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PAKAR PERUNDING PERUBATAN KELUARGA
What is QUALITY?
Means Different Things
To Different People
What is Quality?
Invisible when Good
Impossible to Ignore when Bad
Quality assurance
KKM Definition
Securing optimum achievable result
for each patient,
avoidance of iatrogenic complications
and giving attention
to the patient
and family needs
in a manner
that is cost effective
and reasonably documented
Adapted from Thomson
ABNA concept
Ideal
100
Optimum
75
50
ABNA
Actual
means
ABNA
difference between OA &
25
0
present level
QA aims at narrowing or
eliminating the gap
QUALITY ASSURANCE
is equal to
Problem
identification
Problem
Prioritisation
Re-evaluation
of the Problem
Implementation of
Remedial Actions
Quality
Assurance
Cycle
Problem
Analysis
Quality
Assurance
Study
Identification
of Remedial
Actions
Evaluation
Verification of the
problem
Problem
identification
Problem
Prioritisation
Re-evaluation
of the Problem
Implementation of
Remedial Actions
Quality
Assurance
Cycle
Problem
Analysis
Quality
Assurance
Study
Identification
of Remedial
Actions
Evaluation
Problem identification
It is problem or perception
1.
1.
2.
3.
1.
SMART
28
December
2014
Methodology of QA Study
1. Problem / Opportunity Statement
A complete opportunity/ problem statement should
describe :
* the problem or area of concern and its
significance for the quality of care
* possible causes and contributory factors
* rationale of the study
* scope of the study
* intention to use the results to improve the
quality of care
Quality Problem
Related to
Customer Satisfaction
Cost Savings
Increase Efficiency
Reduce Discomforts
11
28
December
2014
2014
6000
4912
5013
108(2.7%)
127(2.6%)
145(2.9%)
2006
3916
2007
4912
2008
5013
108
127
145
3916
JUMLAH PESAKIT
5000
4000
3000
2000
1000
0
Kes DM Type II
Diabetic f oot Ulcer
TAHUN
Problem
identification
Problem
Prioritisation
Re-evaluation
of the Problem
Implementation of
Remedial Actions
Quality
Assurance
Cycle
nominal
Group
Technique
Problem
Analysis
Quality
Assurance
Study
Identification
of Remedial
Actions
Evaluation
THE GROUP
Common interest ----> quality improvement
NUMBER : 7 - 12
< 7 : Inadequate expertise
>12 : Too many
Unsatisfactory group dynamics
Few loud-mouth, many nodders & sleepers
15
28
December
2014
NGT steps
Silent generation phase:
individual think about ideas
free from comment and interference
Round robin phase:
one-by-one responses
list exact phrases and displayed
no discussion except clarification
16
28
December
2014
NGT steps
( cont)
Clarification phase :
Voting phase:
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28
December
2014
Permanent disability ?
Complication? Pain?
Costly?
Causing distress to patient?
Impact on patient, community &
hospitals image
Impact on cost & resources
Frequent occurrence though not serious
Big room for improvement
Large ABNA
18
28
December
2014
28
December
2014
Timeliness / Timed
no current operational, financial or political
issues which might affect the success of
project
Social, political, ethically acceptable
Does not take very long to remedy
28 December 2014
20
Problem
identification
Problem
Prioritisation
Implementation of
Remedial Actions
Quality
Assurance
Cycle
Problem
Analysis
Quality
Assurance
Study
Identification
of Remedial
Actions
Evaluation
Cause-effect
Re-evaluation
of the Problem
Problem
statement
2014
Problem Analysis
To analyse the problem and the factors influencing
it
(a) 4W1H What, Where, When,Who are
involved and How it happened
Cause-Effect Analysis
( In QA we use the bubble chart )
List down all possible causes first
Look at the main causes , then put in as 1st
generation bubble
Bubble chart
Secondary causes
Secondary causes
Primary causes
Primary causes
Primary causes
Secondary causes
Memberi
pendidikan kesihatan
kepada ibu OA
MENINGKATKAN PENGETAHUAN
TENTANG KEPENTINGAN
AMALAN PERANCANG KELUARGA
Meningkatkan
kefahaman mengenai
kepentingan perancang
keluarga
Melibatkan
orang berpengaruh
seperti bomoh,
Tok Batin
dan JHEOA
Menggunakan
flip chart bergambar yang
jelas dan menarik
MENINGKATKAN AMALAN
PERANCANG KELUARGA
DI KALANGAN IBU OA
DI DAERAH PEKAN
MENINGKATKAN
PENERIMAAN IBU
TERHADAP AMALAN
PERANCANG KELUARGA
Penggunaan
kaedah perancang
keluarga yang
sesuai
27
Memberi motivasi
kepada ibu, suami dan
keluarga terdekat tentang
kepentingan perancang
keluarga
Tingkatkan
perkhidmatan
klinik bergerak
Memberi
latihan berterusan
kepada anggota
kesihatan
MENINGKATKAN
PERKHIDMATAN
PERANCANG KELUARGA
Pengesanan
awal kes-kes cicir &
lawatan ke rumah
dijalankan
Penyelianan dan
pemantauan
yang berterusan
standards
Standard is the line that differentiates the good from the bad.
- Acceptable lowest limit
The standard is to :
i) verify problem exist (First level)
Ii) show factors identified are responsible for the
problems (Second Level)
Problem: Long waiting time in OPD
1st Level standard : within 60 mts. from registration and
seeing doctor,
2nd Level : 75%f the patient should <60 mts. waiting time
standards setting
Setting too high a standard may make the problem
Process of care
Flowchart / pathway of care the steps of
activities while delivering a particular care.
No
Uncontrolled
Out patient Tx
Yes
Admit to ward
Pt seen by HO
Pt seen by MO/Pakar
Education
No
Ix
BP optimally
controlled
Rx
Yes
Disc.
F/U
What is MOGC
MOGC is the process involves for specific health care
Standards of MOGC
For each criteria, a standard s set
Setting of standards is a percentage of fulfillment of
criteria
If the criterion is related to a vital indicator, the
standard is 100%
MOGC
Step
1
Process of care
Criteria
Standard
Admit :BP>160/100
mm Hg
(CPG 1998)
90%
Diagnosis of HPT
(Uncontrolled/For
stabilization)
100%
Pt reviewed by MO
4
Specialist
100%
100%
No.
1.
Process
Registration
*2.
Address
Time of registration
Educational status
History Taking
LMP
Age
Parity
Family History
Past Obstetric History
History
Conduct / TBA
PE
IUGR
LSCS
Past gynae history
Past medical history
Symptoms of
eclampsia
Criteria
< 12 / 52
Standard
90 %
1x/
pregnancy
100 %
(During
booking)
Every ANC
visit
Every Home
visit
Problem
identification
Problem
Prioritisation
Re-evaluation
of the Problem
Implementation of
Remedial Actions
Quality
Assurance
Cycle
Problem
Analysis
Quality
Assurance
Study
Identification
of Remedial
Actions
Evaluation
To know
magnitude of
problem & to
prove the
cause-effect
QA STUDY
A planned and systematic collection of data using
Methodology of QA Study
1 Objectives: General & Specific
2 Type of study
3 Terms ( key words ) definition
4 Inclusion & Exclusion criteria
5 Proposed Indicator and Standard
6 Plan for data collection ( + proposed
formats )
7 Plan for data analysis ( + proposed
dummy tables )
8 Gantts chart
9 References
2. Literature review
will help us in;
clarify our problem
state the study objectives
know what has happen elsewhere
check the implicit standards
set explicit criteria and standards
suggest suitable study methods
find appropriate remedial actions
avoid duplication of works
To determine
To verify
To calculate
- To compare
- To establish
- To describe
2.
3.
4.
Variables
A characteristic of a person, object or
phenomenon that is measureable and can
take on different values
variable
Height
Sex
Knowledge
Socioeconomic status
value
tall , short
male , female
Good, poor
High, middle, low
income group
Type of Study
PAST
NOW
FUTURE
RETROSPECTIVE
CROSS-SECTIONAL
PROSPECTIVE
Looks at development of
a condition over time
Descriptive study;
Analytical study;
Experimental study
is always prospective
Sampling
Sampling method
1. Non-probablility
-
2. Probability sampling
storing
Data processing
Data analysis
GANTTs CHART
Tugas
T/jawab
Taklimat
Ahli kumpulan
Surat arahan
Ketua Jabatan
Sediakan format
pengumpulan
data
Ahli kumpulan
Pengumpulan
data
Ahli kumpulan
Analisa data
Ahli kumpulan
Perlaksanaan
Ahli kumpulan
Penilaian
Ahli kumpulan
Sediakan laporan
Ketua kumpulan
Jul
03
Ogos
03
Sept
03
Okt
03
Nov
03
Dis
03
Jan
04
Feb
04
plan
1
1
1
actual
9. References
List down all references quoted or
References
1. Clinical Practice Guidelines on The Management of
HPT ( Academy of Medicine; 2002 )
2. Standard Operating Procedure for MA ( Ministry of
Health; 2000 )
3. King H. Revers M. Diabetes in adults is now a third
choosing indicator
Reflects the QUALITY of service that is measured ( proxy )
Can be assessed objectively using certain CRITERIA
Can differentiate between the ones with quality from those
without
Should directly address the problem
Usually expressed in the form of rates (%) (rate based)
variables
IN SIMPLE TERMS ARE MEASURABLE DATA
A VARIABLE is a characteristic of a person, object or
data collected
STANDARD
(*)
and poor
widely / professionally accepted value
Error of ommision
Error of commission
FAKTOR / KRITERIA
2001
2002 (*)
1.
36.7%
71.4%
2.
60.0%
92.2%
3.
78.3%
92.2%
4.
48.3%
93.5%
LANGKAH-LANGKAH PENAMBAHBAIKAN
Bil
Isu/ masalah
1.
Pendaftaran
antenatal <12/52
yang rendah
a. JM & S/N
b.S/Kesihatan.
P. Penasihat
c. JM/SN
2.
Penggunaan
senarai semak
yang tidak lengkap
a. KJK/JKU
a. FMS/MHO/
KJK
b. SN/JM
c. SN/JM
3.
Pengendalian kes
a. Perawatan &
pencegahan
anaemia
Aktiviti
Staf b/jawab
b. KJK/ SN
5
4
3.95
ABNA
sebelum
3
2
Peratus anemia
pada 36/52 POA
ABNA
selepas
1.7
1
0
2001
2002
std
Study Criteria
Inclusion criteria:
Specific conditions or characteristics that are applied
Exclusion criteria:
The certain characteristic of the samples that to be
GANTTs CHART
Tugas
T/jawab
Taklimat
Ahli kumpulan
Surat arahan
Ketua Jabatan
Sediakan format
pengumpulan
data
Ahli kumpulan
Pengumpulan
data
Ahli kumpulan
Analisa data
Ahli kumpulan
Perlaksanaan
Ahli kumpulan
Penilaian
Ahli kumpulan
Sediakan laporan
Ketua kumpulan
Jul
03
Ogos
03
Sept
03
Okt
03
Nov
03
Dis
03
Jan
04
Feb
04
plan
1
1
actual
9. References
List down all references quoted or
Problem
identification
Problem
Prioritisation
Re-evaluation
of the Problem
Implementation of
Remedial Actions
Quality
Assurance
Cycle
Problem
Analysis
Quality
Assurance
Study
Identification
of Remedial
Actions
Evaluation
- be practical:
* specific
* realistic
* flexible
* manageable
* cost effective
* timeliness
74
CHANGE
75
76