Advisor,

MD 322

The American Medical Association defines the quality of care services as “the degree to which

[these] services influence the probability of optimal patient outcomes.

The World Health Organization offers a more comprehensive definition and divides quality in four sections :

1 Professional performance

2.Use of resources

3 Risk management

4 Patient satisfaction

‘whole system’

Quality Infrastructure

1. Planned OPD, IPD & OT

2. Proper equipments

3. Trained human resources

4. Record maintenance

5. Accreditations

Building and Infrastructure :

1. Layout

2. Maintenance

3. Sanitation and Hygiene

Layout of facilities

• Amenities OPD FACILITIES Reception– Seating – Consulting rooms: optometrists, opthalmologists– Investigation rooms– Speciality clinics - Squint clinic, retinal clinic, glaucoma clinic

etc – laser and minor procedures room– Patient counselor– Canteen – Banking / ATM– Medical Shop– Optical shop– Parking– Telephone facility– Travel Desk

OPD

Patient waiting hall

Hospital Atmosphere

• Ambience– Clean, Safe environment– Infection free atmosphere– Pleasant

LAYOUT

• IPD facilities –

- proper OT layout

- pre OT and post OT facilities

- wards and private cabins

- nurses station

- emergency medicines and treatment facilities

• Store

Operation Theatre

• OT complex

• Pre OT

• OT walls and flooring

• Laminar airflow

• Septic OT

• Autoclave room, proper autoclave, scrub area

• Facilities for patient emergency

Wall & Floor

Floor and wall construction

• Nonporous material with minimal joint is recommended for Walls and floors

• Surface should be smooth for better disinfection.

• Corners should be rounded

• Thorough wiping of walls and floor with disinfectants is currently preferred to regular fumigation.

Theatre lay out and interior

• Minimum two barriers are recommended between external air and the Operating Room.

• Prevent entry of external air to prevent contamination of inside air.

• No window in the theatre.• Any surface that may gather dust should be

avoided like fans, cupboards etc. Only essentials

• Split AC

OT Layout

Appropriate Technology / Techniques

• Will it minimize complications

• Will it improve visual outcomes

• Will it enhance productivity

• Will it minimize follow up

• Will it improve satisfaction

“ Technology is a queer thing. It brings you great gifts with one

hand, and it stabs you in the back with the other”

Monitoring surgical supplies

• Use the same source

• Periodic QC of the supplies used : irrigating solutions,

viscoelastics, disposables etc

• Check sterility, pH etc

“Most worthwhile achievements are the result of many little things done in a single direction”

Safety Control

• Electricity safety and Power Loss

• Fire Safety

• Biological Hazard

• Reporting of Mishaps/ Just missed events.

Systems to Ensure Efficiency & Quality

• Clinical Protocols

• Standardization of procedures

• Resources - Usage & Balancing

• Staff Training & Discipline

• Documentation Systems

Hospital Management software

Total Computerization

• Administrative

• Medical records

• Finance and Book keeping

Human resources

1. Trained staff

2. Technical Skills

3. Task to skill matching for individual

“you can have the best strategy and best building in the world, but if you don’t have the hearts and minds of the people who work with you, none of it comes to life”

”

Appropriate use of manpower

• Increases out put & Reduces cost

• Maintains quality of skill at high level

• Eliminate non-productive activities

• Increases job satisfaction

“ At the end you bet on people , not on

strategies”

Staff Training & Discipline

• Systematic procedure

for training

• Individual skills are

continuously upgraded

by training to reach

acceptable levels

• Motivating the staff to

train others

“Management is nothing more than motivating people”

Standardization of procedures

• Essential to streamline workflow

• Person responsible for each task/process identified

• Expected outcomes quantitatively & qualitatively

well defined

• Clarity is achieved by frequent discussion and re-

emphasis

ACCREDITION

• NABH

• ISO....

What is Accreditation

• Accreditation means Certification of competence in a specified subject or areas of expertise by external agencies.

• There are four principal component

1. It is based on written and published standards

2. Reviews are conducted by professional peers

3. The accreditation process is administered by an independent body

4. The aim of accreditation is to encourage organizational development.

5. On going process

Patient Centered Care

Effective philanthropy requires a lot of time and creativity – the same kind of focus and skills that building a business requires

-- Bill Gates

THANK YOU

DR DIVYESH P SHAH, TA MD 322

Surgical Quality

Surgical Complication rate

XYZ LIONS EYE HOSPITAL

– 2007 1.45%

– 2008 1.24%

– 2009 1.06%

– Surgeons’ performance review

Follow up Visual Outcome

Vision category

PAYING FREE CAMP

NOS. % NOS. % NOS. %

Unaided Visual Outcome

(6/6-6/18) 1706 86.25% 925 52.11% 2207 55.56%

(6/24 - 6/60) 235 11.88% 783 44.11% 1666 41.94%

(<6/60) 37 1.87% 67 3.77% 99 2.49%

NO ENTRY 0 0.00% 0 0.00% 0 0.00%

TOTAL 1978   1775   3972  

Best Corrected Visual Outcome

(6/6-6/18) 1914 96.76% 1466 82.59% 3805 95.80%

(6/24 - 6/60) 42 2.12% 303 17.07% 126 3.17%

(<6/60) 22 1.11% 6 0.34% 41 1.03%

NO ENTRY 0 0.00% 0 0.00% 0 0.00%

TOTAL 1978   1775   3972  

Compliance to Treatment

• Counseling – Providing maximum information

• Health Education inputs – Audio Visual aids (Brochures, posters, pamphlets, etc.,)

• Informed decision making – Risks, complications, benefits, alternative

procedures, guarded prognosis, etc.,

Comprehensive Eye Examination

• History

• Visual Acuity/Refraction

• Systemic Examination (BP/Blood sugar)

• IOP

• External torch light examination

• Slit Lamp Examination

• Fundus Examination

Non-medical needs

Employee safety and Policies

To prevent mistakes

• Create culture of safety

• “First do no harm”

• Improve Processes– Reduce complexity– Develop reliable processes– Create independent checks for key

processes

• Make the organization depend on systems and not on individuals

Most of the errors / failures go unreported…

Due to

staff fear of reprisal

lack of adequate systems to report

limited staff education about safety and report process

and

lack of computerized surveillance systems

So, alleviate the fear of reporting through training and sharing the importance of IR system

So, alleviate the fear of reporting through training and sharing the importance of IR system

Hospital Assessment Tool

• Dr. Moses file on Assessment

• Safety -

• Patient-Centred - care should be based on individual needs

• Timely - waits and delays in care should be reduced

• Effective - care should be evidence-based

• Efficient – best use of resources and reduced waste

• Equitable - care should be equal for all people irrespective their gender, economic status, caste, religion, etc

Access

Availability

•Core services matching the community needs

•All services under one roof

•Outreach programs

•Open Access system

Core result of service:Patient satisfaction

• Patient complaint is everybody’s responsibility

• Viewing Complaints as feedback for improvement

• Patient feedback monitoring

Handling patient complaints promptly improves satisfaction

Handling patient complaints promptly improves satisfaction