Quality Healthcare Flashcards
Healthcare
The maintenance or improvement of health via the diagnosis, treatment & prevention of disease, illness, injury & other physical & mental impairments in human beings
Quality of care
The degree to which health services increase the likelihood of desired health outcomes
6 dimensions of good quality healthcare
- Safety
- Effective
- Patient-centred
- Accessible
- Efficiency
- Equitable
Safety
- minimise risk & avoid injuries to service users from the care that is intended to help them
Effective (3)
- evidence based therapy
- improve health outcomes
- based on the needs of the patient
Patient-centred (2)
- patient preferences, needs & values
- shared decision making
Accessible
- timeliness
Efficiency
- maximise / optimise resource use
- avoid waste
Equitable
- provide care that does not vary in quality
- regardless of personal characteristics
eg gender, ethnicity
Is the provision of quality healthcare easy?
No.
But the public/patients hold the government/provider accountable for the quality of healthcare
Barriers to quality healthcare (4)
- Rapid changes in medical science & technology
- Growing complexity of healthcare
- more to know
- more to do - Change in public health needs
- aging population
- increase chronic diseases - Disorganised healthcare delivery
- complex & uncoordinated
- esp during transition of care & institutions working in silo
Singapore Healthcare Landscape & Delivery (5)
- aka types of healthcare services
- Health Promotion
- individual & community responsiblity
- supported by HPB - Primary Care
eg GP, family medicine clinics & polyclinics - Acute Care
- private hospitals
- restructured hospitals & national centres - Intermediate Care
- community hospitals - Long term Care
- nursing homes
- vanguard health (nursing homes owned by the government)
government owned facilities are mainly acute care (restructured hospitals & national centres)
Singapore Healthcare Philosophy (3)
- Achieve better health for all
- well people
- promote healthy living
- promote preventive health programmes - Ensure quality & affordable basic medical services
- for all
- at public hospitals or clincis - Anchored on individual responsibility
- copayments
- pay more for a higher level of service
In Singapore,
- core issues (2)
- pain points (3)
Core issues (2)
- quickly aging society
- more people with chronic diseases
Pain points (3)
- increase out-of-pocket cost
- increase bed occupancy
- decrease ILTC capacity (Intermediate Long Term Care)
Healthcare 2020 to Beyond Healthcare 2020
Healthcare 2020
- accessibility
- quality
- affordability
Beyond Healthcare 2020
- Move beyond hospitals to community
- Move beyond quality to value
- 3 main clusters (NHG, NUHS & Singhealth) - Move beyond healthcare to health
- promote healthier lives
Healthcare clusters in Singapore
- reorganised from 6 to 3 in 2017
- optimise resources & capabilities
- provide more comprehensive, integrated & patient-centred care
Number of
- general hospitals
- community hospitals
- primary care
General hospitals : 8
Community hospitals : 6
Primary care : 23 (polyclinics)
Singapore Healthcare Financing Approach (2)
What are the various tiers of protection to ensure no Singaporeans are denied access to basic healthcare due to affordability issues (1)
- individual responsibility
- affordable healthcare
- S + 3M
Subsidies
Medisave (personal savings)
Medishield (basic health insurance)
Medifund (safety net)
Subsidised drug list & schemes (3)
Subsidised drug list
- Standard Drug List (SDL)
- Medication Assistance Fund (MAF)
Scheme
1. CHAS
Frameworks for quality healthcare in Singapore (2)
- Legislative framework
2. Non-legislative framework
Legislative framework (3)
- Private Hospitals & Medical Clinic Acts
- ensures quality of healthcare service providers
- ensures compliance to the act - Professional registration & conduct
- licensed HCP
- upholding professional standards
- continue professional education for license renewal (practicing cert) - Medical products, procedures & diseases
- Health Product Act
- what medical profession can & cannot do
- follow recommended guidelines
Non-legislative framework (4)
- Evidence-based clinical practice guidelines & practice standards
- ACE on cost effective patient care - Monitoring patient satisfaction
- national survey - Market-based mechanisms to promote competition & transparency
- fee benchmarks & bill amount information - Voluntary accreditation for quality & safety standards
eg Joint Commission International
The National Pharmacy Strategy (NPS)
A transformation programme to make pharmacy services
- accessible & timely
- affordable
- quality focused
- giving patient safer & more integrated care
5 key thrusts of NPS
- Pharmaceutical Care Excellence
- Confident Pharmacy Workforce
- Re-design Supply Chain
- Information Enablement
- Technology Enablement
Pharmaceutical Care Excellence (5)
- establish the role of pharmacy in the community care setting
- improve drug stewardship in non-acute care setting
- establish collaborative models of care for medication reconciliation
- implement a clinical governance framework for medication management
- promote pharmacists as part of the mutli-disciplinary healthcare team
Confident Pharmacy Workforce (6)
- implement advanced practice framework for pharmacists
- establish pharmacy residency programmes
- enhance pre-reg training
- develop & train pharm technicians
- build up manpower capabilities for community care setting
- build capability in collaborative prescribing
Re-design Supply Chain
- centralise procurement, packaging, compounding & distribution
- deliver medications when patient need it (timely & accessibility)
Information Enablement (3)
- common platform to stimulate & share clinical-based research & innovation
- increase consumer & patient access to contextualised health information & education
- establish a National Drug Formulary (NDF)
Technology Enablement (3)
- standardise drug terminology & code structures (seamless & accurate transfer of information)
- common pharmacy system for harmonised medication dispensing
- enhance telepharmacy services
Why should we care about quality improvement?
- its about improving health & disease conditions of our patients
- an attitude we have & want our patients to have
- to make healthcare better
Quality Improvement Mindset (3)
- Will
- must have the will to improve - Ideas
- ideas alternatives to the status quo - Execution
Model for Quality Improvement Steps (5)
- Set an aim
- Establish process & outcome measures
- Identify changes
- Test changes using PDSA cycle
- pilot tests - Implement changes
PDSA cycle
- Plan
- Do
- Study
- get feedback
- study current plan - Act
Phenomenon in Singapore’s population (5)
- Declining population
- Low birth rates
- Smaller ratio of old age support
- Higher life expectancy
- Higher healthcare expenditure
