Quality improvement tools

Supervised by: Dr. Nagwa Abou el enein

Prepared by:
Sabreen elsaka amera elaraby Ekramy sief

Safa Thaki

(x) unit is a rural unit in ElBehera. It was opened10 years ago in a rural area with low coverage of health care services At the beginning of the operation of the unit, the staff was formed of3 doctors,9 nurses and two laboratory technicians. The unit building contains 6 rooms (apart form the administrative and service area): 1 outpatient clinic (for general practitioners) 1 emergency room 1 MCH clinic 1 laboratory room 1 Family planning clinic 1 filing room

now, the staff number falls to one physicians,4 nurses and one laboratory technician

Patients and staff Complaining about shortage of Clinic supplies ( tongue depressors / antiseptics / syringes etc Drugs Laboratory supplies no maintenance to building which lead to Bad plumbing and electricity services

By gathering information through questionnaire, from registers, monthly outcome indicators and number of customer on monthly basis and making comparison between the collected data in different months and comparison of it with previous year it was found that the attendance of patients or customers is decreased, opening of new file decreased and follow up of the diabetic patient and hypertensive patients is also decreased.

The staff monthly rewards are affected by the percentage of attendance as the reward avoided or decreased the health team frustration increases and this leads to increase of absenteeism, increase turn over, shortage in the staff in a another hand one. Moreover there is a shortage in supplies, drugs lading to patient's dissatisfaction and indirectly leading to increasing waiting time, staff dissatisfaction. Also there is no wide area for waiting, insufficient devices,

present rate rate of the same months last years referral rate 25% 8%

Out patient Number

200pt

600pt

By analyzing the collected data the quality team pinpoints five problems:
1-Decrease the attendance of patient 2-Shortage in staff. 3- long Waiting time to enter to physician. 4-Patient dissatisfaction. 5-Family files not reacted.

The quality team tries to start with most important problem by making prioritization matrix

problem

Freq. of problem

Ability to Impact of improve change

Import problem

Total score

rank

Decrease of patient attendance Shortage in Staff

Waiting time Family files not reacted Pt dissatisfaction

1-10 10

1-10 10

1-10 10

1-10 10

40

10 10 9

10 10 10

10 7 4

10 10 10

40 37 33

1 3 4

10

10

10

38

According to matrix problem (1) has the highest score & rank (1) therefore this is the one we start with

Problem Definition

Declining patient numbers in the outpatient clinic in (x) unit to 60% of the previous recorded rates which resulted in :

1-Loss of the main objective of the unit which is providing good quality health services near to the community in this area. 2-Loss of image 3-Loss of income 4-Low staff morals 5-Increased doctors turnover 6-staff monthly reward decreased

(Q.t )analyzed the root cause by using brain storming of ideas about the causes of decreasing customers attendance
-quality coordinator choose the group who will participate [physicians ;nurses; technicians; administrative workers] -quality coordinator send invites by telephone telling the group who will participate the time and the place and how long the session will last

the causes of decreasing the attendance of the the customers

1-decrease in drugs 2-decrease in supplies 3- staff absentism 4-the staff not skillful 5-the staff not concern with the pt 6-physicion delay every day 7-quick examination 8-increase waiting time 10-shortage in the staff 11-no controlling from administration

12-increase cost 13-administration not participate to solve problems 14-increase staff turn over 15- Poor communication (doc/lab, doc/adm)

After define causes of problem through Brianstroming ( q.t) start to organize large Number of causes in affinities

affinities
Staff problems 1-Bad communication 2-Absenteeism 3-Not concerning with patient 4-No Health education 5-Quick Examination 6-Delaying every day 7-Not skillful

System problems 1-Increase of cost 2-Family files opening expensive to the patient 4- increase Waiting time

Unit problems 1-Not accessible 2-Very bad toilet 3-Bad lighting 4-Narrow examination room 5-Ultra sound not present 6-Narrow and uncomfortable waiting place

Administrative problems 1-No controlling 2-Supplies drug not available 3-No support to solve problems 4-No training program

Administrative

Staff problems Absenteeism Delaying Quick Examination Not concern with pt Quick Examination Decrease of patient attendance

No training No controlling Shortage in supplies

. Increase of cost

Not accessible Waiting time increase

Very bad toiletAbsence of ultrasound Bad lighting Narrow examination room

System problems

Unit Problems

TABLE show reasons of problem after analyzing 100 Questionnaires, opinion sheet

reasons

frequency Percent

Cumulative Line

administrative 40
staff unit system 20 30 10

40%
20% 30% 10%

40
60 90 100

pareto chart
100.00

Pareto Rule: 80/20

100%

80.00

80%

Frequency

60.00

Clinic

60%

Percent

40.00

40%

20.00

40.00 30.00 20.00

turnover

20%

10.00 0.00 administrative Unit Staff System 0%

Causes