Dr. Ziaul Matin, UNICEF
Dr. Ziaul Matin, UNICEF
Dr. Ziaul Matin, UNICEF
Outline
Background of Quality Improvement Initiative
Different QI approaches for MNCH services
5S-CQI-TQM Approach for QI
Applying 5S-CQI-TQM approach for Quality
Improvement of Newborn Care
Findings from 11 hospitals under 5S-CQI-TQM
Challenges and Way forward
Dignity
Basic human needs
Prompt attention for care and treatment
Communication
Confidentiality
4
Policy advocacy
QI Strategic Planning
Resources
Knowledge management on QI
Technical assistance on 5S-CQI-TQM
Capacity building
South-South collaboration
Competency
Based
Training
SBM-R
Regional
Roaming QI
Teams
Step 1: 5 S
Step 2: KAIZEN
Step 3: TQM
MPDR
Joint
Supervisory
Visits
(Supportive
Supervision)
MNCH/FP/N
Clinical services at
facility & community
Work environment
Problem solving
Quality services &
customer satisfaction
TQM Approach
What is 5S?
Sort
Set
Shine
Standardize
Sustain
11
12
Trunk
KAIZEN
Water
LEADERSHIP
Root
14
Formation
of QIT/WITs
Assess situation/
baseline
Develop WIT
Action Plans
and
monitoring
framework
Implement
WIT Action
Plans; track
progress;
Monitoring
by QIT
5S-CQI-TQM
15
5S Activities: Implementation
Support implementation
of 5S activities
Work Improvement
Team
[3 - 5 persons]
Top
management
Implement 5S in respective
work units/dept.
Develop WIT Action Plans
Conduct periodical
monitoring
Reporting to QIT
Quality
Improvement
Team
[5 - 15 persons]
Work Improvement
Team
[3 - 5 persons]
Work Improvement
Team
[3 - 5 persons]
16
District
Hospital
Bandarban,
Coxsbazar,
Kishorganj,
Netrokona
Moulavibazar,
Narail
Tangail
Upazila
Health
complex
Funding
GoJ
Kalia,
Barolekha
DFATD
(MNHI)
UNICEF/
KOICA
18
5S Activities (SORT)
in Coxs Bazar District Hospital
19
BEFORE 2011
AFTER 2014
20
3S: Shining
21
3S: Shining
22
4S: Standardize
23
24
CQI in SCANU
Before
After
25
26
28
Small CQI/KIZEN
29
2012
2011
31
Competency based
training and use of audiovisual tools for skill
development
Paper-based record
keeping and reporting to
Dashboard and individual
case-tracking through
web-based MIS
32
Record Keeping
100%
90%
80%
70%
60%
50%
40%
Maintenace of Equipments
30%
Bandarban DH
Out-patient Department:
Maternal
10%
0%
Chittagoong MCH
Cox's Bazar DH
20%
Human Resource Management
and Leadership
Barlekha UHC
Out-patient Department:
Neonatal
Kalia UHC
Kishoregonj DH
MoulviBazar DH
Mynenshigh MCH
Pharmacy Management
Narail DH
Netrokona DH
Tangail DH
Store Management
Emergency Management
Pathology Management
33
Record Keeping
Maintenace of Equipments
Overall outlook
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Bandarban DH
Barlekha UHC
Out-patient Department:
Maternal
Chittagoong MCH
Cox's Bazar DH
Kalia UHC
Kishoregonj DH
Out-patient Department:
Neonatal
MoulviBazar DH
Mynenshigh MCH
Narail DH
Store Management
Pathology Management
Indoor Management: Neonatal
Pharmacy Management
Netrokona DH
Tangail DH
Emergency Management
Indoor Management: Maternal
34
10000
8000
8007
7178
7560
6000
3785
4000
2947
1541
2000
99
0
MMCH
CMCH
KDH
2013
2140
138
BDH
CDH
2014
35
Measuring KIZEN/CQI
SCANU total admission in 2013 and 2014
30000
30.0
27996
25000
25.0
20000
19772
20.0
15000
15.0
17.2
14.4
10000
10.0
5000
3405
0
Total Admission
4041
Total mortality
2013
5.0
0.0
2013
2014
2014
36
Divisional QI
Committee
QI Assessor team
District/Upazila QI
Committee
QIT/WIT
Lessons Learned
This initiative has demonstrated evidence of changes resulting from the
QI interventions in a small unit of targeted hospitals and documented
those changes and processes for knowledge and evidence generation.
This has facilitated the programme managers to adopt the 5S-CQI-TQM as
a feasible and doable approach for improving the quality of maternal and
newborn care services at Primary/Secondary/Tertiary level hospitals within
the HSS framework..
This has led to useful learnings and strategic directions to the policy
makers and programme managers to further scale-up any Quality
Improvement Initiatives/ in Bangladesh.
Challenges
Poor institutional mechanism and organogram for QI
Inadequate institutional capacity at national and subnational level for QI programme management
Lack of effective coordination, harmonization and
integration among different programmes and
agencies for Quality Improvement (QI)
Operationalize the national strategic framework and
comprehensive Action Plan for QI
Shortage of human resources in number and skills
Inadequate monitoring & supervision system
Poor motivation of service providers for compliance
of clinical standards and protocols
Way Forward
Capacity building of Quality secretariat and Qi committees both at
national and Sub-national levels
Develop a realistic implementation plan with costing based on the
national strategic framework for QI
Bring synergy, harmonisation and effective partnership under
different QI programmes
Scale-up 5S-CQI-TQM sequentially from MNCH to cover whole
hospital services leading to TQM
Develop assessors team at divisional level and conduct periodic
assessment of facilities
Integrate core sets of quality indicators in the DHIS 2 (web-based
HMIS)to monitor the quality of care
Institute comprehensive QI/QA system at all levels of health
facilities leading to formal accreditation and reporting mechanism
After