QAP in KKM

Dr Suhazeli Abdullah Family Medicine Specialist Klinik Kesihatan Marang
Courtesy slides from Dato· Dr Abdul Jamil Abdullah, Head of Surgery Department, HSNZ

What is QUALITY? 

Excellence,  mutu

goodness

- baik buruk sesuatu
Kamus Dewan

Vision for Health
Malaysia is to be a nation of healthy individuals and families communities, through a health system that is equitable affordable efficient technologically appropriate environmentally adaptable consumerconsumer-friendly
,

and

MOH·s vision««
with emphasis on quality innovation health promotion and respect for human dignity, which promotes individual responsibility and community participation

towards an enhanced quality of life

Quality activities of MOH 
Registration 
Doctors

& Paramedicals 

Licensing 
Hospital,

Pharmacy 

Accreditation  Credentialling  Code

of conduct, code of ethics

Quality activities of MOH 

Morbidity & mortality reviews 
Perinatal

MR, MMR, POMR 

Committee meetings 
Infection

control, OT, Drug 

Audits 
Medical,

Nursing

Quality activities of MOH 
Reviews 
Utilisation, Peer, CPC Investigations Sentinel events, public complaints Guidelines  CPG, SOP, checklist ISO, QCC, TQM, PKPA, HTA

QA milestone in KKM
Up to 1980·s - coverage, target & goal 1985 - introduce element of Quality in Healthcare:
QAP for In-Patient Care Services In14 pilot Hospitals & 12 indicators 19 indicators for all Hospitals

Two approaches : NIA & HSA

Bil. 1. 2. 3. 4. 5. 6. 7. 8.

Programme Patient Care Services Pharmaceutical Services Public Health Services Engineering Services Dental Services Laboratory Services Training & Manpower Planning & Development

Year of Implementation 1985 1990 1990 1992 1992 1992 1996 1998

Current No. of Indicators 19 7 13 7 9 11 5 3

Aims 
To

improve the quality, efficiency and effectiveness of the delivery of health services facilitate the planned and systematic evaluation of quality process 

To

QA - KKM definition
´Securing optimum achievable result for each patient, patient, avoidance of iatrogenic complications and giving attention to the patient and family needs in a manner that is cost effective and reasonably documented Adapted from Thomson

QA APPROACHES
National Indicator Approach (NIA) Hospital Specific Approach (HSA)

Features
Problem identification Specificity of problem Priority for hospital Setting of standards Problem verification QA study ReRe-evaluation

HSA
Hosp level Specific to hosp High Hospital level Related data in hospital Similar Decided by hospital

NIA
KKM level Common to all Variable KKM level Data collected for indicator approach Once a year

NIA

NIA
* MOH set & provides: - a standard for each indicator
monitoring format for data collection , analysis & reporting protocols & format for SIQ investigation.

-

* Hospital has to carry out remedial actions & relook of its effectiveness.

NIA Indicators
Indicator Std. 1. Typhoid CFR 0 2. Elective cholecystectomy deaths 0 3. Death due to haemorrhage of pregnancy 0 4. Eclampsia CFR 0 5. Gross death rate 2.13% 6. POP cast complication <5% 7. Clean Wound Infection <4% 8. Pressure sores in bed-ridden pts bed<5% 9. BOR 50 - 80% 10. ALOS 3 - 6.3 days

NIA Indicators
Indicator
1. AMI CFR 2. AGE CFR in children 3. Head injury CFR 4. ARI CFR 5. Lab specimen rejection rate 6. Proportion of urgent lab test 7. Proportions of Ops undergoing x-rays x8. Proportions of Ips undergoing x-rays x9. Proportions of x-ray films rejected x-

Std.
<34.7% <0.6% <7% <3.1% <0.86% <19.6% <8% <70% <10%

Communicable Disease 

TB Sputum Conversion Rate

85% 

Average Notification Time Index for Typhoid <14 days Morbidity Index for Typhoid <2 

Vector Borne Disease 

Dengue Notification Time Index 80% within 24 hours Dengue Outbreak Control Index 100% controlled within 14 days of 2nd case Dengue Law Enforcement Index 80% positive premise taken legal action Malaria Death No death   

Family Health 

Incidence Rate of Eclampsia 8 per 10,000 deliveries Incidence Rate of Severe Neonatal Jaundice < 100 cases per 10,000 live births  

Incidence Rate of Tetanus Neonatorum 0 case per 10,000 live births

HSA

HSA 

Hospital/Unit/Dept. identify own areas of weakness to remedy Idea of local people solving local problems Useful tool in improving quality services  

General Objective To ensure that the patient, family and community obtain the optimum achievable benefit from the services of MOH within the available resources

ABNA
100

75

50

}

Ideal Optimum

With unlimited resource 

ideal level of care targeted level within means

ABNA
Actual

Optimal Achievable Level 

ABNA 


25

0

difference between OA & present level QA aims at narrowing or eliminating the gap

Problem identification Problem Prioritisation ReRe-evaluation of the Problem

Quality Assurance Cycle

Problem Analysis

Implementation of Remedial Actions

Quality Assurance Study

Identification of Remedial Actions

QA Organisation

QAP - Organizational Structure
The MOH Steering Committee Programme Level QAP Committee State QAP Steering Committee State QAP technical sub-committee Hospital / District QAP Committee

Hospital/District QA Committee 

Hospital / District QAP Committee
Chairman: Pengarah Hospital / MOH
Secretary: AMRO (*) Members: - Clinical co-coordinator (*) co- Unit / Dept. Head - M&HO /Matron / Supervisors - Co-opted members Co(*) for hospital

Functions«
To meet at least once in 3 months to: Inform & motivate staff of the need and implementation of QA Plan & initiate QA activities Monitor & evaluate the implementation & remedial actions Identify problems for QA studies Appoint investigators for QA studies

«Functions
Appoint appropriate members Discuss & forward relevant reports / recommendations to State Committee CoCo-ordinate, train and support QA activities planned & conducted by the individual units.

QA APPROACHES
Structure
‡Organizations ‡Personnel ‡Licensure ‡Registration ‡Certification ‡Accreditation

Process/system
‡Protocols ‡CPGs ‡Policies ‡Incident Reporting

Outcome

‡Mortality review ‡Morbidity ‡NIA/HSA

WHO define QUALITY?

These may seem varied, but they almost sound similar;

the requirements of the customer are always a consideration in a valid definition of quality

Patients/Relatives 

Pleasant Staff & Environment Responsiveness Reliable Competence 

 

KKM Definition
Securing optimum achievable result for each patient, patient, Avoidance of (MINIMISE) iatrogenic complications and giving attention to the patient and family needs in a manner that is cost effective and reasonably documented
Adapted from Thomson

ASSURANCE
Implies one party is convincing another that certain standards will be maintained

Quality Assurance 

In general terms means that 

all the measures are taken in order that

the customer or interested party will be consistently provided with quality.  (show them what you are doing)

Why
we need Quality

Professional Need 

related to the fundamental responsibility of all professionals ² appropriateness & necessity for the highest standards of excellence. Effectiveness Standardization (reduced variance) Safety 

  

A Social Need 

related to the accountability of every profession to the society from which the profession obtain authorization and economic support to practice their skills Ethical  

A Practical Need 


The need for continuous improvement Where errors are costly

Costs

Quality is never an accident
´, it is always the result of high intentions, sincere effort, intelligent direction and skillful executionµ

Quality is a journey, not a destination

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