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PR3145 > Quality Healthcare > Flashcards

Quality Healthcare Flashcards

1
Q

What are the 6 dimensions of quality healthcare according to the WHO and US institute of medicine?

A
  1. Safety
  2. Effectiveness
  3. Patient-Centeredness
  4. Accessible
  5. Efficiency
  6. Equity
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2
Q

Explain the Safety dimension as part of quality healthcare

A

Minimize risk and avoid injuries

- i.e. avoiding ADRs

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3
Q

What is the challenge in maintaining safety in quality healthcare and how can we overcome this?

A

Addressing the root cause is difficult (safety highlights the system’s nature of healthcare quality)

  • System’s perspective of safety allows us to catch near misses and potential gaps in safety, notice before an adverse event occurs
  • Quality improvement and culture of safety only arises when we use systems thinking
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4
Q

Explain the Effectiveness dimension as part of quality healthcare

A

Provide healthcare that is evidence based to show improved health outcomes

  • For individuals and communities
  • Based on Need (indication)
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5
Q

What are challenges regarding the effectiveness dimension in quality healthcare?

A
  • Not all medical professionals read publications
  • Some MPs start giving the study drug to all pt when the study focused on a small group of pts
  • guidelines can improve effectiveness but affect other dimensions negatively
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6
Q

Explain the Patient - centeredness dimension as part of quality healthcare

A

Provide care that is respectful and responsive to patient preference/needs/values

  • Ensure patient values guide all clinical decisions
  • Consider culture background as well
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7
Q

As a healthcare professional, how can we provide care that is more patient-centered?

A
  • Provide options for pt
  • i.e. quality of life > length of life for terminal cancer pt
  • patient experience is key
  • ends do not justify means if pt experiences excessive pain/alienation
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8
Q

What is the optimal way to report patient centeredness?

A

Subjectively reported measures are often the best way to report pt centeredness

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9
Q

Explain the accessible dimension as part of quality healthcare

A

Timeliness, reduce wait times and harmful delays (Speed)

  • Ensure care provided in the right setting (skills and resources appropriate to medical need)
  • Eliminating barriers to care
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10
Q

How can we evaluate accessibility?

A

Using objective and subjective information (different but equally valuable)

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11
Q

Explain the Efficiency dimension as part of quality healthcare

A

Maximize resource use
- Avoid waste (equipment/supplies/ideas/energy)

*Waste is a driving factor of cost (impt as we have limited resources)

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12
Q

What are some ways we can ensure efficiency?

A

Ask: do expensive procedures = better outcomes? (vs no procedure vs less expensive procedure)

  • OP vs IP procedure
  • tension between safety vs efficiency
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13
Q

Explain the Equity dimension as part of quality healthcare

A

Providing care that does not vary in quality because of personal characteristics
- i.e. gender, ethnicity, geographic location, socioeconomic status

*Note: some differences in care may be beneficial (some medicines are preferred for certain populations)

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14
Q

According to the Eurobarometer 2009 - Patient’s Perspective survey, what was ranked as the top criteria when patients were asked about quality healthcare?

A

Medical staff that are well trained

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15
Q

Which of the 6 dimensions of quality healthcare is the most important?

A

They are all equal

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16
Q

When improving on the 6 dimensions of quality healthcare, how should we do so?

A

Should focus on each of the 6 dimensions individually

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17
Q

What are some strategies to provide patient centered care?

A
  1. Understand pt’s goals and needs
  2. Provide information in relation to goals by asking what the patients want to know
  3. Leaflets summarizing relevant information can help
  4. Provide avenues of contact (for clarification) i.e. phone number
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18
Q

What are some barriers to healthcare?

A
  1. Rapid changes in medical sci and tech
  2. Growing complexity of healthcare
  3. Change in public health needs
  4. Healthcare delivery is disorganized, complex and uncoordinated (esp during transition and institutions working in-silo)
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19
Q

Why are rapid changes in medical science and tech a barrier to healthcare?

A

Tests our ability to translate knowledge into practice and use technology safely and appropriately
- if unable to consistently deliver today’s science and tech –> less prepared to respond to extraordinary advances in the future

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20
Q

Why are Changes in public health needs a barrier to healthcare?

A

DM, HTN, asthma (chronic diseases) are now leading causes of death due to aging population
- but today’s healthcare still too focused on acute episodic care needs (isolated)

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21
Q

According to the institute of medicine (IOM), what are the 10 approaches for redesign on a health system level?

A
  1. Care is based on continuous healing relationships
  2. Care is customized according to patient needs and values (patient-centeredness)
  3. Patient is source of control (patient-centered)
  4. Knowledge is shared and flows freely
  5. Decision-making is evidence based (effectiveness)
  6. Safety is a system priority (safety)
  7. Transparency is necessary
  8. Needs are anticipated
  9. Waste is continuously decreased (efficiency)
  10. Cooperation among clinicians is a priority
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22
Q

What are some ways we can contribute to ensuring that “Care is based on continuous healing relationships” ?

A

Pt should receive care when they need it (in many forms other than face to face visit) -> need to consider online/telephone services

  • single encounter w pharmacist (hard to improve health/compliance)–> dont go for single episode but prefer long term relationship
  • ideal to call pt (after f2f) –> pt more willing to share and adhere to meds (long term rapport is key)
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23
Q

Does the IOM statement 3 “Patient is source of control” mean that all key decision making is deferred to the patient?

A

No.
- we should provide our recommendation and let pt understand why we provided the recommendation (helping pts make decisions)

24
Q

Regarding IOM statement 4 “Knowledge is shared and flows freely”, what are the people involved?

A
  • pt & healthcare providers

- Between healthcare providers

25
Q

How can we ensure IOM statement 5 “Decision-making is evidence based” is achieved?

A

Use best scientific evidence (should not vary illogically from provider to provider)
- guidelines are key

26
Q

What does IOM statement 6 “Safety is a system priority” mean?

A

We need to pay great attention to system in order to mitigate errors

27
Q

What does IOM statement 7 “Transparency is necessary” refer to?

A

Make available information when choosing tx / healthcare institution

  • data on pt satisfaction
  • healthcare system performance on safety
  • evidenced based practice
28
Q

What are the 3 levels of care in SG?

A
  1. Primary; Polyclinics/GP clinics
  2. Secondary and Tertiary care (Acute care): Restructured hospitals and national specialty centres + Private hospitals
  3. Step down (Intermediate care): Community hospitals (govt and VWO-owned)
  4. Long term Care: nursing homes, day care (run by VWO)

For primary care: 20% polyclinic
80% private

For intermediate and long-term care: more private owned

29
Q

What are the 3 key parts of SG’s healthcare philosophy?

A
  1. Individual responsibility: Co-payment, pay more for higher level of service
  2. Ensure quality & affordable basic med services for all at public hosp & clinics
  3. Achieve better health for all: Preventive health programmes and promote healthy living
30
Q

What are key challenges (2 core issues) to SG’s healthcare?

These core issues drives 3 pain points which are:

  1. Increased ________ cost
  2. Increased _____ occupancy
  3. decreased _______ (ILTC) capacity
A
  1. Aging population
  2. Increasing chronic disease burden
  3. Smaller workforce (not part of core issues)
  4. out of pocket
  5. bed
  6. intermediate and long term care
31
Q

What are some strategies in SG to combat the challenges to healthcare? (3 strategies)

A

(From 2016) 1. Move beyond hospital to community

  • cheaper care (less complex care)
  • higher satisfaction
    2. Move beyond quality to value
  • make good use of reduced resources
    3. Move beyond healthcare to health
  • healthier population = less healthcare burden
  • 65 is the new 45

Expand healthcare workforce, healthcare infrastructure (in 2012)

32
Q

What are the 3 Healthcare clusters in SG and why were they re-organized from 6 original clusters?

A

NUHS (West), NHG (North), Singhealth (Central, East)

  • Better optimize resources and capabilities
  • Provide more comprehensive, integrated patient-centered care
33
Q

How does SG healthcare financing work?

A
  1. Co-payment
  2. Subsidies (with means testing i.e. CHAS)
  3. Medisave/Medishield/Medifund
34
Q

What are the 2 key drug subsidy schemes in SG?

A

Standard drug list (SDL) 1 and 2

Medication Assistance Fund (MAF)

35
Q

What is the SDL1?

A
  • very essential drugs (1st line therapy in guidelines)
  • available for a long time
  • found to be very useful
  • highest level of subsidy –> pay about 1.40 for 1 week’s supply regardless of dose and no. of tablets (i.e. atenolol)

*Note: SDLs commonly used and shown to be cost effective –> no requirement for clinical condition (expect healthcare professional to give appropriately)

36
Q

What is the SDL2?

A
  • newer on market
  • more expensive
  • usually SDL 1 alternatives
  • lower subsidy than SDL 1
  • about 50% subsidy (off private cost)

*Note: SDLs commonly used and shown to be cost effective –> no requirement for clinical condition (expect healthcare professional to give appropriately)

37
Q

What is the MAF?

A
  • newer and more expensive drugs used for certain conditions
  • less clinical use
  • indication specified
  • pt must be subsidized pt + drug in MAF + condition fulfills MOH condition
38
Q

What is the SG legislative framework for Quality?

A
  1. Private Hospitals and Medical Clinics Act*
  2. Professional Registration and Conduct
  3. Medical Procedures, Products and Diseases Regulations

*to be replaced by Healthcare Institution Act

39
Q

What does the Private Hospitals and Medical Clinics Act include?

A
  • Mandatory Quality Assurance (QA) committees
  • Empowers MOH officials to inspect and ensure compliance
  • Mandates monitoring of services and clinical indicators (quality indicator)
40
Q

What are the services and clinical indicators monitored under the Private Hospitals and Medical Clinics Act?

A
  • Waiting time
  • Inpatient(IP) mortality
  • Unscheduled return to Operating Theatre
  • Unscheduled admission within 15 days
  • Unscheduled admission following ambulatory procedure
  • IP admission following unscheduled return to A and E
  • Device utilization and device associated infection in ICU
  • Review of mortalities and morbidities (MM)
  • Serious reportable events (SRE)
41
Q

What does Professional Registration and Conduct mean in the SG context?

A
  • Licensing of HPs
  • Empower professional councils/boards to uphold professional standards, investigate misconduct and remove unfit HPs from register
  • Mandates continuing education (CE) for license renewal (i.e. 50 CE points/2 years)
42
Q

What are some of the Medical Procedures, Products and Diseases Regulations in SG?

A
  • Health products Act
  • Termination of Pregnancy Act
  • Infectious disease act
  • Human organ transplant Act
43
Q

What are the NON-legislative framework for quality in SG?

A
  • Evidence based guidelines (ACE) and sharing of best practices from root cause analysis of SREs (MOH)
  • Monitoring patient satisfaction (annual, in restructured hospitals, specialty centers and polyclinics)
  • Market-based mechanisms to promote competition and transparency (i.e. drug comparison using PSS; fee benchmarks)
  • Voluntary accreditation for quality and safety standards (i.e. JCI, ISO14001, OHSAS 18001, SS577:2012)
44
Q

What are the 5 key thrusts of the National Pharmacy Strategy (NPS)?

A
  1. Pharmaceutical Care Excellence
  2. Confident pharmacy workforce
  3. Re-design supply chain
  4. Information enablement
  5. Technology enablement
45
Q

What are the 5 strategies to develop Pharmaceutical Care Excellence under the NPS?

A
  • Establish role of pharmacy in community setting (improve community accessibility)
  • Improve drug stewardship in non-acute care setting (interventions from community pharmacy)
  • Establish collaborative models of care for med recon
  • Implement clinical governance framework for med management
  • Promote Pharmacists as part of multidisciplinary healthcare team
46
Q

What are the 6 strategies to develop a Confident pharmacy workforce under the NPS?

A
  • Implement Advanced practice framework for pharmacists
  • Establish pharmacy residency programs (specialization)
  • Enhance pre-reg training (holistic experiential learning)
  • Develop and train pharmacy technicians
  • Build up manpower capabilities for community care setting
  • Build capability in collaborative prescribing (pcist as part of multidisciplinary care)
47
Q

What are the 2 strategies to Re-design supply chain under the NPS?

A
  • Centralize procurement, packaging, compounding and distribution (improved efficiency)
  • Deliver medications when/WHERE pts need it (timely access)
48
Q

What are the 3 strategies for Information enablement under the NPS?

A
  • Deliver a common platform to stimulate and share clinical based research and innovation (improve communication)
  • Increase consumer/pt access to contextualized health information and education
  • Establish a National Drug Formulary (NDF)
49
Q

What are the 3 strategies for Technology enablement under the NPS?

A
  • Standardize drug terminology and code structures for seamless communication and accurate transfer of information
  • Provide a common pharmacy system for harmonized dispensing and implement a national charging engine to streamline medication-related billing process (efficiency)
  • Enhance telepharmacy services (access)
50
Q

What is the quality improvement mindset (Institute for Healthcare Improvement)?

A
  1. Will (Must have the will to improve)
  2. Ideas (Must have ideas about alternatives to the status quo)
  3. Execution

*Changing the system

51
Q

What is the 5 step quality improvement model for change and learning (Institute for Medical Improvement)?

A
  1. Set an aim (how good and by when)
  2. Establish Process and Outcome measures (allow measurement of improvement)
  3. Identify changes (ideas that help achieve aim)
  4. Test changes using PDSA (Plan-Do-Study-Act) in pilot
  5. Implement changes (after multiple pilots)
52
Q

Example of setting an aim under the QI model (IMI)?

*E.g. getting pts discharged by 11am

A
  • In 90 days

- 90% pts listed for discharge to be discharged by 11am on discharge day

53
Q

Example of Process and Outcome measures under the QI model (IMI)?

A
  • How many pts discharged daily
  • Time from decision to placing in orders
  • Time to inform pt/caregivers
  • Time of medication
54
Q

Example of identifying changes under the QI model (IMI)?

A
  • Timely and clear communication with all stakeholders
55
Q

Example of PDSA under the QI model (IMI)?

A
  1. Plan - develop new discharge planning form (checklist for discharge)
  2. Do (test form and task flow on pilot)
  3. Study (get feedback, look at outcome measures, results)
  4. Act (make changes if necessary, start new PDSA cycle with changes)

PR3145 (10 decks)

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