Quality Healthcare Flashcards
6 dimensions that constitute Quality in Healthcare (WHO & IOM)
1) Safety - Minimise risk & avoid injuries
2) Effective - Healthcare is adherent to an evidence base & results in improved health outcomes, based on need (indication)
3) Patient-centredness - Care is respectful & responsive to pt’s preferences, needs & values
4) Accessible - Ensure timeliness, care provided in the right setting (site)
5) Efficient - Maximise/optimise resource use, avoid waste
6) Equitable - Care that does not vary in quality bc of personal characteristics
Gist of Quality Healthcare
- Meets the needs of pts/community in a timely manner
- Most effective, minimises risk, optimise use of resources
Barriers to Quality Healthcare
1) Rapid changes
- Medical science & tech advanced @ an unprecedented rate
2) Growing complexity of healthcare
3) Change in public health needs (ie. aging population, ppl living with chronic diseases in the community)
4) Healthcare delivery is disorganised
- Complex & uncoordinated (esp at transitions of care), institutions working in silos
What is SG’s healthcare policy
- Ensure quality & affordable basic med services
- Achieve better health for all
- -> Promoting healthy living
- -> Promoting preventive health programmes
- Anchored on indv responsibility
- -> Co-payment, pay for higher lvl of service
Core issues in SG’s healthcare scene & their impacts
1) Rapidly aging society
2) More people with chronic diseases
Impacts:
- Increases out-of-pocket costs
- Increase bed occupancy rates
- Decrease ILTC capacity
Goals of “Beyond Healthcare 2020”
1) Move beyond hospital to community
- So that SGpreans can receive care in the community nearer to home
2) Move beyond quality to value
- Streamlining & integrating care to give every SGprean best value, while keeping system sustainable
- 3 clusters in 2017: Optimise resources & capabilities to provide > comprehensive, integrated & patient-centred care
3) Move beyond healthcare to health
- Help & support SGpreans to lead healthier lives
SG Healthcare’s Financing Approach
- Twin philosophies of indv responsibility + affordable healthcare for all
- Multiple tiers of protection to ensure no SGprean is denied access to basic healthcare needs bc of $ issues
S + 3Ms:
- Subsidies (up to 80% in public healthcare institutions)
- Medisave - To pay for smaller healthcare bills
- Medishield Life - Basic health insurance to help with larger hospital & healthcare bills
- Medifund - Safety net to provide for needy SGpreans
Drug subsidies & schemes
Standard Drug List
- SDL I & II
Medication Assistance Fund (MAF)
- Indication specific
- Means testing (ability to pay)
- Lvl of subsidies vary
Legislative framework for Quality Healthcare
Private hospitals & Medical clinics act
- Mandatory to have quality (assurance) committees
- Empowers MOH officials to inspect premise & ensure compliance
- Mandates monitoring of services & clinical indicators (quality indicators)
Professional registration & conduct
- Licensed healthcare professional
- Empower respective professional Councils & Boards to uphold professional standards
- Empower Councils & Boards to remove those deemed unfit to practice from register
- Mandates CPE for license renewal
Medical products & diseases
- Rigorous regulation of Health Products (ie. HPA)
- Spell out what medical profession can & cannot do in relation to specific situations (ie. Termination of pregnancy act, human organ transplant act)
Non-legislative framework for Quality Healthcare
Evidence-based clinical practice guidelines & practice standards (eg. MOH website)
- ie. MOH set up ACE to drive btr decision-making about clinically & cost-effective patient care
Monitoring patient satisfaction
- Surveys to gather feedback from pts recently discharged frm restructured hospitals, specialty centres, polyclinics
Market-based mechanisms to provide competition & transparency
- Comparison of performance index eg. LOS, Cost of procedures
- Fee benchmarks & bill amount info
Voluntary accreditation for Quality & Safety Standards
(eg. ISO 9000)
List the 5 key thrusts of the National Pharmacy Strategy (NPS)
1) Pharmaceutical care excellence
2) Confident pharmacy workforce
3) Re-design supply chain
4) Information enablement
5) Technology enablement
What does the NPS envisions?
- Necessary medications & services are AFFORDABLE to pts who require them
- Pts/consumers have TIMELY, ACCESSIBLE meds & pharmacy expertise @ each point of care
- Pharmacy services focus on QUALITY by providing health & preventive care within community
- Ensure safe & effective med use
- Delivering integrated care across all settings
[NPS] Pharmaceutical care excellence
- Establish role of pharmacy in community care setting
- Improve drug stewardship in non-acute care settings
- Establish collaborative models of care for med reconcilation
- Implement a clinical governance framework for med management
- Promote pharmacists as part of multidisciplinary healthcare team
[NPS] Confident pharmacy workforce
- Implement advanced practice framework for pharmacists
- Establish pharmacy residency programmes
- Enhance pre-reg pharmacist training programme
- Develop & train pharm technicians
- Build up manpower capabilities for community care setting
- Build capability in collaborative prescribing
[NPS] Re-design supply chain
- Centralise procurement, packaging, compounding & distribution
- Deliver meds where pts need it, where patients need it
[NPS] Information enablement
- Deliver a common platform to stimulate & share clinical, practice-based research & innovation
- Increase consumer & pt access to contextualised health info & edu
- Establish a national drug formulatory
[NPS] Technology enablement
- Standardise drug terminology & code structures for seamless communication & accurate trf of information
- Provide common pharmacy system for harmonised med dispensing & implement a national charging engine to streamline the med-related billing process
- Enhance telepharmacy services
Principles of Quality Improvement
1) Will to improve
2) Ideas about alternatives to status quo
3) Execution to make it real
Model for QI
1) Set an aim (what are we trying to accomplish?)
2) Establish process & outcome measures (how will we know a change is an improvement?)
3i) Identify changes
3ii) Plan-Do-Study-Act
3iii) Implement changes
