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VOLTA REGIONAL HEALTH DIRECTORATE

REPORT ON THE FIRST ROUND OF

PEER REVIEW
OF HOSPITALS IN THE VOLTA REGION
DECEMBER, 2011

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SECOND CYCLE PEER REVIEW REPORT,2011

DECLARATION
This report is the result of the Peer Review monitoring by the Regional Clinical Care Division of the Volta Regional Health Directorate, which was actively supported by the Medical Superintendents’ group. The overriding objective of the exercise is to improve the quality and standards of service delivery for all the twenty one hospitals and the only Polyclinic in the region to become centres of excellence. We the undersigned hereby declare that, the findings and the recommendations made in this report shall be used for the improvement in the quality of healthcare delivery in the Volta Region and not for any other purpose apart from the stated objectives of the Peer Review Process. Any person or group of persons wishing to use any part or whole of this report for any purpose or any other objective should contact the undersigned persons of this declaration.

…………………………………………………………… ROBERT KWAKU ADATSI DEPUTY DIRECTOR CLINICAL CARE VOLTA REGION

………………………………………………… DR. KOFI GAFATSI NORMANYO CHAIRMAN, MEDICAL SUPERINTENDENTS’ GROUP VOLTA DIVISION

…………………………………………………………… MR. SIMON YAO DZOKOTO PEER REVIEW COORDINATOR FOR HOSPITALS, VOLTA REGION

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SECOND CYCLE PEER REVIEW REPORT,2011 ABBREVIATIONS AND ACRONYMS

CCD CHPS GPRS GHS M &E MSG MSG-VD PR QA RDHS RHD VRHD WHO

Clinical Care Division Community-Based Health Planning System Ghana Poverty Reduction Strategy Ghana Health Service Monitoring and Evaluation Medical Superintendents’ Group Medical Superintendents’ Group- Volta Division Peer Review Quality Assurance Regional Director of Health Services Regional Health Directorate Volta Regional Health Directorate World Health Organization

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.. 5 2............... 21 2......................................................................................................................1 Environment.................................... 4 CHAPTER TWO...............1.................................................................10..........PERFORMANCE ........................................1............................................................................................................................................8 PERFORMANCE TARGET SET BY THE REGIONAL DIRECTOR OF HEALTH SERVICE TO ALL MEDICAL SUPERINTENDENTS ... 19 2.. 9 2..................................................1 Description of the problem or stimulant (outliers)....................................................................................................................2 Performance Change in Thematic Areas........................................................................................................................................................1..................................................... 26 2................................ vi MESSAGE FROM THE REGIONAL DIRECTOR OF HEALTH SERVICES .............................................................. x CHAPTER ONE-INTRODUCTION.......... 13 2...................................................... ii ABBREVIATIONS AND ACRONYMS .... iv MESSAGE FROM HONOURABLE VOLTA REGIONAL MINISTER .......................................................................................................................... 23 ................. 1 1...........................................................................3 Emergency Systems and Services .................. 27 2..........................5 PERFORMANCE BASED ON ZONAL LOCATION ............................................................................................................................2011 TABLE OF CONTENT DECLARATION .......................................................................................................................iv SECOND CYCLE PEER REVIEW REPORT....................................................................................1...... 25 2....... 23 2. viii ACKNOWLEDGEMENT .......... 12 2................................5 Clinical Practices......................................................................2 Review of the Check list .........................2 Infection Prevention and Control ................................................................................................................................................................. iii TABLE OF CONTENT ........................10...............................................1 Overview ....3 Comparing the Difference in Means and Standard Deviations of the Thematic Areas of the First and Second Cycle Peer Reviews ................................. 24 2............ 1 1........................... 27 2........................10 Improvement or otherwise of facilities ..............................................................................................................................6 Clients Care ...................................10....................... 23 2.........................................................................10.................................... vii EXECUTIVE SUMMARY ................... 15 2.........9 LEAGUE TABLE OF PERFORMANCE OF HOSPITALS ..............4 Performance Change in the Thematic Areas Based On Ownership.................................... 8 2......................................................................................10...... 22 2..............................................................................................10.........................................................1........................ 1 1....................................4 Quality Assurance Activities......3 Progress and Limitation in Organization of Peer Review...... 27 iv ........1.........................................................................................................................................7 OVERALL PERFORMANCE OF HOSPITALS BY OWNERSHIP AND LOCATION.......10........................................................................................................6 SECOND CYCLE PEER REVIEW PERFORMANCE AND POST PEER REVIEW PERFORMANCE .

............................. 29 CHAPTER THREE.............................................2 Regional Director’s Mark for Innovation and Organization of the Peer Review ........1..................... 30 3............7 Occupational Health and Safety Issues ..........................................10........10....1.................................... 27 2.........................2011 2.................................v SECOND CYCLE PEER REVIEW REPORT................................................. 33 v ......................................................................................... 32 APPENDIX ...10.........1 CONCLUSION .......................................................................................................................................................................CONCLUSION & RECOMMENDATION....................... 30 3................................................................................................................ 30 REFERENCES .................. 28 2.......................................................2 RECOMMENDATIONS...............................8 Management.......................................................................

However. It is in this regard that the Regional Coordinating Council applauded the Peer Review approach of the Regional Health Directorate and the Medical Superintendents’ Group to standardize and improve quality of Service in the entire Region through cross fertilization of “best practices”. in the case of Midwives who are the key people in helping to achieve the MDG 4 & 5. the government has chalked a lot of success by embarking on a number of projects aimed at accelerating improvement in the performance of the health sector with special emphasis on prudent use of resources available to the sector and sustainable improvement in access to quality health care. Human resource which is one of the key ingredients to providing quality Health Care has become a challenge in the Volta Region more especially. Health is Wealth and therefore an essential component of the better Ghana Agenda. In other words. It is in pursuance of this that University of Health and Allied Sciences in the Volta Region and Post Basic Midwifery School in Krachi West District are being established. As we get close to the Better Ghana Agenda Part 1. but have received relatively little attention in the past. We at the Regional Coordinating Council will always support programmes like this and project it to put the Region in the limelight. Henry Ford Kamel Volta Regional Minister vi . We hope that further broadening of the frontiers would include an Open Day for wider dissemination. problems of quality health care continue to be a fundamental challenge to access to health care. It is heartening to realize that the implementation of the Peer Review has improved a lot of aspects of the Health Care delivery in the Hospitals. This was indicated in the results of this report. We will continue to strengthen the process by encouraging all the Municipal/District Assemblies to provide the necessary assistance to the Hospitals to enable them provide quality health care to the good people of Ghana thereby making the better Ghana Agenda a reality. government again recognizes that the mere presence of physical structure may not necessarily translate to quality health care.vi SECOND CYCLE PEER REVIEW REPORT. All these efforts of government are targeted at ensuring sustainable improvement in access to quality health care. The Regional Coordinating Council wishes you an exciting third cycle of the Peer Review. Hon.2011 MESSAGE FROM HONOURABLE VOLTA REGIONAL MINISTER Health Care delivery demands a concerted effort to ensure that lives are saved.

2011 MESSAGE FROM THE REGIONAL DIRECTOR OF HEALTH SERVICES We had been through one (2) year of Peer Review and the third cycle already in motion.vii SECOND CYCLE PEER REVIEW REPORT. Joseph Teye Nuertey Volta Regional Director of Health Services vii . It is a welcome innovation that is stimulating and energizing all of us. Due to the improvements seen in the hospitals. It is behoving on us to improve staff attitude to commensurate the gains made in translating the Hospitals’ environments. it became clear that the Hospitals have been transformed tremendously. Dr. We must find a way to measure staff attitude in the exercise and see it influence outcome of service delivery positively. This will in effect ensure quality of service to our clients. Even as performance target for all facilities was moved from 75% to 80%. This gives me confidence that the Internally Generated Funds are being used efficiently and effectively. am highly delighted that 50% of the facilities have crossed this new target. In addition. I am personally happy about the efforts being put in to ensure the quality of the Assessment through the organisation of training on how to properly do the assessment and also to regulating the process through the development of Code of Principles to guide the entire process in the third cycle. I am sure the stakeholders’ involvement and interest in the process. In my administrative visits to all the Districts. especially. the Chiefs and District/Municipal Chief Executives will serve as pressure to ensure the sustainability of the process.

and Management practices from 69.2011 EXECUTIVE SUMMARY Since 2009 two cycles have been conducted with each hospital peer reviewed in each cycle. Client Care. IPC from 73. Results indicated a tremendous improvement over the first cycle PR. Client care which improved from 56. Performance during the second cycle was found to be influenced to a large extent by the performance during the first cycle. Eleven facilities (11) hospitals were able to achieve the target performance of 80% and the other 11 achieved the bracket of 50% .9%.4% to 76. Clinical Practices. Infection Prevention and Control.9%. The PR wind blowing in the Volta Region called for a concerted between all the divisions of the Ghana Health Service to improve the Health Status of the Country.2% to 77. All these areas were carved to ensure the implementation of policies of the Ministry of Health in the Volta Region. Other areas included in the second cycle were Clinical practices which scored 72. Percentage score on Environment improved from 62. Other areas include.0%.79.4% to 78.4%. Occupational Health and Safety issues and Management. Environment (Both Internal and External). Several policy issues were introduced into the second cycle PR and performance target increased to 80% instead of 75% during the 1st cycle.5%.8% to 76. Quality Assurance. Emergency Systems and Services from 64.3% Occupational Health and Safety which scored 77.5% and Regional Directors score on innovation and organization of the PR in the facilities which scored 73. client satisfaction surveys to elicit the perception of clients on quality of care are now being conducted regularly. emergency system were sharpened.viii SECOND CYCLE PEER REVIEW REPORT.6% to 74. Hospitals which hitherto had no incinerators were able to build multi-purpose incinerators.3%.1% and Quality Assurance from 66. The ownership of the facilities was found to have no influence on the performance but the location of the facilities according to the Peer Review demarcation had influence on the performance of facilities. Emergency Systems and Services. None of the Hospitals scored below 50%. Thematic areas covered include. viii . Tremendous improvement has been noticed across the facilities at the end of the second cycle. infection control practices have been taken to admirable level and hospital environment have been noted to be so pleasing.8% to 82%. most hospitals now have strategic plans and yearly action plans which dovetail into the strategic plan.

2011 ix .ix SECOND CYCLE PEER REVIEW REPORT.

He indeed encouraged the process and attended most of the reviews. Asare-Bediaku Aflao Hospital x . Finally.2011 ACKNOWLEDGEMENT The VRHD is very grateful to all people who in diverse ways helped in the Peer Review process in the region. Indeed the enthusiasm and support of Dr.x SECOND CYCLE PEER REVIEW REPORT. we wish to thank the management and staff of all the hospitals in the region who have demonstrated the spirit of commitment and the desire to succeed in all that they do. Chairman of the Social Services Committee of the Assembly The Chairman of the Health Committee of the Assembly (If it exists) Chiefs of the Traditional Area The District Directors of Health Services The Executive Secretary.S. Presiding Member of the District Assembly Members of Parliament in the District in which the Peer Review is being organized. T. Adatsi Mr Emmanuel Aforbu Mr Simon Dzokoto Regional Health Directorate Task Team Ms Comfort Agbadja Mr Divine Azameti Ms Priscilla Tawiah Mr Robert Adatsi Mr Simon Dzokoto Regional Health Directorate Task Team Driver Mr Cudjoe Amankwa Medical Superintendents/Medical Officer-In-Charges Dr Kofi Gafatsi Normanyo Chairman. CHAG The Scheme Manager of NHIS in the District in which Peer Review is being organized. Editorial and Technical Task Team Dr Kofi Gafatsi Normanyo Dr Joseph Teye Nuertey Mr Robert K. Letsa cannot be swept under the carpet. Medical Superintendents Group (Volta Division) Dr K. Our deepest appreciation also goes to all the stakeholders who participated in the second cycle of the Peer Review especially:          District Chief Executives of the District in which the Peer Review is taking place.

E. Dr Lucy Hometowu Dr Alex Ackon Dr A. Sr.xi SECOND CYCLE PEER REVIEW REPORT. Anthony’s Catholic Hospital Ho Polyclinic Battor Catholic Hospital Sacred Heart Hospital.Abor Volta Regional Hospital Comboni Hospital xi .2011 Dr Lawrence Kumi Dr Edwin Danoo Dr. Mary Theresa Catholic Hospital. Mark Ofori-Adjei Dr William Dwuamena Dr Atsu Seake-Kwawu Dr Bowan Dr Kugbe Mlimor Kudjo Dr George Acquaye Dr Moumoudo Cham Peki Hospital Hohoe Hospital Nkwanta Hospital Keta Hospital Sogakofe Hospital Jasikan Hospital Krachi West Hospital Adidome Hospital Akatsi Hospital St. Joseph Catholic Hospital Worawora Hospital Margaret Marquart Catholic Hospital Anfoega Catholic Hospital St. Anthony Ashinyo Dr Felix Tsidi Dr F. Dodi Papase St. Abudey Dr Samuel Abudey Dr Hilarius K Abiwu Dr Doe Ocloo Dr Moses Boni Dr Tetteh Augustus Dr Pius Mensah Rev.

infection control practices have been taken to admirable level and hospital environment have been noted to be so pleasing. Since 2009 two cycles have been conducted with each hospital peer reviewed in each cycle. when properly done. The new policy issues taken on board and their rationale are tabulated below: 1 . The structure of the check list was modified for the second cycle to include the ideal situation.1 Overview Prior to 2009. Tremendous improvement has been noticed across the facilities at the end of the first round.2011 CHAPTER ONE-INTRODUCTION 1. it is pleasing to the eye. most hospitals now have strategic plans and yearly action plans which dovetail into the strategic plan. sets the mind of staff and clients at ease. 1.2 Review of the Check list Feedback during the first cycle strongly indicated that there was the need to review the check list to reflect objectivity of the assessment and include other policy issues which were not added earlier on. and easily rates the institution as a ready entity to deliver the care necessary. client satisfaction surveys to elicit the perception of clients on quality of care are now being conducted regularly. the Volta Regional Medical Superintendent Group having seen the deplorable state of hospitals infrastructure and the non-adherence to National policies and standards decided to adopt a strategy to bring about change which would lead to improvement in the quality of care across the region. All these achievements notwithstanding. Consequently the Regional Health Directorate introduced Peer Review in July 2009. and what to do if the ideal situation is not met. For example grass covering at the hospital. Hospitals which hitherto had no incinerators were able to build multi-purpose incinerators. there were challenges with regards to the objectivity of the checklist used for the assessment calling for systems to remove bias.1 SECOND CYCLE PEER REVIEW REPORT. the reason(s) for the ideal situation. emergency system were sharpened. Policy makers across the spectrum and indeed the entire population were concerned about the deteriorating levels of the quality of care in our hospitals.

2 SECOND CYCLE PEER REVIEW REPORT. etc. For Example occurrence of earthquakes.g. slippery. moderate and chronic cases define such effectiveness.2011 Table 1. evidence of screening done) 2 . Fresh Still Rates 3 Mass Casualty Incidence management 4 System for Emergency 5 Emergency Trays (availability and adequacy) minimum content of emergency tray Occupational Health and Safety issues e. Indicators to measure acute. Floors (Non- To ensure there is a system to manage emergency situations To ensure basic equipment and drugs available to enhance management of emergencies. Safety of staff and patients cannot be compromised under any circumstances and therefore steps must be taken to protect them. No excavation) Fire Prevention (Fire Extinguisher & Appropriate use) Annual Screening of Staff(Protocol available.1 POLICY ISSUES TAKEN ON BOARD. v. Personal Protective Clothing ii. Barrier Nursing iii. landslides. To draw attention to what should go into the Emergency Tray To reduce time spent on managing emergencies To stimulate Management to pay attention to protection of staff 6 iv. To ensure uniformity in the Management of Emergency in all facilities. 1 Proportion of Caesarean Section wound Infection (Select 20 folders randomly) 2 Case Fatality Rates. i. C/S Rates. NO POLICY ISSUE RATIONALE It measures the infection prevention and control measures undertaken by the hospital The entire existence of hospital is to render service through clinical practice. Effectiveness and efficiency of such a practice is paramount. To give focus and organization in the Management of Mass Casualty WHAT THE POLICY ISSUE IS SUPPOSED TO ACHIEVE To reduce infection in the hospitals and To carry out infection control practices A range of indicators looked at how individual facilities fit within the range and indicating the effectiveness and efficiency of managing the case To develop systems and capacity to manage Mass casualty that goes beyond our Emergency rooms.

meet standard action plan requirement. Help in Management decision taking. To introduce a culture of reviewing Management decisions Hospitals think they don’t need a Strategic Plan however. cost involve) 7 Strategic Plan (SP) (Availability. Help in Management decision making. 10 Quarterly Financial Analysis 11 Equipment Replacement Policy Financial Analysis Statement (Half Yearly) Planned Preventive Maintenance Schedule of Equipment and Building (Prop. 3 .3 SECOND CYCLE PEER REVIEW REPORT. It is therefore necessary to assess the records of decisions implemented to determine the progress of work.2011 Records on Implementation of Management Decisions (Should incl. date of implementation. To give focus. direction and motivation to both management and the entire staff. Decision making date. hospitals like any other organization needs to have a focus exactly what a strategic Plan is meant to do. Decision taken. Everything has to be done to ensure that equipment and buildings are maintained 12 To ensure flow of financial information to management members this hitherto is not the case. Staff Knowledge about it) Action Plan (Available in all units. To help in programme monitoring & evaluation To ensure regular replacement of obsolete equipment and ensure financial analysis is done replacing the Obsolete equipment To inculcate Maintenance culture in our Institutions and ensure that equipment and building do not deteriorate beyond repairs. Proportion of implementable activities implemented) 8 Decisions are taken and hardly implemented and even when implemented there are no records to show creating an impression that work is not been done. To help prevent financial malpractices To ensure flow of financial information to management members this hitherto is not the case. Implemented) To ensure that broken down equipment are replaced so as not interrupted service delivery Maintenance culture is a big problem in our institutions. SP involves having broad outlines of local content of activities (including innovations) directed at executing the objectives of MOH/GHS Action plan operationalizes strategic plans and reduces SP to work packages that can easily be managed To ensure decisions taken are not left hanging. It also helps in report writing. To give uniformity action plans To ensure implementation of activities once they are planned To guide expenditure decisions 9 Weekly Cash flow statement (available) To determine financial viability and monitor budget performance.

number of participants per facility became an issue as was the basis for awarding scores in certain thematic areas.3 Progress and Limitation in Organization of Peer Review To promote community participation in health care delivery.2011 1.4 SECOND CYCLE PEER REVIEW REPORT. NGOs in Health and other key stakeholders. 4 . heads of decentralized agencies. District Chief Executives. Confrontation as to who should participate in the peer review and carry out assessment. A problem solving session which was one of the salient parts of the program during the first cycle died down in the second cycle due to lack of time. This was done to solicit their support in bridging the gaps identified in health service delivery and strengthen the arm of peer review to ensure sustainability Another feature of the second cycle Peer Review was the introduction of the Regional Directors Score to encourage innovation using local resources and staff participation. invitation was extended to traditional rulers.

50 86.30 81.00 76.2011 CHAPTER TWO.00 96. Joseph Dodi Papase VRH Jasikan Clinical Practice 92.2 71.30 77. Anthony MMCH Worawor a Battor Jasikan VRH Krachi MGT 95.28 87.00 86. Anthony Ketu South Hohoe Nkwanta Keta St.70 83.67 83.64 67.64 69.96 66.57 75.0 0 100.93 93.71 74.88 79.37 96.96 85.40 84.70 77.27 75.54 69.10 90.12 94.00 85.90 89.44 93.49 5 .12 92.54 70.70 76.50 87.85 84.30 94.42 90.00 92.67 93.24 74.00 100.30 93.29 64.40 65.81 69.60 80.50 73.29 94. Joseph Krachi MMCH Hohoe Peki Adidome Dodi Papase VRH Battor Nkwanta Jasikan IPC 100.1 Performance of the Hospitals by the Thematic Areas of the Checklist Hosp St. Anthony MMCH Abor St.29 Hosp St.50 70.91 92.72 80.30 93.56 79.40 Hosp Sogakofe Peki Adidome Abor Battor Krachi Anfoega Ho Mun St.46 73.90 64.21 71.90 89.14 64.50 Hosp St. Anthony Ho Mun St. Joseph Hohoe Abor Dodi Papase Jasikan Anfoega MMCH QA 97.30 72.60 94.86 90.10 87. Joseph Krachi Sogakofe Jasikan Anfoega Akatsi Keta Nkwanta Emer 100.12 Hosp Ho Mun Ketu South St.94 80. Anthony Worawora Keta Akatsi Sogakofe Ketu South St.0 0 94. Joseph Adidome Keta Akatsi Peki Abor Dodi Papase Sogakofe St.20 79.10 65.33 Hosp Peki Abor St.50 87.57 78.86 66.91 90.04 61.50 82.30 77.14 81.76 74.70 94.5 SECOND CYCLE PEER REVIEW REPORT.70 86.40 73.82 83.67 63.79 77.21 71.50 95.33 80.70 78.18 62.17 77.40 79.20 71.60 76.60 82. Anthony Akatsi Peki Ketu South Sogakofe Keta Ho Mun Worawora Nkwanta Krachi St.80 Hosp Peki Worawora Ho Mun Dodi Papase Ketu South Hohoe St.35 80.86 86.65 89.PERFORMANCE Table 2.60 70.51 85.30 94.56 72.03 90.60 89.60 87.80 78.29 92.60 67.00 86.0 0 94.11 88.82 82.30 68. Joseph Hohoe Krachi Dodi Papase Ho Municipal Jasikan MMCH VRH Anfoega OH&S 98.20 Hosp Sogakofe Ketu South Akatsi Abor St.70 70.61 72.86 68.50 93. Joseph Keta Peki Dodi Papase MMCH Anfoega Abor Battor Hohoe Sogakofe Adidome Jasikan Ketu South Krachi Client Care 100.59 69.32 74.70 96.30 93.30 80.80 64.03 92. Anthony Sogakofe Dodi Papase Peki Anfoega Abor Keta Ho Mun Battor Adidome Hohoe Ketu South Akatsi VRH MMCH Jasikan Ho Poly Env 92.40 70.33 83.70 86.33 93. Anthony Ho Mun Akatsi St.20 71.50 71.88 80.30 90.10 83.

Joseph Worawora Krachi Nkwanta 6 .77 57.10 42.71 60.30 Comboni St.71 48.14 57.38 42.67 30.71 30.00 50.6 SECOND CYCLE PEER REVIEW REPORT.78 76.70 36.70 57.50 56.89 62.00 Comboni Adidome Battor VRH Ho Poly 58.80 48.00 Keta Worawora Comboni Ho Poly Anfoega 77.25 44.55 46.02 51.2011 60.70 Comboni Akatsi Worawora MMCH Ho Poly 60.00 Adidome Battor Comboni Ho Poly Nkwanta 67.09 57.53 41.03 41.90 Worawora Ho Poly VRH Comboni Nkwanta 60.00 35.61 59.67 36.65 66.94 Battor Comboni Ho Poly Adidome VRH 62.39 63.09 59.00 46.90 50.20 48.58 50.29 Hohoe Anfoega Comboni Nkwanta Ho Poly 59.20 35.

50 14.33 80.59 20.33 73.40 57.32 16.45 88.70 66.74 14.90 76.62 18.80 67.28 37.61 30.20 78.1.30 61.70 83. Joseph Worawora Hohoe Krachi MMCH Adidome Jasikan Battor Anfoega VRH Nkwanta Comboni Ho Poly 2nd Round Total 94.70 42.00 76.78 20.63 83.00 96.67 40.90 69.80 91.72 75.47 6.40 79. Anthony Worawora Krachi Adidome Keta Akatsi Ho Poly MMCH Anfoega Battor Sogakofe Ho Mun Hohoe St.58 -3.2011 Table 2.30 23.52 53.99 60.70 86. Joseph Anfoega MMCH Ho Mun Ho Poly Sogakofe Keta Nkwanta VRH Comboni RDHS Score 100. Anthony Sogakofe Ketu South Abor Akatsi Ho Mun Keta Dodi Papase St.33 83.80 91. Anthony Adidome Krachi Worawora Ho Poly 1st Round Total 87.60 64.7 SECOND CYCLE PEER REVIEW REPORT.30 62.20 12.30 66.70 75.78 2. Anthony St.Performance of the Hospitals by the Thematic Areas of the Checklist (cont’n) Hosp Hohoe Krachi Ketu South Jasikan Abor Akatsi Worawora Adidome Peki Dodi Papase Battor St.67 93.00 46.50 49.55 62.50 64.90 70. Joseph Ketu South Abor Dodi Papase Peki Jasikan VRH Nkwanta Comboni % Change in Performance 62.44 -15.40 55.77 61.12 18.20 84.30 87.89 16.90 77.70 66.61 8.90 Hosp St.67 60.57 77.40 82.49 31.90 56.20 78.67 Hosp Peki St.00 26. Joseph Jasikan Hohoe Akatsi Comboni MMCH Keta Nkwanta Battor VRH Anfoega St.91 77.37 51.80 51.33 73.00 86.23 7 .20 75.33 73.33 80.40 87.60 62.45 55.60 71.33 88.30 67.60 73.00 80.34 90.10 Hosp Peki Ketu South Abor Sogakofe Dodi Papase Ho Mun St.40 74.00 65.04 10.

6 1 12 N/A 36 N/A 12.000 0.026 0. Value of tTest(α=0.000 0.2: Paired Differences in the Performance of Hospitals in the Thematic Areas Mean difference in performa nce 11.16 4.63 73.72 77.05) 0.000 Performance/Th ematic Area Cycles 2nd Cycle Mean 77.15 2.89 8.8 69.33 21.056 0.62 72.8 SECOND CYCLE PEER REVIEW REPORT.66 64. In addition.2 revealed that the p-value for all thematic areas were less than 0.5 83.6 N/A 70.05 indicating that there is the need to reject the null hypothesis and accept the alternate hypothesis there is a significant difference in the first cycle and second cycle performances in the thematic areas of the Peer Review.23 2.7 70.2 Performance Change in Thematic Areas H0: There is no difference between the first cycle mean scores and the second cycle mean scores of the various thematic areas H1: There is a difference between first cycle mean scores and second cycle mean scores of the various thematic areas.1 78.84 21 21 21 21 21 21 21 21 21 21 Since the p-value for the overall performance was less than 0.0 75.000 0.19 32.040 0.9 16.75 9.9 N/A 20.5 77.15 5.2011 2. Table 2.000 0.50 3.69 N/A 65. Table 2.6 1st Cycle Mean 62.004 0.9 N/A 56. it indicated that there is enough evidence to reject the null hypothesis and accept the alternate hypothesis that there is a difference in the overall performance during the first and second cycles of the Peer Review.46 % Change 24.002 0.78 66.7 67.72 tvalue Degree of freedom Sig.72 12.6 79.1 Environment IPC Emergency QA Clinical Practice Client Care OH&S Management RDHS Overall 3.49 8.3 72.22 11.05.40 19.21 25. 8 .02 2.04 71.

75 21.75 76.05 indicating that there is enough evidence to accept the null hypothesis that there is no significant difference in the first cycle and second cycle performance in the emergency area of the checklist.25 3.55 0.06 3.78 9 .81 72.00 78.00 16.25 -0.54 14.42 4.30 -0.36 -1.66 17.14 64. Error Mean 2. -0.17 77.3 Paired Samples Statistics (n=22) Thematic Areas of the Peer Review 2 Cycle Environment 1 Cycle Environment 2 Cycle Infection Prevention & Control 1 Cycle Infection Prevention & Control 2 Cycle Emergency Services & Systems 1 Cycle Emergency Services & Systems 2 Cycle Quality Assurance 1 Cycle Quality Assurance 2 Cycle Clinical Practices 1 Cycle Clinical Practices 2 Cycle Client Care practices 1 Cycle Client Care practices 2 Cycle Occupational Health & Safety 1 Cycle Occupational Health & Safety 2 Cycle Management 1 Cycle Management 2 Regional Director of Health Services 1 Regional Director of Health Services 2 Cycle Overall Performance nd st nd st nd st nd st nd st nd st nd st nd st nd st nd Mean 74.52 Skewness -0.37 Std.47 2. 2.00 11.40 0.24 -0.25 0.33 0.63 81.05 -.60 13.52 3.00 78.72 0.39 76.78 -0.20 3.35 -1. Deviation 11.99 0.82 Std.60 15.3 Comparing the Difference in Means and Standard Deviations of the Thematic Areas of the First and Second Cycle Peer Reviews Table 2.91 3.00 4.85 0.82 16.70 2.43 66.45 0.00 3.23 0.05 0. -0. with regards to Emergency.01 18.51 14.89 56.54 3.00 2.40 73.43 -.14 -0.07 -1.36 10.96 73. the p-value was more than 0.00 77.59 3.52 -.97 4.9 SECOND CYCLE PEER REVIEW REPORT.02 -0.30 10.00 20.60 2.2011 However.49 0.61 21.35 18.08 0.52 62. -1.02 69.

65 10.31 -0.99 71.75 77.4 Paired Samples Test for the Thematic Areas Paired Samples Test Paired Differences 95% Confidence Interval of the Difference Lower 4.40 19.45 83.08 1.82 2.60 3. Occupational Health and Safety and RHDS areas were introduced in the second cycle.19 Upper 18.15 65.08 3.RDHS1 Overall2 . On the whole.49 8.93 27.23 2.QA1 Clinical Practice2 .72 77.01 32.34 0.3 above revealed the Mean performance in the various Thematic Areas of the Peer Review. Environment and Emergency services and systems whilst Infection Prevention and control practices attracted the lowest mean difference in performance.16 4.19 32.90 16.89 8.72 3. 77.33.026 0.10 st SECOND CYCLE PEER REVIEW REPORT.21 25.93 -0.02 2.94 11.040 0.87 18.72 12.33 21.OHS1 Management2 – Management1 RDHS2 .Clinical Practice1 Client Care2 – Client Care1 OHS2 .45 16.25 5.58 10.22 Std.Overall1 Mean Std. hence their mean performance differences were seen to be higher.49 and 73. Table 2. Error Mean 3.25 Paired Samples Test Pair 1 Pair 2 Pair 3 Pair 4 Pair 5 Pair 6 Pair 7 Pair 8 Pair 9 Pair 10 Environment 2 .16 3.65 10.85 2.Environment1 IPC2 . Apart from these three areas.27 20. (2tailed) 11.002 0.62 72.4 indicated the mean differences in performance during the first and second cycles of the Peer Review in terms of the various thematic areas of the checklist used and the overall performance of the Hospitals.81 4.056 0.50 3.000 0.000 0. Clinical Practices.39 2.72 respectively.40 2.15 2.22 11.2011 65.15 5. 10 .10 1 Cycle Overall Performance Table 2.004 0.IPC1 Emergency2 – Emergency1 QA2 .55 24. thus 72.75 9.84 21 21 21 21 21 21 21 21 21 21 0.20 14. the overall standard deviation during the second cycle was lower than the first cycle indicating that every facility was performing to meet the Performance Target.63 73. the other thematic areas with high mean differences in performance were the Client Care practices.05 10.50 23.11 81.85 2.72 17.18 t df Sig. Deviation 15.50 67.000 0.000 Table 2.54 5.000 0.71 8.96 13.84 18.

0. with regards to the various thematic areas. there was enough evidence to reject the alternative hypothesis that there is difference in the first cycle and second cycle performance and conclude that there is high probability that the means of the first cycle performance did not influence the second cycle performance. Table 2.4 again revealed that there is a significant difference in the overall performance of the Hospitals hence the need to reject the Null Hypothesis that there is no significance difference in overall performance of the Hospitals during the first cycle and the second cycle of the Peer Review hence the need to reject the null hypothesis at p-value of 5% and conclude that there is high probability that the overall mean during the second cycle was influenced by the overall mean during the first cycle of the Peer Review.545 11 .005 0. there is high probability that means of second cycle performance were influenced by the first cycle performance.071 0.11 SECOND CYCLE PEER REVIEW REPORT.09 0. Similarly.704 0. Table 2.58 0. for Emergency systems and services. However.14 Sig.2011 Table 2.5 Correlation between first cycle performance and Second Cycle Performance Paired Samples Correlations N Pair 1 Pair 2 Pair 3 Pair 4 Environment1 & Environment2 IPC1 & IPC2 Emer1 & Emer2 QA1 & QA2 22 22 22 22 Correlation 0.4 revealed a significant difference in the performance of the Hospitals hence the need to reject the Null Hypothesis and conclude at significance level of 5% that.39 0.

4 Performance Change in the Thematic Areas Based On Ownership H0: There is no difference in performance of CHAG Hospitals and GHS Hospitals. Table 2.35 69.67 GHS 1st Cycle Mean 59.116 0.73 N/A 12.38 10. However.83 75.044 0.60 0.21 % Change 15.08 N/A 66.003 Pair 5 Pair 6 Pair 7 With regards to the correlation between the first cycle results and the second cycle results.37 N/A 21.64 78.28 11.71 77.65 79.72 5.18 N/A 62.13 76.66 75.53 N/A 15.18 N/A 51.50 N/A 68.38 N/A 26.00 2nd Cycle Mean 72.52 20.21 76.92 72.32 % Change 21.72 83.74 N/A 58.34 0. 2. H1: There is difference in the performance of CHAG Hospitals and GHS Hospitals.3 72. it was revealed from table 2. the correlation coefficients revealed weak relationships except between IPC1& IPC2 and the Over1 & Over2 which revealed stronger correlation than in the other thematic areas.12 SECOND CYCLE PEER REVIEW REPORT.2011 Client1 & Client2 Mgt1 & Mgt2 Over1 & Over2 22 22 22 0.16 14.54 N/A 12.46 76.44 72. This indicated that in most cases.97 12 .84 N/A 70. there were improvements in performance of all the hospitals in the thematic areas.25 74.7 83.43 0.12 74.54 61.58 79.57 77.5 that there are generally positive correlation between the first cycle performance and the second cycle performances.15 N/A 65.96 74.73 72.6 GHS & CHAG Hospitals Performance Compared According to Thematic Areas CHAG Performance Areas Environment IPC Emergency QA Clinical Practice Client Care OH&S Management RDHS Overall 2nd Cycle Mean 77.61 70.51 63.7 79.69 20.14 1st Cycle Mean 67.

Table 2.194 Sig.8 Performance by Zonal Location Compared According to Thematic Areas Southern Zone 2nd Cycle 1st Cycle % Mean Mean Change 77.3062 The model above indicated that about 98.3 .050 F 477.5 62.9 63.592 95. 37.1% of the variations with regards to first cycle performance and the second cycle can be explained by the above model whilst 30.2011 An analysis of variance to infer whether ownership of the Hospitals affects the performance of the various hospitals revealed that at significance level of 5%.78 16.184 1805.6% of the variation between ownership and second cycle performance is explainable by the above model. Also.7 71.93 3. there is enough evidence to reject the null hypothesis that ownership of the hospitals has no influence on the performance of the Hospitals and accept the alternate hypothesis that ownership of the Hospital has influence on the Performance of the Hospital.9869 0.13 SECOND CYCLE PEER REVIEW REPORT.67 37.0 79. It is imperative to identify the ownership factors or arrangements that helped in influencing the performance of the facilities so as to infuse the system to ensure continuous quality improvement.225 1065.205 4.04 24.66 1.946 138042.675 1065.7% of the variation in the model can be explained by the model.33 12.5 PERFORMANCE BASED ON ZONAL LOCATION Table 2.061 398.3 66.0034 0.061 797.0000 0.773 11.0 13 Performance Areas Environment IPC Emergency Northern Zone 2nd Cycle 1st Cycle % Mean Mean Change 70.7 Analysis of Variance Table for 2nd Cycle overall performance and Ownership of Hospitals Tests of Between-Subjects Effects Dependent Variable: Second Cycle Overall Performance Source Model First cycle Overall Performance Ownership of Facility Error Total Type III Sum of Squares 136236.9 76.9 84.9 83.7 61.3710 0.0310 Partial Eta Squared 0. 0.6 67.621 Df 3 1 2 19 22 Mean Square 45412. 2.

9 12.9 72.6 36.9 RDHS 69.5 67.459 F 5.621 2933.207 .9 Analysis of Variance Table for overall performance and Location of Hospitals Tests of Between-Subjects Effects Dependent Variable:Over2 Source Corrected Model Intercept Overall 1st cycle Zonal Location Error Total Corrected Total Type III Sum of Squares 1043.841 99.7 64.191 .1 N/A N/A 79.6 N/A N/A 76.263 .0 72 69.841 1889.728 673.356 (Adjusted R Squared = .14 SECOND CYCLE PEER REVIEW REPORT.5 N/A N/A Management 79.46 20.5 N/A N/A 68.126 1015.6 65.8 N/A N/A Client Care 77 56.288) An analysis of variance to infer whether Location according to the Peer Review demarcation affects the performance of the various hospitals revealed that at significance level of 5%.191 .730 138042.928 Partial Eta Squared .015 .1 65.186 df 2 1 1 1 19 22 21 Mean Square 521.8 70.2011 QA 72.09 4.018 .3 55.005 . 14 .6 OH&S 75.1 78.87 18.0 78. R Squared = .457a 673.356 .246 6.008 Sig.69 12.349 . there is no enough evidence to reject the null hypothesis that the location of the hospitals has no influence on the performance of the Hospitals and reject the alternate hypothesis that location of the Hospital has influence on the Performance of the Hospital.6 H0: There is no difference between the first cycle and second cycle Mean performance scores based on the location of the hospital according to the Peer Review Demarcation H1: There is a difference between the first cycle and second cycle Mean performance scores based on the location of the hospital according to the Peer Review Demarcation Table 2.000 a.5 N/A N/A Overall 78.2 Clinical Practice 70.84 6.768 10.126 1015.7 40. .

9 77.4 84.96 36.0 57.6 63.9 42.8 25. all facilities scored lower during the post peer review monitoring except Hohoe Municipal Hospital.1 44.01 11.68 15. Deviation 19.2 73.77 Std.36 75. Error Mean 4.8 100.39 15 .8 40.20 39.20 74.8 25.3 28.4 82.8 33.2 76. This indicates that most facilities relaxed after the main peer review exercise hence the low performance.51 11.6 74.0 78.8 25.5 60.16 2.6 83.0 94.1 43.52 51. Comparing the performance differences.0 20.0 70.5 51.35 63.54 34.64 69.65 25.6 53.9 75.2011 2.25 7.5 51.6 SECOND CYCLE PEER REVIEW PERFORMANCE AND POST PEER REVIEW PERFORMANCE POST PEER REVIEW AND PEER REVIEW PERFORMANCE COMPARED 91.3 90.6 57.8 24.2 88.5 57.82 81.19 Std.3 87.0 89.72 20.33 2.32 6.4 91.10 Comparing Peer Review Performance and Post Peer Review Performances Paired Samples Statistics (n=22) Thematic Areas Pair 1 Pair 2 Environment Post Peer Review Environment Peer Review Infection Prevention & Control Post Peer Review Infection Prevention & Control Peer Review Pair 3 Emergency System Post Peer Review Emergency System Peer Review Pair 4 Quality Assurance Post Peer Review Quality Assurance Peer Review Pair 5 Clinical Practices Post Peer Review Clinical Practices Peer Review Mean 49.8 Overall PPR Overal PR Generally.3 33.0 30.0 34.5 48.25 28.6 54.5 48.4 50.15 SECOND CYCLE PEER REVIEW REPORT.40 4.52 4.3 90.6 80.2 30.23 2.0 10.83 10. Table 2.5 87.3 31.9 80.0 69.7 78. a paired t-test was used as shown in the table 2.34 5.0 0.0 60.82 19.4 77.02 72.5 55.10 below.12 3.

60 77.054 0.104 0.09 24.65 6.11 Paired thematic areas Correlations Paired Samples Correlations Thematic Areas of Peer Review Pair 1 Pair 2 Pair 3 Pair 4 Pair 5 Pair 6 Pair 7 Pair 8 Pair 9 Environment Post Peer Review & Environment Peer Review Infection Prevention & Control Post Peer Review & Infection Prevention & Control Peer Review Emergency systems Post Peer Review & Emergency System Peer Review Quality Assurance Post Peer Review & Quality Assurance Peer Review Clinical Practices Post Peer Review & Clinical Practices Peer Review Client Care Post Peer Review & Client Care Peer Review Occupational Health and safety Post Peer Review & Occupational Health and safety Peer Review Management Post Peer Review & Management Peer Review Overall Post Peer Review & Overall Peer Review N 22 22 22 22 22 22 22 22 22 Correlation 0.71 5.87 22.91 76.15%.58 24.241 0.520 Sig.64 17. As to the correlation between the Post peer review and the main peer review performances.16 SECOND CYCLE PEER REVIEW REPORT.356 0.49 44. Clinical Practices. Infection Prevention and Control.10 30.141 0.417 0.615 0.73 4.500 0. Table www also revealed a smaller standard deviation and standard error mean performance between the facilities during the main peer review than during the post peer review. Emergency systems and services and Overall performances indicated stronger correlation. Occupational Health and Safety and Management Issues.52 Pair 6 Pair 7 Pair 8 Pair 9 Management Post Peer Review Management Peer Review Overall Post Peer Review Overall Peer Review The mean performance during the actual Peer Review was 78.91 3. Similar trend was shown in all the thematic areas. The table also 16 .55 3.15 78.535 0.486 0.2011 Client Care Post Peer Review Client Care Peer Review Occupational Health & Safety Post Peer Review Occupational Health & Safety Peer Review 35. Client Care.018 0.55 76.157 0. the correlation was weak for Environment.013 Table 2.00 40.36% whilst the post peer review revealed an average performance of 44.11 revealed a positive correlation between the Peer Review and Post Peer Review Monitoring. However.35 16.280 0. Table 2.62 2.99 11.36 26.010 0. Quality Assurance.114 0.75 18. the table qqq below presents the strength of the correlation.324 0. 0.82 5.25 3.

Error Mean 4.69 Upper -16. 17 .11 -19.81 -6.02 31.000 Pair 5 -6.17 SECOND CYCLE PEER REVIEW REPORT. Emergency Systems and Services and Overall Performance.000 Pair 2 -30.37 6. which indicated that the correlations were statistically significant.12 indicated the mean differences in performance during the main second cycle of the Peer Review and the Post Peer Review Monitoring in terms of the various thematic areas of the checklist used and the overall performance of the Hospitals.55 -49.220 Pair 6 -41. Client Care.000 Pair 3 -38.84 29. (2tailed) 0.49 -27.86 -25.33 6. the correlations for Environment.67 -40.87 Std.64 -9.23 21 0.52 -8.78 14.83 21 21 21 0.36 -21.16 -27.13 22.000 0.26 -51.66 -37. Deviation 18.65 -5.02 Sig.20 21 0.000 Pair 8 Pair 9 Table 2.97 32.82 5.77 3.95 -1.62 -47.33 31.03 21 0.29 df 21 Thematic Areas of the Peer Review Mean Pair 1 Environment Post Peer Review & Environment Peer Review Infection Prevention & Control Post Peer Review & Infection Prevention & Control Peer Review Emergency systems Post Peer Review & Emergency System Peer Review Quality Assurance Post Peer Review & Quality Assurance Peer Review Clinical Practices Post Peer Review & Clinical Practices Peer Review Client Care Post Peer Review & Client Care Peer Review Occupational Health and safety Post Peer Review & Occupational Health and safety Peer Review Management Post Peer Review & Management Peer Review Overall Post Peer Review & Overall Peer Review -25. Quality Assurance.58 -34.25 -10.74 4.16 -62.2011 revealed that apart from Infection Prevention and Control.000 Pair 7 -51.95 T -6.79 -6. Table 2.12: Paired Samples Test for Peer Review and Post Peer Review Monitoring Paired Samples Test Paired Differences 95% Confidence Interval of the Difference Lower -33.14 17.07 6.82 -56.22 25.000 0.32 Std.76 -22.00 6.21 3.85 -16.79 -40.18 3.56 -5.26 21 0.000 Pair 4 -33.46 -35.15 21 0. Occupational Health and Safety and Management Issues were not statistically significant.

there is high probability that means of Post Peer Review Monitoring were influenced by the performance during the main second cycle performance except with the Clinical Practices where it was realized that. Table 2. with regards to the various thematic areas. there was enough evidence to reject the alternative hypothesis that there is difference in the Post Peer Review Monitoring and the second cycle performance and conclude that there is high probability that the means of the main second cycle performance did not influence the post Peer Review performance.12 revealed a significant difference in the performance of the Hospitals hence the need to reject the Null Hypothesis and conclude at significance level of 5% that.2011 Table 2. Similarly.12 again revealed that there is a significant difference in the overall performance of the Hospitals hence the need to reject the Null Hypothesis that there is no significance difference in overall performance of the Hospitals during the Peer Review and Post Peer Review Monitoring hence the need to reject the null hypothesis at p-value of 5% and conclude that there is high probability that the overall mean during the Post Peer Review was influenced by the overall mean during the main second cycle of the Peer Review.18 SECOND CYCLE PEER REVIEW REPORT. 18 .

4 62.0 80.3 67 64.0 50.0 0.3 63.8 91.4 88.0 61.0 94.0 20.3 31.5 51.3 70.8 25.6 80.4 87.0 60.0 30.5 45.3 90.2 84. GHS FACILITIES PPR AND PR PERFORMANCE COMPARED 100.6 77.6 63.0 80.6 74.0 20.3 87.7 78.7 OVERALL PERFORMANCE OF HOSPITALS BY OWNERSHIP AND LOCATION OVERALL PERFORMANCE OF GHANA HEALTH SERVICE HOSPITALS DURING THE MAIN SECOND CYCLE PEER REVIEW 100.4 42.4 43.6 71.0 94.1 51.7 75.0 60.6 80.9 76.4%.557.5 89.0 87.2 78.8 91.7 77.8 49.0 0.253.3 28.8 25.3 33.6 57.7 60.2 77.2 84.0 40.674.8 67.2011 2.2 79.3 90.2 78.9 2nd Round 1st Round The mean performance of the Ghana Health Service Hospitals showed an increase from 71.1 51.0 60.0 70.4 87.0 90.8 Overall PPR Overall PR 19 .9 33.2 75.9 76.0 40.3% during the first cycle Peer Review to 88% in the second cycle indicating an increase of 23.6 53.8 30.19 SECOND CYCLE PEER REVIEW REPORT.0 10.5 55.3 87.

6 62.4% as against 78.8 24. OVERALL PERFORMANCE OF CHRISTIAN HEALTH ASSOCIATION OF GHANA (CHAG) HOSPITALS DURING THE MAIN SECOND CYCLE PEER REVIEW 100.8 82.5 48.3 57.5 48.8 82.0 40.0 St.0 57.3 88.8 88.0 20.5 34.9 83.4 77.6 55.0 0.5 56. This indicates a decrease of 42.0 80. Anthony Abor MMCH Dodi Papase Battor Anfoega Comboni Mean 54. the Post Peer Review indicated a fall in the Performance as indicated in the graph below: CHAG FACILITIES PPR AND PR PERFORMANCE COMPARED 100.6 60.0 40.0 80.4 77.8% during the second cycle indicating 22.4 2nd Round 1st Round The CHAG Hospitals on the other hand moved from an average performance of 69.0 0.9 83.9 Overall PPR Overall PR 20 .9 69. However.6 69.3%.5 42.3 78.9 69.0 77.4 73.4 73.8 25.9 55.5 64.4 91.9 75.20 SECOND CYCLE PEER REVIEW REPORT.4 84.0 60. Anthony Abor Papase St.2 42.4% during the first cycle to 84.0 20.4 65.0 St.2% increase in performance.9 71.7% during the main Peer Review. Joseph St.2011 The Mean Performance of the GHS Hospitals during the Post Peer Review was 45. Joseph MMCH Battor Anfoega Comboni Mean 91.

all Medical Superintendents were given a performance target of at least 80% during the second cycle instead of the 75% that was used during the first round of the Peer Review.e. The dashboard indicated that during the first round of the Peer Review.0% as against 77.2011 The Mean Performance during the Post Peer Review was 42. 11 (i.1%. 50%) Hospitals were able to achieve the Performance Target. The dashboard also indicated the performance based on the thematic areas of the peer review process. only 2 Hospitals were able to score at 80% (the New Performance Target) whilst during the second cycle. The dashboard below depicts the performance of the Hospitals in meeting this Performance Target set by the Regional Director of Health Services. 2. 21 .21 SECOND CYCLE PEER REVIEW REPORT.9% during the main Peer Review. This indicates a decrease of 46.8 PERFORMANCE TARGET SET BY THE REGIONAL DIRECTOR OF HEALTH SERVICE TO ALL MEDICAL SUPERINTENDENTS To ensure that facility heads are held accountable for the performance of their Hospitals.

6 42.4 -15.2 79.0 30.2 12.4 82.3 87.2 78.4 77.8 62.8 91.9 49.5 61.6 14.0 60.3 75.6 83.6 55. Joseph Worawora Hohoe Krachi MMCH Adidome Jasikan Battor Anfoega VRH Nkwanta Comboni Ho Poly 2nd Round 94.3 16.9 67 74.2 78.3 14.4 71.6 37.6 -3.6 73.4 62.9 % Change 8.4 23.4 88. Table 2.3 51.8 91.7 51.6 10.13 League Table of Performance of Hospitals 2nd Round Hospital Peki St.6 63.4 56.6 64.9 31.5 53.8 Position 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 1st Round Position 1st 18th 4th 2nd 3rd 10th 6th 13th 5th 7th 21st 9th 20th 12th 19th 8th 15th 17th 16th 14th 11th 22nd 22 .5 64.4 55.4 87.9 61.6 20.2 84.9 69.1 1st Round 87.1 2.22 SECOND CYCLE PEER REVIEW REPORT.9 76.3 80.9 77.2011 2.8 70.7 75.8 18.9 LEAGUE TABLE OF PERFORMANCE OF HOSPITALS The League Table below indicated the extent of the competition among the Hospitals.6 77.3 20.8 18.5 62.4 16.5 6. Anthony Sogakofe Ketu South Abor Akatsi Ho Municipal Keta Papase St.6 65.3 57.3 90.7 67.

23 SECOND CYCLE PEER REVIEW REPORT. Hohoe Hospital etc. Sogakofe.1 Environment All Hospitals within the second cycle saw a lot of improvement in their environments.1.10. Peki Hospital. Anthony’s Hospital.1 Description of the problem or stimulant (outliers) 2. Krachi West District Hospital. Significant among the Hospitals were St.10 Improvement or otherwise of facilities 2. District Hospital. Before Second Cycle Peer Review Pictures Krachi West District Hospital before the Second cycle Krachi West District Hospital During the 2nd Cycle of the Peer Review 23 . both the Landscaping and the Infrastructure.10.2011 2. Dzodze.

Hospital during 2 Cycle nd State of Environment during 2 cycle nd Peki Recreational centre during 1st cycle 24 .24 SECOND CYCLE PEER REVIEW REPORT.2011 State of Hohoe Hospital conference Room during 1 Cycle st State of External Environment during 1 Cycle st Renovated Conference in Hohoe Mun.

40 2.90 2. Stores.10. Still more needs to be done in this regard.69 3. and the User Units of the Hospitals. Hand washing.14 below depict the average score of the cadres of workers assessed during the Peer review. Sogakofe. During Post Peer Review Monitoring 2.93 3. However.1.14 Mean Performance of Cadres of workers on Hand washing Medical Laboratory Pharmacy Hand washing Orderlies Nurses Officer/Assistant Staff Staff Mean (Expected Score is 4) 2. Table 2. The Table 2. Chlorine is now being used in all the hospitals in the Region as requested by the IPC Policy of the Ministry of Health. a major way of controlling microbes is still a problem in few of the Hospitals.2 Infection Prevention and Control 1. the flow of accurate information concerning the chlorine between the suppliers. Procurement Officers.25 SECOND CYCLE PEER REVIEW REPORT. 2.2011 Second Cycle Hospital Environment District Hospital. 25 .24 3. Facilities without Proper Incinerators were also able to build ultra-modern Multi-Purpose Incinerators to take of the solid wastes.

meet over the protocols to develop a standard protocol for Mass Casualty Incident Management in the Region.2011 New Multipurpose Incinerator-St. Anthony’s Hosp Burning Pit Constructed in Worawora Hosp. New Washing Machine installed in Adidome Hosp. there was no standard protocol for Mass Casualty Incident Management in the entire Region.3 Emergency Systems and Services One of the major challenges faced by the facilities concerning Emergency Systems and Services was the non-availability of Largactil for Management of Emergency Mental conditions.1.26 SECOND CYCLE PEER REVIEW REPORT.10. Also. There is therefore the need to collate all the protocols developed by the various facilities. 2. 26 .

It also exposed the quality of the referrals being done in our facilities across the region.1. Fire Extinguishers were also procured and serviced by most of the Hospitals. Issues concerning high Ceasarean Section rate came up strongly in some facilities. Another significant thing the revealed with regards to quality Assurance was the fact that Maternal Death Audits were organized at least in all the Hospitals in which there were these deaths. at least twice in a year. 2. Most Caesarean section wound conditions were not properly document both by the Medical Officers and the Nurses.2011 Some facilities also realizing the need for proper Emergency Services were able to start construction or completed a new Emergency Units.5 Clinical Practices One major outlier concerning Clinical practices is the issue of documentation. Ketu South Hospital was able to construct a New Emergency Unit and procured a Patients Monitor for the Unit.1.4 Quality Assurance Activities Few challenges concerning the current referral system were exposed such as feedback to the referring facility. awareness was created to ensure complaints Management systems are strengthened in all Hospitals. 2. Briefing of Staff by Incident Commander Emergency Preparedness in a Hospital 2. At least barrier nursing and wearing of Personal Protective clothing was enforced to some extent.27 SECOND CYCLE PEER REVIEW REPORT.10.6 Clients Care To a very large extent.10.1.10. 2. The use of Colour coded bins and liners were enforced to ensure segregation of waste.10. Client Satisfaction Surveys are also being conducted by most hospitals regularly. This issue also revealed a lot of concerns about the referral system in the Region.1. 27 .7 Occupational Health and Safety Issues Occupational Health and Safety issues incorporated into the check list indeed expose the gaps in the system.

To some extent facilities were also entreated to implement their action plans hitherto. This to a large extent is helping to ensure information flow on the finance of the Hospital at least among Management members. action plans were usually prepared but not shared amongst staff and not even implemented. it is an attempt in the right direction.10. the process is encouraging other Members of management to demand weekly cash flow and Quarterly Financial Analysis from the Accountants. Even though.1.28 SECOND CYCLE PEER REVIEW REPORT. Furthermore. 28 .2011 Laundry Staff on the way to collect dirty Linen Waste Segregation point in VRH 2.8 Management Attempts were made by some facilities to develop Strategic Plans to give them a strategic direction since this was a requirement of the Checklist. Planned preventive maintenance was also emphasized as a result of the Peer Review. Efforts were also made by the various Hospitals to analyse the state of their equipment and prepare Equipment replacement financial analysis. some of the documents submitted did not include the ingredients of a strategic Plan.

In addition. Joseph Catholic Hospital. Renovation of Krachi West District Hospital Building of a New Pharmacy Block at St. Collaboration with MPs to provide Street Light at Nkwanta South District Hospital Collaboration with MP to provide Blood Bank Fridge in Mary Theresa’s Catholic Hospital. Nkwanta Completion of a New Maternity Unit at the Margret Marquart Catholic Hospital New Pharmacy Block @ St. Hosp 29 New Maternity Block @ MMCH . this was expected to stimulate the facilities to judiciously use their resources especially the Internally Generated Fund (IGF) was introduced. Joseph Cath.10. the Regional Director’s Score was introduced to encourage facilities to innovate using the local resources available to them.2 Regional Director’s Mark for Innovation and Organization of the Peer Review As part of excitement.2011 2.29 SECOND CYCLE PEER REVIEW REPORT. Conversion of Recreational centre to a conference room by Peki Government Hospital Building of Emergency Unit and Procurement of Patients’ Monitor to improve Emergency Management in Ketu South District Hospital Staff accommodation initiated and an Orange orchard also started in Sogakofe Hospital. This element resulted in a lot of the facilities committing their resources into things such as:          Renovation of apartment used for training to a proper conference room standard in Hohoe Municipal Hospital.

All the thematic areas on the Checklist indicated great improvement over the first cycle performance.1 CONCLUSION The second cycle of the Peer review revealed that 1. etc. Waste Management. To identify factors that needs further attention. It also intends to look at how Human Resource situations are influencing the implementation of the programme. one success factor is the periodic/process evaluation of the programme to: 1. 4. The evaluation also intended to look at Clients’ perspective.2011 CHAPTER THREE. 30 . Fifty (50) per cent of the Hospitals were able to meet the Regional Director’s performance target 2. Staff perspective and Influence of Management skills of the Hospital Managers and Management’s perspective of the outcomes of the programme. it was agreed that since this is the second cycle of the Implementation of the Peer Review. Performance of the Hospitals improved tremendously. It was also expected that this Evaluation will inform on the necessary steps to take in order to improve the process and the expected outcomes. Team approach to work has been strengthened through the Peer Review since everybody in the facilities understands that they will be jointly accountable to the good or bad performance during the Peer Review. As part of the plan of the Peer Review Coordinating team. 3. Re-strategizing. 3. Policies such as Infection Prevention and Control.CONCLUSION & RECOMMENDATION 3. Key lessons learnt and sustainability factors of the programme. Occupational Health and Safety. 5. identify internal and external impediments/success factors of the programme. 3. This has even catch-up with the Community members as the Chiefs and community members were found helping the Hospitals during Communal Labour. 2. Most Policy documents lying on shelves not implemented were implemented to a large extent through the Peer Review. an Evaluation be done to inform on the key implementation challenges.2 RECOMMENDATIONS 1. Evaluation of the Peer Review In every programme Implementation.30 SECOND CYCLE PEER REVIEW REPORT. Internally Generated Funds were being used judiciously as most facilities ensured the availability of basic equipment and drugs for service delivery.

there was the need to streamline the behaviours of participants.2011 The evaluation was not done due to reasons beyond the Peer Review Secretariat. 2. This resulted in the development of Code of Principle to guide the entire process. How to Continue with the Peer Review In other to ensure that the current momentum is sustained. Modification of the Process and the Checklist and what it should contain Due to challenges encountered with regards to conduct of some reviewers. there was the need to incorporate activities that may continue to entice Management of the Hospitals to always attend the Peer Review hence the need to refine the checklist and add other activities. 3. 31 . The Code of Principles will be used during the third cycle of the Peer Review. District Health Directorates. Hospitals (Regional and District/Municipal).31 SECOND CYCLE PEER REVIEW REPORT. This will help to compare performance at all levels of service delivery and improve all the indicators. Regional Health Directorates and all Divisions. develop a national Checklist for all the Health Centres. It is also recommended that the Headquarters takes up the process.

32 SECOND CYCLE PEER REVIEW REPORT. The Quality Assurance Strategic Plan for the Ghana Health Service 2007-2011 2. Peer Review of Hospitals in the Volta Region.2011 REFERENCES 1. December 2010 32 .

OCTOBER. sets the mind of staff and clients at ease.b Flowers (Availability. grass cut (mowed) very low.5 -If Grass mixed with weeds deduct 0. -If no grass cover score overall 0 -If Grass not green deduct 0. 2011) PREAMBLE: Documentation is a huge problem in Ghana and for that matter the Health Sector.5 3 1.a EXTERNAL ENVIRONMENT Grass Covering Therapy involves many facets including the impact of the environment on staff and patients satisfaction When properly done. area well ‘boxed’ by kerbs.availability of the grass -Grass should be Green.Not properly kept deduct 0.5 . it is pleasing to the eye. The guideline therefore takes this into consideration in many respects. Spread) -Availability of the flowers -Variety of flowers -Spread of the flowers (all over the landscape) -Arrangement of the flowers (planted to follow a pattern) .5 .Caring of the flowers (Properly taken care of) 33 If flowers not available give overall score 0 -Same Variety of flowers deduct 0.5 -If bare areas available deduct 0. 2010.2011 APPENDICES Appendix A: Checklist used in 2011 Peer Review VOLTA REGIONAL HEALTH DIRECTORATE CHECKLIST AND NOTES/GUIDELINES ON SCORING AT PEER REVIEW SESSIONS (NOVEMBER. not mixed with weeds (other grasses.5 -Not well Spread (all over the landscape) or localized deduct 0.5 3 .If grass bushy deduct 0.5 -No pattern (planted haphazardly) deduct 0. Arrangements.33 SECOND CYCLE PEER REVIEW REPORT. easily rates the institution as a ready entity to deliver the care necessary Flowers by themselves give a lot of healing . ENVIRONMENT (EXTERNAL AND INTERNAL) ITEM RATIONALE HOW TO SCORE EXPECTED SCORE IDEAL(EXPECTED) SITUATION EXISTING OR ON THE GROUND SITUATION NO OVERALL SCORE (after deduction) 1. this problem must be addressed. 1.5 -If grass not ‘boxed’ by kerbs deduct 0. no bare area.

Hedges check erosion and beautify the environment 1.5 -Toilet Rolls not available 0.5 -Not Functional WC (Flushable) deduct 0.2a INTERNAL ENVIRONMENT Staff Toilet -Non-availability give overall score of 0 4 -If trees do not provide shade deduct 0.5 -Leaves droppings left under the trees deduct 0. no pieces of paper on floor.c Trees and Hedges Trees give shade and serve as a wind break and oxygen source for the environment.5 -Broken Pot and Cistern) deduct 0.5 -Not Clean deduct 0.5 -No pattern in planted trees (planted haphazardly) deduct 0. No sweet smelling fragrance) deduct 0.5 -Not Functional WC (Flushable) deduct 0.5 -Toilet Rolls not available 0.5 -Odour ( No sweet smelling fragrance) deduct 0. no stains on WC & Walls.5 -Hedges not trimmed deduct 1. no stains on WC & Walls.5 -Odour Present deduct 0.) -Functional WC (Flushable) -Unbroken Pot and Cistern) -Toilet Rolls available -Odourless (sweet smelling 34 -Not available in all unit deduct 0.5 -Broken Pot and Cistern) deduct 0.5 -Trees not well spread all over the facility deduct 0.2c Client Toilet To provide speed and comfort in attending to natures call 4 .Hedges trimmed to provide pattern 1.) -Functional WC (Flushable) -Unbroken Pot and Cistern) -Toilet Rolls available -Odourless (sweet smelling fragrance) -Waste Paper bin (not to be used for anal droppings -Available in all Wards & OPD -Clean (No water on floor. no pieces of paper on floor.5 -Not available in all units deduct 0.2011 1.5 A sanitized internal Environment gives staff and the clients the needed confidence and easy mobility and safety To provide speed and comfort in attending to natures call in a hygienic manner -Available in all Units -Clean (No water on floor.5 -Waste Paper bin (contains anal droppings) 4 -Availability of trees & Hedges -Trees provide shade -Spread of the trees and Hedges (all over the landscape) -Arrangement of the trees & Hedges (planted to follow a pattern) .5 -Not Clean deduct 0.5 -Odour present.5 -Waste Paper bin (contains anal droppings) deduct 0.34 SECOND CYCLE PEER REVIEW REPORT.0 -Trimmed Hedges not providing a pattern deduct 0.

5 -Not Pedal operated deduct 0.2f Waste Bins in Offices To prevent littering of the Environment -Dirt on Floor deduct 0.5 4 1.2011 fragrance) -Waste Paper bin (not to be used for anal droppings -Non-leaking roof and ceiling -No cracks in the Walls -No cracks or breaks in the floor -Walls painted -Non-peeling paints and washable -Walls not damp with fungal growth -Ceilings intact and painted with one colour -Nature of the floor (Not slippery) -Floor should not have dirt -Floor should not be stained -Floor must be sparkling .5 -Cracks in the Walls deduct 0.No cobwebs on the ceilings and walls -No stains on the ceilings and Walls -Well arranged furniture(to create space and prevent injury) -Cleanable working table top -Steady tables and chairs (Nails not popping up etc) -Stuffed Chairs should not have torn leathers -Adequate windows or ACs to allow free flow of air) -Working area should be bright -Available in every office -Pedal operated -Pedals are functioning 35 deduct 0.5 -Walls damp with fungal growth deduct 0.5 -Non-Steady tables and chairs (Nails popping up etc) deduct 0.5 -Stains on the ceilings and Walls deduct 0.5 -Non-Cleanable working table top deduct 0.5 .5 -Ceilings not intact and painted with more than one colour deduct 0.5 6 2 .5 -Floor not sparkling deduct 0.5 -Stuffed Chairs having torn leathers deduct 0.5 .5 -Inadequate windows or No ACs to allow free flow of air) deduct 0.5 -Stains on Floor deduct 0.5 -Non-painted Walls deduct 0.5 -Working area not bright enough deduct 0.5 1.5 -Furniture not well arranged deduct 0.5 -Peeling paints deduct 0.Nature of the floor (Slippery) deduct 0.5 -Pedals not functioning deduct 0.Cobwebs on the ceilings and walls deduct 0.35 SECOND CYCLE PEER REVIEW REPORT.2e Working Areas Should not pose danger to both clients and staff 1.2d State of Infrastructure To provide safety for staff & clients and aesthetic beauty -Leaking roof and ceiling deduct 0.5 -If not Available in some offices deduct 0.5 -Cracks or breaks in the floor deduct 0.

1a INFECTION PREVENTION AND CONTROL Decontamination Procedure Use of Chlorine based Disinfectant (Chlorine disintegrates rapidly.5 -Waste segregation practices not taking place deduct 0.5 3 1. To remove microorganisms likely to be transmitted.5 -Not Available in every Service Area deduct 0.36 SECOND CYCLE PEER REVIEW REPORT.5 -Inability of an interviewee to appropriately answer in terms of (time {duration}. type of material and appropriate concentration for use in the different scenarios 36 -Stock strength of chlorine not known by user units deduct 0.5 -Pedals are not functioning deduct 0. Should not be left overnight)! i. type of material and 3 .2011 -Should have a black liner in -No black liner in the waste bins deduct 0.2g Waste Bins in Clients -Service Areas To prevent littering of the Environment and to prevent danger posed by microorganisms and chemicals -Available in every Service Area -Proper Colour coding adhered to -Waste segregation practices taking place -Bins are pedal operated -Pedals are functioning -Appropriate liners for waste segregation INFECTION PREVENTION AND CONTROL NO ITEM RATIONALE HOW TO SCORE IDEAL(EXPECTED) SITUATION EXISTING OR ON THE GROUND SITUATION EXPECTED SCORE OVERALL SCORE (after deduction) II II .5 -Stores not giving accurate info about stock strength deduct 0. -Stock strength of Chlorine communicated to all user Units -Prepared chlorine solution well labelled for strength and date -3 people describe appropriate use of chlorine with regards to time for disinfection. To reduce longer stay of clients through infection To remove microorganisms likely to be transmitted. To prevent danger of infection posed to clients and staff. ii.5 -Prepared chlorine solution not labelled deduct 0.5 -Proper Colour coding not adhered to deduct 0.5 -Bins are not pedal operated deduct 0.5 -Inappropriate liners for waste segregation deduct 0.1 II.

5 each -Not Available in all user units/points of preparation deduct 1 -Not Bold enough to fill an A-3 Paper and well laminated deduct 1 -Not Conspicuously displayed deduct 1 II.5 -Multiple-use hand towel deduct 0. deduct 0.1b Written Protocol for Preparation of appropriate Chlorine solution (Available at all user units.5 -No running water deduct 0.5 -Soap dish or dispenser not appropriate deduct 0. Nurse iii.37 SECOND CYCLE PEER REVIEW REPORT.2011 appropriate concentration) deduct 0. Orderly ii. Laboratory Personnel v. Medical Officer and Medical Assistant iv.2 PRACTICES A new member of staff will not have difficulty in preparing the chlorine solution -Available in all user units/points of preparation.5 -Contamination of tap after hand wash deduct 0. if cake then soap dish) -Running Water -One-per-wash hand towel in a dispenser -Towel in dispenser easily reached but not soiled with hand water -Inter digital space rub -Avoid contaminating with tap after hand wash -Avoid soiling distal forearm after hand wash For each category of staff mentioned if: -Soap not appropriate deduct 0.) i.2a Randomly select any 3 of the following Category of staff to perform social hand washing and score them (Take into consideration availability of all necessary inputs for the hand washing before allotting marks. conspicuously displayed) HAND WASHING II.5 -No towel dispenser and easily soiled with hand water.5 12 (4 per person) II.5 -Soiled distal forearm after hand wash deduct 0. Pharmacy Staff 37 . -Bold enough to fill an A-3 Paper and well laminated -Conspicuously displayed 3 To decontaminate the hand in order to prevent cross infection Social hand washing (routine hand washing) is for every health worker so as not to transfer micro organism from one place to the other and from one person to the other Inputs for hand washing: -Soap (liquid or Carbolic Cake soap.5 -Wrong inter digital space rub deduct 0.

5 3 To have liquid waste properly disposed to avoid the danger it will pose to both staff and clients To have liquid waste properly disposed to avoid the danger it will pose to both staff and clients Drains condition -not broken down.3b Wet/Liquid Waste Disposal Soak-Away (available to collect soiled water from maternity & Theatre. easily accessible by truck.3c Drains condition (not broken down.38 SECOND CYCLE PEER REVIEW REPORT.5 -Not easily accessible deduct 0.5 . General Waste. Tissue Waste -Multipurpose Incinerator Functional -Multipurpose Incinerators used for the purpose.5 -Static collection of water deduct 0.Water collected around it deduct 0.3d Septic Tanks condition (Functional.5 -Drains Silted deduct 0.free of rubbish and weeds. -no static collections of water -Not silted -No fungal growth -Available -Well sealed -No water collected around it -Easily accessible -Surrounding not weedy Drains condition: -Broken down deduct 0.3a WASTE DISPOSAL Dry/Solid Waste Disposal II. no static collections of water II.5 3 3 38 .5 -Contains rubbish and weeds deduct 0. Burning pit and Incinerator for -If no Burning pit deduct 3 3 sharp -If no Placenta pit deduct 3 3 To have liquid waste properly disposed to avoid the danger it will pose to both staff and clients To have liquid waste properly disposed to avoid the danger it will pose to both staff and clients -Available II. Functional) II.5 -Fungal growth deduct 0.5 -Water collected around septic tank deduct 0. not weedy) -Well sealed -No water collected around it -Not available score overall score of 0 -Not well sealed deduct 0.2011 To remove source of infection and prevent wrongful deposition of rubbish in and around client areas as an eyesore To prevent infection -Availability of Multipurpose 9 Incinerator (MI)for sharps.5 -Septic tank not available overall score of 0 -Not well sealed deduct 0. . If Multipurpose Incinerator not available there must be Placenta -If No incinerator deduct 3 3 Pit.3 II. free of rubbish and weeds.

triage and a -emergency tray not in an emergencies. * anaesthetists.0 each -minimum content of -minimum content of emergency tray EXISTING OR ON THE GROUND SITUATION 39 HOW TO SCORE IDEAL(EXPECTED) SITUATION EXPECTED SCORE III III.5 flow diagram outlined -No flow diagram outlining what happens to emergency cases deduct 0. It is ideal that systems are built to take care of both category of cases To ensure there is a -Emergency duty roster found in all Duty roster for any team category not 5 system to manage Units covering all the categories in available deduct 0.2011 -Surrounding weedy deduct 0.5 -flow of what happens to the -No outline of where emergency cases are emergency case after received in a to be sent 0.5 emergency situations the team – *doctors.39 SECOND CYCLE PEER REVIEW REPORT. *lab Technicians.5 EMERGENCY SERVICES AND SYSTEMS NO ITEM RATIONALE OVERALL SCORE (after deduction) Hospitals receive individual (single) cases and large number of cases needing emergency services. with telephone numbers of all the Team members with the Telephonist -Clearly defined line of who calls the team -where emergency cases are to be -No clearly defined line of who calls the sent outlined team deduct 0. designated emergency expected unit or ward. *pharmacy. triage and room a designated emergency room deduct 1. give overall available to enhance -emergency tray in all score of zero management of wards.2 Emergency Trays (availability and adequacy) .5 To ensure basic -Emergency Trays Emergency Tray not available in 20 equipment and drugs (availability and adequacy) all expected units.1 EMERGENCY SERVICES System for Emergency III.

pediatric. large.40 SECOND CYCLE PEER REVIEW REPORT. extra-large *Stethoscope *Flashlight and extra batteries * Oxygen tank with mask (serviced yearly and checked monthly) * Syringes and needles of various sizes * Alcohol swabs or sponges * Gloves. *Promethazine 20mg/mL vials (a minimum of 4) *Hydrocortizone 100mg ampoules (at least 2) *Atropine sulfate ampoules 0. . *Largactil ampoules at least 5. ex.6 mg/mL (optional) 40 * Aqueous epinephrine (1:1000. medium. *One-way masks – small. *Diazepam ampoules at least 4. extra-large *Stethoscope *Flashlight and extra batteries * Oxygen tank with mask (serviced yearly and checked monthly) * Syringes and needles of various sizes * Alcohol swabs or sponges * Gloves. *Promethazine 20mg/mL vials (a minimum of 4) *Hydrocortizone 100mg ampoules (at least 2) *Atropine sulfate ampoules 0.2011 emergency tray The lack of one of each item in children’s and maternity ward deduct 0. *Diazepam ampoules at least 4. large.6 mg/mL (optional) * Poison Control phone number GHANA. *Sphygmomanometer. * Aqueous epinephrine (1:1000. adult. *Largactil ampoules at least 5. 1mL ampoules.5 *AMBU bag – at least 1 Adult and 1 Pediatric unit *One-way masks – small. adult. ex. age appropriate. *Sphygmomanometer. pediatric. 1mL ampoules. *Bag Valve Mask (AMBU bag) – at least 1 Adult and 1 Pediatric unit. age appropriate. medium.

Supplies. 0302-244773. 0243-646758 National Ambulance No. supplies and medications inventory list with log of monthly reviews/inventory * Emergency protocols signed by a local physician *A copy of the Emergency Equipment. emergency tray or off-site emergency kits with a copy of the current signed protocols Protocol on Mass Casualty available in all units NATIONAL Poison Center Emergency Phone: 0302-243552.2011 * Poison Control phone number GHANA. 0302-238626. NATIONAL Poison Center Emergency Phone: 0302-243552. 0302-244773. Of The Catchment Area * Emergency equipment. Of The Catchment Area * Emergency equipment. emergency tray or off-site emergency kits with a copy of the current signed protocols III. supplies and medications inventory list with log of monthly reviews/inventory * Emergency protocols signed by a local physician *A copy of the Emergency Equipment. 0302-238626. Supplies. and Medications list is to be placed on the crash cart. and Medications list is to be placed on the crash cart.3b Simulation Exercise for Mass Casualty Management (at least once a year) To give focus and organization in the Management of Mass Casualty To keep staff alert and to review procedures and processes of managing Mass Casualties RATIONALE No protocol available give overall score 0 5 Simulation exercise for Mass Casualty Management conducted once a year Report available No evidence of simulation exercise conducted give overall score of 0 5 QUALITY ASSURANCE NO ITEM HOW TO SCORE IDEAL(EXPECTED) SITUATION 41 EXISTING OR ON THE GROUND SITUATION EXPECTED SCORE OVERALL SCORE .41 SECOND CYCLE PEER REVIEW REPORT. 0243-646758 National Ambulance No.3a Protocol for Mass Casualty Management III.

5) for each: 8 .5) and not properly filed (deduct 0.5 *Remarks column deduct 0. -Form 1A.5 No evidence of implementation of activities score overall 0 -Remark column not indicating status of activities whose date has elapsed deduct 0.5 *Start Date deduct 0.1b To be sure the action is being implemented 4 Proportion of Activities in Action Plan Executed IV.5 *Person/Team Responsible for specific actions deduct 0.5 *Cost element (Budget for the activities) deduct 0.5 *Finish date deduct 0.2a Maternal Mortality (Report Forms filled? audits conducted? Report To improve on maternal care given -100% of activities whose time has elapsed undertaken All Report Forms filled and properly filed: -Notification Form.5 -% scored on activities undertaken multiplied by 3 gives the score 4 IV.5 -Action Plan not properly filed in QA designated file deduct 0. QUALITY ASSURANCE To improve on care given to clients To guide the QAT’s focus -Availability of action plan for the year -Properly filed in QA designated file -Action plan must have *Activity list *Start Date *Finish date *Person/Team Responsible for specific actions *Cost element (Budget for the activities) *Remarks column -Reports/Evidence of implementation of activities -Remark column indicating status of activities whose dates has lapsed -If not Available overall score is 0 -No QA designated file deduct 0.2011 (after deduction) IV.42 SECOND CYCLE PEER REVIEW REPORT.5 -Action plan not having *Activity list deduct 0. 42 The following Report Forms (all may be in the same file) properly not filled (deduct 0.1a Quality Assurance Action Plan available IV.

43

SECOND CYCLE PEER REVIEW REPORT,2011
- Form 1B, -Audit Form -Notification Form -Form 1A - Form 1B, -Audit Form - Audits not conducted deduct 2 -Report not Submitted to RHD, deduct 0.5 - Recommendation not implemented deduct 1 -List of the Maternal deaths not available deduct 0.5 *If No Maternal Death Scores Not applicable -List of deaths not available deduct 1 -Minutes of conference not available deduct 1 -Recommendations not implemented deduct 1

Submitted to RHD, Recommendation)

- Audits conducted -Report Submitted to RHD, - Evidence of Recommendation implemented -List of Maternal deaths Available

IV.2b Evidence of other Mortality Conferences (Minutes, evidence of implementation of recommendations) IV.2c Evidence of Clinical Meetings (Reports Available, Attendance List) IV.3a

To improve on care given

-List of deaths available -Minutes of conference available, -evidence of implementation of recommendations

3

To improve on care given

-Reports Available, -Attendance List

-Reports not Available deduct 1.5, -No Attendance List deduct 1.5

3

To reduce undue delay in case management with other institutions

-Available at all units, -staff knowledge of guidelines

Referral Guidelines (Available at all units, staff knowledge of guidelines) IV.3b Referral Forms (Available, proper

To ensure uniformity of referrals forms

-Available, - proper utilization- inspect 5 filled 43

Interview 3 Nurses/Doctors selected at random to find out their knowledge about: - the levels of referrals deduct 0.5 for each person -Procedure for referrals (Form filling, Telephone calls, staff accompanying patient etc) deduct 0.5 for each person -Not Available, overall score 0 - Improper utilization of the form (inspect

3

5

44

SECOND CYCLE PEER REVIEW REPORT,2011
forms for cases referred 5 filled forms for cases referred) deduct 1for each -Not Available at all referring units/wards, overall score 0 -Not utilized in these units deduct 1 for each unit -No Composite Register with the Matron deduct 2 -If no evidence of feedback for each of 5 cases referred deduct 1 5

utilization- inspect filled forms for cases referred) IV.3c Referral Registers (Available at all referring units/wards, utilized) IV.3d Evidence of feedback to referring facility within 1 month of referral IV.4a Case Management Protocols Available at all treatment units (at least Malaria, Diarrhoea, Convulsion) IV.4b Case Management Protocols for Maternal cases available (Eclampsia, PPH) IV.4c Use of Partograph in Maternity/Labour Ward (Evidence of Use) IV.4d Is Cold Chain Maintained for To ensure uniformity of referrals and provide information

-Available at least 3 referring units/wards, -utilized in these 3 units -Composite Register (Referred in & Out) with the Matron Evidence of feedback to referring facility within 1 month of referral

To ensure uniformity of referrals

5

A new member of staff will not have difficulty in treatment of Malaria, Diarrhoea, Convulsion etc

-Available in all user units/points. -Bold enough to fill an A-3 Paper and well laminated -Conspicuously displayed

-Not Available in all user units/points deduct 1 -Not Bold enough to fill an A-3 Paper and well laminated deduct 1 -Not Conspicuously displayed deduct 1

3

A new member of staff will not have difficulty in treatment of Eclampsia, PPH

-Available in all user units/points. -Bold enough to fill an A-3 Paper and well laminated -Conspicuously displayed

-Not Available in all user units/points deduct 1 -Not Bold enough to fill an A-3 Paper and well laminated deduct 1 -Not Conspicuously displayed deduct 1

3

A guide to monitoring of clinical skills for good maternal health

Partograph is used on all labour cases that needs it

Select 5 normal delivery cases and find 5 out -if partograph is not used appropriately deduct 1 for each
-No Temp chart available (Laboratory, Pharmacy & Maternity) deduct 1for each 6

-Temp chart available -Thermometer for Fridge available 44

45

SECOND CYCLE PEER REVIEW REPORT,2011
-No Thermometer for Fridge available (Laboratory, Pharmacy & Maternity) deduct 1 for each

ASV,ARV, ATS, Oxytocin, Ergometrine

CLINICAL PRACTICES
NO ITEM RATIONALE HOW TO SCORE IDEAL(EXPECTED) SITUATION EXISTING OR ON THE GROUND SITUATION EXPECTED SCORE OVERALL SCORE (after deduction)

CLINICAL PRACTICES

V.1a

Proportion of Caesarean Section wound Infection (Select 20 folders randomly)

V.1b
Fresh Still birth rates in the previous year Monthly monitoring of the ff. Outcome Indicators

The entire existence of hospital is to render service through clinical practice. Effectiveness and efficiency of such a practice is paramount. Indicators to measure acute, moderate and chronic cases define such effectiveness. All C/S wounds not infected It measures the Each caesarean section wound infected 20 infection prevention deduct 1 and control measures undertaken by the hospital Baseline Information on Fresh Still When Fresh Still Birth Rate is: 3 Birth Rate in VR is 3.2% 0-3.98 overall score is 3 3.99-4.75 deduct 1.5 4.76 or more give overall score of 0

V.2 V.2a

Baseline CFR for Malaria in VR is 4.35% i. Malaria Case fatality Rate

When CFR (in %) for Malaria is: 0-5.06 overall score is 3 5.07-5.78 deduct 1.5 5.79 or more give overall score of 0

3

45

98 deduct 1.82-33.70 overall score is 3 6.3b Average number of Drugs per Prescription V.3 V.38 deduct 1. Caesarean Section Rate Baseline information on Caesarean Section Rate in VR is 15.09 deduct 1. Institutional Maternal Mortality Rate Monitoring of Rational Use of Medicine V.81 overall score is 3 24.71-8.2d When Caesarean Section Rate (in %) is: 0-17.2b Baseline CFR for Diabetes Mellitus in VR is 15.10 or more give overall score of 0 V.3c Percentage of Drugs prescribed by Generic Name Expected Percentage Prescriptions with written Diagnosis is 100% Average number of Drugs per Prescription is 3 Percentage of Drugs prescribed by Generic Name 90% 46 When Expected Prescription with diagnosis is 95-100% overall score 3 69-94 deduct 1.5 33.5 Less or equal to 62 award 0 3 3 3 .5 8.39 or more give overall score of 0 When Institutional Maternal Mortality Rate (in %) 3 3 0-6.59-19.46 SECOND CYCLE PEER REVIEW REPORT.99 or more give overall score of 0 3 V.32% iv.5 more than 5 award 0 When Expected Percentage of Drugs prescribed generic name is 89-100% overall score 3 62-88 deduct 1.65% ii.78% Baseline information on Institutional Maternal Mortality Rate in VR is 5.2c iii. Diabetes Mellitus Case Fatality Rate V.5 19.5 Less or equal to 68 award 0 When average number of drugs per prescription is: Less or Equal to 3 award 3 3-5 deduct 1.58 overall score is 3 17.3a Percentage Prescriptions with written Diagnosis V.2011 When CFR (in %) for Diabetes Mellitus is: 0-24.

5 for about the service being -Recommendation listed for each delivered implementation -List of recommendations not available -Report or recommendation deduct 0.3f Percentage of Prescriptions with Injection V.5 More than 19.2011 When Expected Percentage of Drugs prescribed are from EML is 89-100% overall score 3 62-88 deduct 1.1a Client satisfaction surveys (# conducted in past year.6 award 0 When Expected Prescription with Review date is 95-100% overall score 3 69-94 deduct 1.5 deduct 1.3d Percentage of Drugs in Essential Medicine List V.47 SECOND CYCLE PEER REVIEW REPORT.g.5 More than 58. This is to improve on Service delivery To accurately judge -2 Surveys conducted every year -Each report score 1 clients expectation -Hard copies of Reports available -Hard copies not available deduct 0.6 award 0 When Expected Prescription with Antibiotic is 0-10% overall score 3 11-19.5 Less or equal to 62 award 0 When Expected Prescription with Antibiotic is 0-30% overall score 3 31-58.5 for each report. records available. disseminated (Evidence e.5 deduct 1.5 47 4 . major issues identified) Hospitals exist for client care.3g Percentage of Prescriptions with Review Date Percentage of Prescriptions of Drugs in EML 100% 3 Percentage of Prescriptions with Antibiotic 30% 3 Percentage of Prescriptions with Injection 10% 3 Percentage of Prescriptions with Review Date 100% CLIENT CARE NO ITEM RATIONALE HOW TO SCORE IDEAL(EXPECTED) SITUATION EXISTING OR ON THE GROUND SITUATION EXPECTED SCORE OVERALL SCORE (after deduction) CLIENT CARE VI. -No dissemination deduct 0.5 Less or equal to 68 award 0 3 V.3e Percentage of Prescriptions with Antibiotic V.

2c To ensure clients have access to information easily and also to ensure that they don’t get confused Information Desk not available – 4 functional *No permanent staff to manage deduct 0.5 -If Action plan does not have *Activity list *Start Date *Finish date *Person/Team Responsible for specific actions *Cost element (Budget for the activities) *Remarks column Deduct 0. deduct 0. etc) VI.5 There will always be conflicts in an organization. Aggrieved parties (Staff or clients) will complain to Managers and avenues to register complains must be available To document all complains and ensure they are addressed -Register Available i.5 3 48 .5 -No evidence of action taken. weekly report from Information Desk to Management) VI.2b Complaints Management System VI.5 *No evidence of being reviewed by a senior officer deduct 0.5 *Not properly filed in a designated file deduct 0.5 *No Documentation available deduct 0.5 for each item above 4 VI. evidence of implementation) -Availability of action plan for the year -Properly filed in QA dedicated file -Action plan must have *Activity list *Start Date *Finish date *Person/Team Responsible for specific actions *Cost element (Budget for the activities) *Remarks column -Info Desk Available -Functional * Permanent staff to manage the unit *Documentation available *Evidence of being reviewed by a senior officer -Evidence of report to Management and -properly filed in a designated file.48 SECOND CYCLE PEER REVIEW REPORT.1b To ensure expectation of clients identified are addressed Client satisfaction surveys (strategies to address major issues. -If not Available overall score is 0 -If not properly filed in QA dedicated file deduct 0.2a Information Desk (Available. evidence of action taken on complaints) -Existence of Designated Complaints File -Evidence of action taken should be on Complaints file -Complaints register not available give overall score 0 -No designated complaints file deduct 0. functional.2011 minutes. Complaints Register (available.5 *No report to management deduct 0.

goggles) VII. appropriate use of gloves. aprons.5 Inappropriate use deduct 0.5 .1a OCCUPATIONAL HEALTH AND SAFETY ISSUES Personal Protective Clothing (Available. boots. EXISTING OR ON THE GROUND SITUATION To prevent cross infection and injury Available. boots.49 SECOND CYCLE PEER REVIEW REPORT. goggles) Ask 1 staff each from 3 different units applicable to demonstrate the use of -How to wear gloves -How to wear masks . aprons.5 .1b Personal Protective Clothing for Highly Infective We have all forgotten barrier nursing to the detriment of already -Assess staff knowledge on barrier 15 nursing for the 5 elements (5 steps to make barrier technique whole): 49 .2011 OCCUPATIONAL HEALTH AND SAFETY ISSUES NO ITEM RATIONALE OVERALL SCORE (after deduction) Safety of staff and patients cannot be compromised under any circumstances and therefore steps must be taken to protect them. appropriate use of gloves.5 .How to wear boots -How to wear aprons -How to wear goggles Ask 1 staff each from 3 different units applicable to demonstrate the use of -Unable to wear gloves properly deduct 0.Unable to wear goggles properly deduct 0. If staff display no knowledge about barrier nursing score 0 4 HOW TO SCORE IDEAL(EXPECTED) SITUATION EXPECTED SCORE VII VII. masks.5 Select 3 nurses at random and ask details about barrier nursing.Unable to wear masks properly deduct 0.5 .5 Non availability deduct 0.Unable to wear boots properly deduct 0.Unable to wear aprons properly deduct 0. masks.

5 -Breaks on floor deduct 0. * Doctors. masks gloves and goggles *Number of visitors are restricted *Disposable materials are burned after use *Reusable materials are sterilized before use *all surfaces cleaned with a sanitizing solution Select 3 nurses at random and ask details about barrier nursing.5 -Inappropriate linings deduct 0.5 -Folded wrongly deduct 0. No improvised) -Evidence of use Black for General Waste Yellow for Infection Brown for hazardous Appropriate linings Corresponding Bigger Bins each Deduct 1. Lassa Fever. Dengue Fever.2011 compromised staff.5 3 3 Segregation of Waste (Appropriate use of colour coded bins & Linings VII.0 for each step missed Conditions e. -Available (WHO approved. Nurses & other technicians attending to the patient wear gowns.2a Sharp Disposal Box (available and evidence of use) VII.2b -Not available score 0 -overflowing deduct 0. Staff exposed to the dangers of highly infective conditions must be protected at all cost.50 SECOND CYCLE PEER REVIEW REPORT. -No breaks on the floor Select 3 units and look out for availability of Fire Extinguishers 50 3 VII. H1N1 etc (knowledge of use) VII.4 -Score overall 0 if no Fire Extinguishers are not available 3 .g.5 -Slippery floor deduct 0. No excavation) Fire Prevention (Fire Extinguisher 3 wards selected at random and examined that floors.5 -When yellow is not used for Infectious waste deduct 0.5 -Inappropriate corresponding bigger bins deduct 0.3 Floors (Nonslippery.5 -When black is not used for General Waste deduct 0.5 -When brown is not used for hazardous waste deduct 0. -Non-slippery.

Issues that are related to management therefore cannot be taken out of any review. and even when deemed from other sources. Decision taken.2 a Strategic Plan (SP) (Availability. cost involve creating an impression -Decision implementation date not clear that work is not been deduct 0.5 done.1 Records on Implementation of Management Decisions (Should incl.Ledger should include Decision -No decision making date deduct 0.5 implementation.If available award 2 marks but 9 and motivation to both -Review plan available Not available award overall score management and the -Monitoring report of progress of 0 EXISTING OR ON THE GROUND SITUATION 51 RATIONALE HOW TO SCORE IDEAL(EXPECTED) SITUATION EXPECTED SCORE VIII MANAGEMENT VIII.5 if No protocol exist on Annual screening of staff 3 MANAGEMENT NO ITEM OVERALL SCORE (after deduction) Management is the engine room for any endeavour and for that matter Hospital practice. direction -SP is available . cost involve) VIII. It also helps in report writing.2011 -3 Staff in those units Appropriately use) Protocol available for screening of Staff annually All staff screened annually & Appropriate use) VII. date of no records to show -Decision taken not clear deduct 0.5 Annual Screening of Staff(Protocol available.51 SECOND CYCLE PEER REVIEW REPORT. Decisions are taken and -Availability of Register/Ledger to -Ledger not available deduct 2 4 record the implementation of hardly implemented .5 necessary to assess the records of decisions implemented to determine the progress of work. Decision taken. Staff Knowledge about .If decisions have been implemented as management decision. evidence of screening done) -Deduct 0. date of implementation. It is therefore -Cost involved not stated deduct 0.5 for each if not able to appropriately use the fire extinguisher Score overall if no annual screening of staff (evidence that screen done is report on the screening) Deduct 0. just give 1 implemented there are .5 making date. Decision making date. To give focus.

meet standard action plan requirement.e.2011 entire staff.2 b VIII.3 a Action Plan (Available in all units.5 -Does not meet Standard action plan requirement i.At least 3 decisions executable by staff of the Ward implemented -Once a quarter month (The measure -Not available at all give overall score 0 -Not available in all units deduct 0.52 SECOND CYCLE PEER REVIEW REPORT.3 b Ward meeting exert team work practices for resolution of problems related to patients care and resource management Provide platform for info sharing. Proportion of implementable activities implemented) Ward Meetings (Frequency. minutes available) -Available in all units -Meet standard action plan requirement Action plan must have *Activity list *Start Date *Finish date *Person/Team Responsible for specific actions *Cost element (Budget for the activities) *Remarks column -Implementation of the action plan -Once a month (The measure of being held is the availability of minutes) . SP involves having broad outlines of local content of activities (including innovations) directed at executing the objectives of MOH/GHS Action plan operationalizes strategic plans and reduces SP to work packages that can easily be managed implementation of the SP Staff knowledge (interview 5 members of staff about awareness of the strategic plan and about the vision of the SP) No Review plan deduct 1 No Monitoring deduct 1 No Awareness by each staff interviewed deduct 0.5 for each *Activity list *Start Date *Finish date *Person/Team Responsible for specific actions *Cost element (Budget for the activities) *Remarks column -% scored on activities undertaken multiplied by 3 gives the score -Each month not held deduct 0. minutes available.5 No awareness of the Vision by each staff deduct 0.5 5 VIII. conflict prevention and promoting unity among 9 -Each of the 3 decisions unsubstantiated as being implemented deduct 1 -Each quarter not held deduct 1 -Less than 50% of entire staff attendance during the Peer Review year of the institution deduct 1 4 of being held is the availability of minutes) -At least 50% of staff must attend 52 .5 it) VIII. verify implementation of decisions taken) Staff Durbars (Frequency. if the following are not on the plan deduct 0.

53 SECOND CYCLE PEER REVIEW REPORT. Matron. *Duration. Administrator.4 Health Care Delivery is dynamic and therefore sharpening the skills and updating knowledge necessary for service delivery is very important In-Service Training conducted (records available. *Objective. Supt. *Venue.5 a Weekly Cash flow statement (available) VIII.2011 staff each quarter during the PR year -Training assessment done -Training plan available -At least 2 Facility based organized In-service training (basis of IST conducted is the availability of Report covering it) -No Training Need Assessment done deduct 1 -Training plan following the standard deduct 0. *Target Group. Administrator. Supt. Of Participants. Person. -2 Facility based organized training deduct 2 for each if not conducted -Designated file not available deduct 1 -No Records in file deduct 1 -Core management members (Med.5 for each *Programme Area. *Resp. *Date. Matron.6 a To ensure that broken down equipment are -Equipment needs assessed (include those broken down and 53 3 . * Funding. To guide expenditure decisions Every Cash flow statement is filed in a designated file and made available to core management 7 Every Quarterly Financial Analysis filed in a designated file and made available to core management 7 VIII. *Expected Output. Pharmacist & Accountant) not having copies deduct 1 -Designated file not available deduct 1 -No Records in file deduct 1 -Core management members (Med. *Course Title. *No. Pharmacist & Accountant) not having copies deduct 1 -List of equipment needs not available deduct 1 12 VIII. *Health Learning Materials Req.5 b Quarterly Financial Analysis Equipment Replacement To determine financial viability and monitor budget performance. *Activity. TNA done) VIII.

date last serviced. *Lifespan of the equipment deduct 0.54 SECOND CYCLE PEER REVIEW REPORT. location of equipment. *next service date. *location of equipment. Current status (functional/nonfunctional/obsolete).1 To encourage creativity and local initiative Mark for Innovation Any Institution should be able to solve local problems using appropriate local technology. Implemented) PPM Schedule available.6 b Maintenance culture is a big problem in our institutions. Everything has to be done to ensure that equipment and buildings are maintained Planned Preventive Maintenance Schedule of Equipment and Building (Prop. If it does not include *Current status(functional/nonfunctional. date of procurement. next service date. Of implemented -List of equipment to be procured based on prioritization not available deduct 1 -Financial analysis statement on the list not available deduct 1 Policy Financial Analysis Statement (Half Yearly) VIII.5 for each -No action taken to dispose obsolete equipment deduct 1 -% scored on activities undertaken multiplied by 5 gives the score 9 REGIONAL DIRECTOR’S MARK (TO BE AWARDED BY REGIONAL DIRECTOR/REPRESENTATIVES) NO ITEM RATIONALE HOW TO SCORE IDEAL(EXPECTED) SITUATION EXISTING OR ON THE GROUND SITUATION EXPECTED SCORE OVERALL SCORE (after deduction) IX. This must be a bonus for the facility must not be 54 .2011 replaced so as not interrupted service delivery need to replaced) -List of equipment to be procured available (for a year) -Financial analysis statement on the above list -PPM Schedule available (include list of equipment & building. This innovation should be outstanding (as seen by the Regional Health Directorate) 5 for any particular innovation. Lifespan of the equipment) -Actions taken to dispose obsolete equipment -Prop. *date last serviced. obsolete) *date of procurement.

2 *Timeliness *Ushering *Arrangement of the conference area *Participation of the General staff (questioning. poor This must be *Participation of the General staff a bonus for (questioning. seeking clarification) the facility *Inability to ensure the other stakeholders must not be are present part of the denominator but the numerator IX.2011 part of the denominator but the numerator *Staff not on time 10 for any *Ushering poor particular *Arrangement of the conference area innovation.55 SECOND CYCLE PEER REVIEW REPORT. seeking clarification) Mark for Organization of the Peer Review 55 .

56 SECOND CYCLE PEER REVIEW REPORT.2011 56 .

57 SECOND CYCLE PEER REVIEW REPORT.2011 CORE VALUES  Client Centred Service  Staff Centred Service  Professionalism  Teamwork  Innovation/Excellence  Discipline  Integrity 57 .