Quality healthcare

Question 1

What is quality healthcare

Answer 1

1) Meets the needs of patient/community in timely manner
2) Most effective (based on best evidence) & provides the best outcomes
3) Minimize risk
4) Optimal use of resources (cost-effective)

Question 2

6 dimensions of healthcare

Answer 2

1) Safety
- Minimize risks and avoid injuries

2) Effectiveness
- Evidence based
- Results in improved health outcomes, based on need (indication)

3) Patient-centered
- Provide care that is respectful and based on individual patient’s values, preferences & needs
- Take into account culture of patient’s community

4) Efficient
- Optimize use of resources
- Reduce waste

5) Equity
- Same quality of care, regardless of personal characteristics e.g. race, gender

6) Accessible
- Timeliness
- Reduce wait & harmful delays
- Ensure care is in the right setting, where skills & resources are appropriate to medical need

Question 3

Barriers to quality healthcare

Answer 3

1) Rapid changes - growing advances in medical science & technology
2) Growing complexity of healthcare
3) Changing needs
- Aging population, increase in chronic disease
4) Healthcare system is disorganized, complex, uncoordinated
- Especially at transition of care, institutes working in silos

Question 4

IOM 10 Approaches for redesign at health system level

Answer 4

1) Care is based on continuous healing relationships
- Patient receives care when needed, in any form (e.g. telepharmacy)

2) Customized to patient’s values & needs

3) Patient is source of control
- Provide patient with information & opportunity to exercise degree of control over healthcare decisions
- System should accommodate difference in patient preference & encourage shared decision making

4) Knowledge is shared, information flows freely
- Between HCP-patient, HCP-HCP
- Patient should have access to own medical information & clinical knowledge

5) Waste continuously reduced
6) Decision making is evidence based
7) Safety is a system property

8) Transparency
- Provide patient with information needed to make informed decisions

9) Cooperation among clinicians & institutions is a priority
- Actively collaborate & communicate to ensure exchange of information & coordination of care

10) Needs are anticipated

Question 5

Healthcare transformation in SG

Answer 5

Healthcare 2020

• Accessibility (e.g. expanding capacity)
• Quality (good quality)
• Affordability

Beyond Healthcare 2020

• Hospital to community
• Quality to value (efficacy
• Healthcare to health (healthy living)

Question 6

Clusters in SG

Answer 6

From 6 to 3: SingHealth, NHG, NUHS

• Optimize resources & capabilities
• Provide more comprehensive, integrated & patient-centered care

Question 7

Healthcare financing in SG - Philosophies

Answer 7

1) Individual responsibility

2) Affordable healthcare for all

Question 8

Healthcare financing in SG - Payment method

Answer 8

Co-payment - Co-pay part of medical expenses via mixed financing system

Question 9

Healthcare financing in SG - Mixed financing system

Answer 9

1) Subsidies
- Up to 80% at public healthcare institutes
- Level of subsidies depends on: Ward class, income, healthcare institution
- CHAS subsidies - Able to receive subsidies at registered GP clinics (Merdeka & Pioneer generation receive further benefits at polyclinic, hospitals, specialist outpatient clinics)

2) Medisave
- From own personal savings
- Used for smaller medical bills

3) Medishield Life
- Basic health insurance
- Used for larger medical bills
- Can pay more for private insurance

4) Medifund
- For needy Singaporeans (safety net)

Question 10

Drug subsidies in SG

Answer 10

Standard drug list (SDL):

1) SDL I
- Essential drugs
- Highest level of subsidy - $1.40 for week’s supply
2) SDL II
- New in market, more expensive, usually alternatives to SDL I drugs
- ~50% of standard price

Medication Assistance Fund (MAF)

• Newer, more expensive drugs
• Subsidies only received when drug used for specific clinical condition/indication

Question 11

Legislative frameworks for quality - Hospitals/Clinics

Answer 11

1) Private Hospitals & Medical Clinic Act
2) Mandatory to have QA committee
3) Empower MOH officials to inspect premises & ensure compliance with minimum standards
- Check for valid reports, workflow, compliance with standards
4) Mandatory monitoring of service and clinical indicators

Question 12

Legislative frameworks for quality - Professional registration & conduct

Answer 12

1) License for HCP
2) Empower professional Councils & boards to uphold professional standards & investigate complaints on professional misconduct
3) Empower professional Councils & boards to remove those deemed unfit for practice from register
4) Mandatory continuing professional education for license renewal

Question 13

Legislative frameworks for quality - Medical products, procedures, diseases

Answer 13

1) Spell out what medical profession can/cannot do in relation to specific conditions
2) Regulation of health products e.g. Health Products Act, Clinical Trial Act
3) Other Acts e.g. Termination of Pregnancy Act, Infectious Disease Act, Human Organ Transplant Act

Question 14

Non-legislative frameworks for quality

Answer 14

1) Introduce evidence-based clinical guidelines & practice standards
- MOH, ACE
2) Monitor patient satisfaction
- Yearly survey
3) Market-based mechanisms to promote competition & transparency
4) Voluntary accreditation for quality & safety standards

Question 15

5 key thrusts in National Pharmacy Strategy

Answer 15

1) Pharmaceutical care excellence
2) Confident pharmacy workforce
3) Redesign supply chain
4) Information enablement
5) Technology enablement

Question 16

5 key thrusts in National Pharmacy Strategy - Pharmaceutical care excellence

Answer 16

1) Establish role of pharmacy in community care setting
- Increase access to trusted pharmacy service in community care setting
- Able to receive guidance & support on preventive health, management of long-term conditions

2) Improve drug stewardship in non-acute care setting
- Medication intervention is coordinated –> safe & effective use of medication to improve patient outcomes

3) Enable collaborative models of care for medication reconciliation
- Empower patients to actively manage their own medication list

4) Establish clinical governance framework for medication management
- Patient-centered, standards-driven, consistent care

5) Promote pharmacist as part of multi-disciplinary healthcare team
- Holistic care delivered by integrated, coordinated teams

Question 17

5 key thrusts in National Pharmacy Strategy - Confident pharmacy workforce

Answer 17

1) Implement Advanced Practice Framework for pharmacists
- Competency framework that defines scope of skill & practice required for development of pharmacy

2) Establish pharmacy residency programmes (specialization)
3) Enhance pre-registration training
4) Develop & train pharmacy technicians
5) Build-up manpower capabilities in community care setting
6) Build capability in collaborative prescribing

Question 18

5 key thrusts in National Pharmacy Strategy - Redesign supply chain

Answer 18

1) Centralise procurement, packaging, compounding & distribution
- Consolidate operating functions to drive efficiencies & economies of scale –> affordable & readily available medications

2) Deliver medications when and where needed
- Timely, convenient access to medications, supported by expertise & advise from pharmacy services

Question 19

5 key thrusts in National Pharmacy Strategy - Information enablement

Answer 19

1) Establish common platform to share research & innovation –> stimulate pharmacy to address challenges in healthcare landscape & transform practice to deliver better standards of care

2) Increase consumer/patient access to contextualised health information & education
- Empower patients to proactively manage their medications

3) Establish National Drug Formulary (NDF)
- Standardised & safe use of medications, supported by best clinical practices

Question 20

5 key thrusts in National Pharmacy Strategy - Technology enablement

Answer 20

1) Standardize drug terminology & code structure –> ensure seamless communication & accurate transfer of information
2) Provide common pharmacy system for harmonised medication dispensing & national charging system to streamline billing process

3) Enhance telepharmacy service
- Convenient, provides care at point of need

Question 21

Model for quality improvement

Answer 21

1) Set aim
2) Establish process & outcome measures
3) Identify changes that will lead to improved outcomes
4) Test changes using PDSA cycle (plan, do, study, act)
5) Implement changes at larger scale