A template approach to quality improvement activity: a primary care example

2013 ◽  
Vol 37 (4) ◽  
pp. 535 ◽  
Author(s):  
Christopher Fawcett ◽  
Helen Moriarty ◽  
Roshan Perera
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Health Service ◽  
Health Services ◽  
Community Practice ◽  
Quality And Safety ◽  
Quality Improvement Activity ◽  
Community Based ◽  
Quality Framework ◽  
Area Of Concern

Introduction. This paper demonstrates the use of a Quality Framework and Implementation Template to review processes for improving the quality and safety of opiate prescribing for chronic non-malignant pain (CNMP). Escalating use of prescription opiates for chronic pain is of national and international concern, with major implications for personal and public health as well as for patient safety and health service quality and safety. Objectives. This paper uses opiate prescribing for CNMP as a worked example to illustrate use of the Quality Framework for self-directed quality improvement in smaller specialist medical or community-based practices. Methods. An Implementation Template, comprising a series of focussed questions derived from the Quality Framework, was applied to one specific quality improvement activity arising from clinical practice (opiate prescribing for CNMP). This helped the practice team understand current systems and processes, identify actual and potential problems, and find possible solutions to institute interventions for change. Conclusion. The template approach to quality activity is very applicable within smaller specialist or community health service settings, enabling such health services to focus on their own quality improvement activities and address topics of importance to the practice in a systematic and productive manner. What is known about the topic? There are complex interactions and activities to be considered when undertaking quality improvement within community practice. Repeat opiate prescribing for CNMP is a significant issue for practices and patients. What does this paper add? This paper examines the specific case of improvements to quality and safety of repeat prescribing of opiates for CNMP in small clinics and other community-based health services. This example shows how users may utilise an Implementation Template to perform a systematic and comprehensive review of their systems and processes in relation to any chosen aspect of practice-based quality improvement activity. Services could apply these same principles to any topic of interest, or practice and/or organisational activity, to undertake systematic quality improvement. What are the implications for practitioners? The Implementation Template was designed for use by clinical practice teams. It will be helpful for practices that wish to undertake a quality improvement activity but lack the knowledge of how to proceed. Use of the template approach provides practice teams with the means to ensure that they consider the area of concern from all angles, and helps to uncover areas that might not otherwise have been considered.

scholarly journals The role of boards in clinical governance: activities and attitudes among members of public health service boards in Victoria

2013 ◽  
Vol 37 (5) ◽  
pp. 682 ◽  
Author(s):  
Marie M. Bismark ◽  
Simon J. Walter ◽  
David M. Studdert
Keyword(s):  
Public Health ◽  
Quality Of Care ◽  
Health Service ◽  
Health Services ◽  
Public Health Service ◽  
Clinical Governance ◽  
Board Members ◽  
Quality And Safety ◽  
Quality Performance

Objectives To determine the nature and extent of governance activities by health service boards in relation to quality and safety of care and to gauge the expertise and perspectives of board members in this area. Methods This study used an online and postal survey of the Board Chair, Quality Committee Chair and two randomly selected members from the boards of all 85 health services in Victoria. Seventy percent (233/332) of members surveyed responded and 96% (82/85) of boards had at least one member respond. Results Most boards had quality performance as a standing item on meeting agendas (79%) and reviewed data on medication errors and hospital-acquired infections at least quarterly (77%). Fewer boards benchmarked their service’s quality performance against external comparators (50%) or offered board members formal training on quality (53%). Eighty-two percent of board members identified quality as a top priority for board oversight, yet members generally considered their boards to be a relatively minor force in shaping the quality of care. There was a positive correlation between the size of health services (total budget, inpatient separations) and their board’s level of engagement in quality-related activities. Ninety percent of board members indicated that additional training in quality and safety would be ‘moderately useful’ or ‘very useful’. Almost every respondent believed the overall quality of care their service delivered was as good as, or better than, the typical Victorian health service. Conclusions Collectively, health service boards are engaged in an impressive range of clinical governance activities. However, the extent of engagement is uneven across boards, certain knowledge deficits are evident and there was wide agreement among board members that further training in quality-related issues would be useful. What is known about the topic? There is an emerging international consensus that effective board leadership is a vital element of high-quality healthcare. In Australia, new National Health Standards require all public health service boards to have a ‘system of governance that actively manages patient safety and quality risks’. What does this paper add? Our survey of all public health service Boards in Victoria found that, overall, boards are engaged in an impressive range of clinical governance activities. However, tensions are evident. First, whereas some boards are strongly engaged in clinical governance, others report relatively little activity. Second, despite 8 in 10 members rating quality as a top board priority, few members regarded boards as influential players in determining it. Third, although members regarded their boards as having strong expertise in quality, there were signs of knowledge limitations, including: near consensus that (additional) training would be useful; unfamiliarity with key national quality documents; and overly optimistic beliefs about quality performance. What are the implications for practitioners? There is scope to improve board expertise in clinical governance through tailored training programs. Better board reporting would help to address the concern of some board members that they are drowning in data yet thirsty for meaningful information. Finally, standardised frameworks for benchmarking internal quality data against external measures would help boards to assess the performance of their own health service and identify opportunities for improvement.

scholarly journals Health Service Utilization and Out-Of-Pocket Health Expenditure Among Insured and Uninsured: A Comparative Study in Baglung District, Nepal

2019 ◽  
Author(s):  
Laxman Datt Bhatt ◽  
Shankar Singh Dhami
Keyword(s):  
Health Insurance ◽  
Health Service ◽  
Health Services ◽  
Service Utilization ◽  
Health Expenditure ◽  
Health Service Utilization ◽  
Social Health ◽  
Insurance Status ◽  
Community Based ◽  
Health Security

Abstract Background Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias.Method A community based cross-sectional comparative study was conducted in Baglung district of Nepal to find out and compare the health service utilization and direct out-of-pocket health care expenditure among the 225 insured and 225 uninsured households under the national health insurance program of Nepal. Insured households were randomly chosen from study area and uninsured households were selected by using neighborhood method.Result The study focused that insurance status was strongly associated with heath service utilization with odds ratio 1.774 (95% CI = 1.127-2.791, P = 0.013). The study also depicts that insurance status was major determinants of out of pocket health expenditure. The median out-of-pocket health expenditure among insured households Nepalese Rupees 200 while among uninsured was 1225, which was statistically significant (p = <0.001 MW-U test). Among uninsured group, non-dalit were 2.846 times more likely to utilize health services compared to the dalit (p = 0.003) but it was not significant (p = 0.47) among insured group.Conclusion Nepal’s Health Insurance Board is responsible for purchasing the quality health care service and make available at possible nearest point of its member. Our study reveals that Occupation, perceived health status, wealth status played significant role with health service utilization among uninsured group while it was not significant among insured group. Among both insured and uninsured group none of the study variables were found significant with out-of-pocket health expenditure.

scholarly journals MODEL PENGEMBANGAN MASYARAKAT BERBASIS LAYANAN KESEHATAN CUMA-CUMA UNTUK KAUM DHU’AFA Kasus di Pos Sehat Al Ikhwan Parung-Bogor

2014 ◽  
Vol 34 (2) ◽  
pp. 197
Author(s):  
Wati Nilamsari
Keyword(s):  
Health Service ◽  
Community Development ◽  
Health Services ◽  
Local Community ◽  
Research Result ◽  
Healthcare Services ◽  
Development Model ◽  
Community Based ◽  
The Poor

<p>This paper is a research result examining the development model of community-based free health services to the poor (dhuafa) at Pos Sehat Al Ikhwan, Parung-Bogor. The writer used the Rothman and Glen’s theory to analize the case. This study used the local community development model. It is aimed to build the economic autonomy of community, in which they could determine and meet their own needs by using creative and operative processes. Having completed the mentoring process conducted by Da'wah and Communication Faculty, “Pos Sehat Al Ikhwan” attempts to maintain the continuity of health services for the dhu'afa in Bojong Indah, Parung, Bogor by strengthening network of the similar healthcare services being performed by advanced institutions to support the operational of “Pos Sehat”. Some of those are the health service of At Taqwa Mosque, and free health services of Dompet Dhu'afa which is until now still help advocating the “Pos Sehat Al Ikhwan” through connecting the Dompet Dhuafa donors with the “Pos Sehat Al-Ikhwan”.</p><p align="center"><strong>***</strong></p><p>Paper ini merupakan hasil penelitian yang mengkaji tentang Model Pengembangan Masyarakat berbasis layanan kesehatan Cuma-Cuma untuk kaum Dhuafa, dengan mengangkat kasus yang terjadi di Pos Sehat Al Ikhwan, Parung-Bogor. Analisis mengenai model pengembangan masyarakat pada  layanan Kesehatan Pos Sehat Al Ikhwan menggunakan teori dari Rothman dan kawan-kawan maupun Glen. Penelitian ini merupakan model pengembangan masyarakat lokal. Model ini bertujuan untuk membangun kemandirian masyarakat, dimana masyarakat sendiri yang mendefinisikan dan memenuhi kebutuhan mereka sendiri dengan menggunakan proses-proses yang kratif dan operatif. Upaya yang dilakukan oleh Pos Sehat Al Ikhwan untuk menjaga keberlangsungan layanan kesehatan untuk kaum dhu’afa di Desa Bojong Indah, Parung, Bogor setelah selesainya proses pendampingan yang dilakukan oleh Fakultas Dakwah dan Komunikasi yaitu dengan memperkuat jaringan pada layanan kesehatan mandiri yang dilakukan oleh lembaga yang sudah maju untuk mendukung operasional Pos sehat, antara lain dengan Layanan Kesehatan Masjid At Taqwa Bintaro, dan juga Layanan Kesehatan Cuma-Cuma Dompet Dhua’afa yang hingga sekarang melakukan pendampingan pada pos sehat Al Ikhwan melaui mekanisme menghubungkan donatur Dompet Dhuafa dengan pos sehat Al Ikhwan.</p>

scholarly journals Promotion of Mental Health Rehabilitation in China: Community- Based Mental-Health Services

2020 ◽  
Vol 1 (2) ◽  
pp. 21-27
Author(s):  
Y. Zhu ◽  
X. Li ◽  
M. Zhao
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
National Standards ◽  
Chinese Government ◽  
Public Health Services ◽  
Community Based ◽  
The 1960S

Community-based mental health services are important for the treatment and recovery of patients with mental health disorders. The Chinese government has made the establishment of a highly efficient community-based health service an enduring priority. Since the 1960s, community-based mental health services have been developed in many Chinese cities and provinces. National policies, including mental health regulations and five-year national mental health working plans, have been issued to support the development of quality of mental health services. The accessibility and efficiency of community-based mental health services are now highly promoted to community residents. According to the National Standards for Primary Public Health Services, community-based mental health services are one of the most important components of primary public health services. They are mainly provided via Community Health Service Centres (CHCs), by a combination of general practitioners, public health physicians, nurses and social workers. Patients receive individualized and continuous health services according to their rehabilitation status. These services include regular physical examination, health education, rehabilitation guidance, social function rehabilitation training, vocational training and referral services; family members also receive care and psychological support. Future work will focus on expanding mental health service coverage and usage, increasing awareness of mental health and decreasing stigma, and strengthening service capability to establish an integrated model to enhance the overall efficiency of mental health services.

scholarly journals Accuracy of national key performance indicator reporting from two Aboriginal medical services: potential to underestimate the performance of primary health care

2018 ◽  
Vol 42 (4) ◽  
pp. 453 ◽  
Author(s):  
Isaac Hill ◽  
David Johnson ◽  
David Scrimgeour ◽  
Robyn McDermott
Keyword(s):  
Quality Improvement ◽  
Health Service ◽  
Health Services ◽  
Performance Indicator ◽  
Data Extraction ◽  
Information Management System ◽  
Health Data ◽  
Service Performance ◽  
Key Performance Indicator ◽  
Local Quality

Objective The aim of the present study was to assess the accuracy of extracting national key performance indicator (nKPI) data for the Online Community Health Reporting Environment for Health Services (OCHREStreams) program using the Pen Computer Systems (Leichhardt, NSW, Australia) Clinical Audit Tool (CAT) from Communicare (Telstra Health Communicare Systems, Perth, WA, Australia), a commonly used patient information management system (PIMS) in Aboriginal primary care. Methods Two Aboriginal Community-Controlled Health Services (ACCHSs) were recruited to the present study. A sample of regular clients aged ≥55 years from each ACCHS was selected and a subset of 13 nKPIs was examined. A manual case note audit of the nKPI subset within Communicare was undertaken by a clinician at each participating ACCHS and acted as a ‘gold standard’ comparator for three query methods: (1) internal Communicare nKPI reports; (2) PenCS CAT nKPI manual filtering (a third-party data-extraction tool); and (3) nKPI data submitted to the Improvement Foundation qiConnect portal. Results No errors were found in nKPI data extraction from Communicare using the CAT and subsequent submission to the qiConnect portal. However, the Communicare internal nKPI report included deceased clients and past patients, and we can be very confident that deceased clients and past patients are also included in the qiConnect portal data. This resulted in inflation of client denominators and an underestimation of health service performance, particularly for nKPIs recording activity in the past 6 months. Several minor errors were also detected in Communicare internal nKPI reports. Conclusions CAT accurately extracts a subset of nKPI data from Communicare. However, given the widespread use of Communicare in ACCHSs, the inclusion of deceased clients and past patients in the OCHREStreams nKPI data program is likely to have resulted in systematic under-reporting of health service performance nationally. What is known about the topic? There has been limited validation of health data exported via data-extraction tools in Australia. More specifically, there are no current published data describing the accuracy of the CAT in mapping health data extracted from Communicare or the accuracy of internal nKPI reports generated by Communicare. Further, no systematic review has been undertaken to assess the accuracy of the nKPI data submission pathway from PIMSs at the health service level to the OCHREStreams qiConnect portal using the CAT. What does this paper add? The CAT accurately extracts a subset of nKPI data from Communicare and accurately submits this to the qiConnect portal. Minor errors exist in some Communicare internal nKPI reports. The inclusion of deceased clients and past patients in the nKPI reporting system for ACCHSs is likely to have resulted in systematic under-reporting of health service performance nationally through this program. What are the implications for practitioners? The inclusion of deceased clients and past patients in the OCHREStreams nKPI program limits the usefulness of these data for local quality improvement activities and national monitoring of health service performance for participating ACCHSs. The use of the CAT by ACCHSs independently from the OCHREStreams program can enable deceased clients and past patients to be excluded from reports that can provide more accurate nKPI data from Communicare for local quality improvement and planning purposes.

Consumer Participation in Service Evaluation and Quality Improvement: Key Ingredients for a System to Deliver National Indicators

2011 ◽  
Vol 19 (6) ◽  
pp. 493-497 ◽  
Author(s):  
Karen Oakley ◽  
Gillian Malins ◽  
Louisa Riste ◽  
John Allan
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Mental Health Service ◽  
Health Service ◽  
Health Services ◽  
Service Evaluation ◽  
Consumer Participation ◽  
Local Systems ◽  
Health Performance ◽  
Health Service Evaluation

Objectives: The aim of this paper is to describe the fundamental components of a system to ensure consumer participation in mental health service evaluation and quality improvement. Conclusions: The seven fundamental components identified provide the basis for a system to deliver national indicators for consumer participation in quality improvement under the National Health Performance domain of “responsiveness to consumers”. The MH-CoPES Framework satisfies these criteria and may be drawn upon as the basis for developing local systems for consumer participation in quality improvement within mental health services.

scholarly journals Bridging existing governance gaps: five evidence-based actions that boards can take to pursue high quality care

2019 ◽  
Vol 43 (2) ◽  
pp. 126
Author(s):  
Sandra G. Leggat ◽  
Cathy Balding
Keyword(s):  
Health Service ◽  
Health Services ◽  
Care Delivery ◽  
Quality Care ◽  
Successful Implementation ◽  
Evidence Based ◽  
Quality And Safety ◽  
Quality Systems ◽  
High Quality ◽  
High Quality Care

Objective To explore the impact of the organisational quality systems on quality of care in Victorian health services. Methods During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. Results This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Conclusion Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. What is known about this topic? Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation’s pursuit of high quality care. What does this paper add? Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. What are the implications for practitioners? Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for successful implementation, which is actively guided and monitored by the board.

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