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13th and 14th October 2011

Safety, Standards and Customer Service

….. sharing healthcare best practices

2011 Conference Report

N O 8 M A R I N E R O A D A P A P A L A G O S , N I G E R I A

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..........sharing healthcare best practices

Conference Report The Society for Quality in Healthcare in Nigeria held its 3rd conference at the Royal Tropicana Hotel, 13, Waziri Ibrahim Crescent, off Elsie Femi Pearce, off Adeola Odeku Street, Victoria Island, Lagos on the 13th and 14th of October 2011. The theme for the Conference was Safety, Standards and Customer Service. The conference attracted over 300 attendees from diverse sectors in Nigeria, especially the Healthcare Sector which saw medical practitioners, nurses, researchers, students, government delegates from both Federal and State Ministries of Health as well as members of the society. The conference provided a platform for selected speakers, local and international, to share best practices within their institutions and the opportunity for lively debate on issues relating to healthcare quality. It also provided a library of information and contact persons for those looking to possibly adopt some of the practices show cased. The first day of the conference had 3 scientific sessions with a total of 5 presentations and 3 presentations by representatives of Member hospitals – Shell Producing Development Company and Lagoon Hospitals. The Society is particularly grateful to Dr. Mohammed Ali-‐Pate, the Honorable Minister of State for Health, who sent a representative to give the opening address for the conference in the person of Professor Akin Osibogun and the Executive Secretary, NHIS, Dr. Dogo Mohammed, represented by Dr. Abdulrahman Sambo, who gave the keynote speech on the Importance of Standards in a Demand Driven Health Insurance System. This objective of this year’s conference was to

1. Emphasize the importance of Safety as an essential dimension of quality in healthcare

2. Define structures and processes that must be available to guarantee patient safety 3. Show a link between customer service and the mission, vision goals, and culture of an organization 4. Advocacy and membership drive for the Society for Quality in Healthcare in Nigeria

Welcome remarks were also given by Mrs. Njide Ndili, the Secretary of the Society and member of the conference organizing committee and Prof. E. A. Elebute, the founder and President of the society.

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Conference Programme of activities Thursday, 13th of October 2011

Time Activity Co-coordinator

8:30 – 9:30 am Arrival and Registration of Guests Ms. Ema Oche

Opening Session

9:30 – 9:40 am Introduction of Guests & Update on the Society Mrs. Njide Ndili Secretary SQHN and member Programmes Committee

9:40 – 10:00 am Welcome Remarks Professor Ade Elebute Chairman, SQHN

10:00 – 10:30 am Opening Ceremony & Address Dr. Muhammed Ali-Pate Hon. Minister of State for Health

10:30 – 11:15 am Keynote: Importance of Standards in a Demand Driven Health Insurance System

Mr. Dogo Muhammed mni fss Executive Secretary, NHIS

11.15-11.30am Tea break

11:30 – 12:15 pm The National Health Bill and the impact on the Quality Agenda

Professor Emmanuel Otolorin Country Director, JHPIEGO

12:15 -12.45 pm Quality Improvement at the Shell Hospital, Warri Drs. Mosuro, Akintola & Osakwe Shell Hospital, Warri

12:45 – 1:15 pm Attaining the Gold Standard in Nosocomial Infection Control

Dr. Alexander Dimoko Consultant General Surgeon, Shell I A Hospital, Ogunu, Warri

1:15 – 1:45 pm JCI – The Lagoon Hospitals Journey to Accreditation Dr. Olujimi Coker Lagoon Hospitals

1:45 – 2:45 pm Lunch

2:45 –3:15 pm

The Use of Standard Clinical Core Measures in Comparing Hospital Quality Standards in the United States: A case for

a similar strategy in future health care delivery in Nigeria.

Dr. Olutoyin Abitoye

Virtua Medical Group, USA

3:15 – 3:45 pm Dr House or Dr Welby -‐ where did we miss it? Dr. Christy Okoroma Consultant Cardiologist, Department of Paediatrics, Lagos University Teaching Hospital

3:45 –4:15 pm Questions & Answers

4:15 – 4:45 pm Wrap up Rapporteur

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Keynote Speaker – Mr. MBW Dogo Mohammed, Executive Secretary/CEO from the National Health Insurance Scheme Topic: Importance of Standards in a Demand Driven Health Insurance System

Mr. Dogo-‐Mohammed began his presentation by commending the effort of the Society for Quality In

Healthcare in Nigeria by saying that the theme of this year’s conference (Safety, Standards and Customer Service) is aptly titled, as it a reflection of the reality

that service to the customer is key to the growth and sustainability of health insurance industry in Nigeria.

According to Mr. Dogo-‐Mohammed, standards are not only desirable but also important in the health

insurance system, which is demand driven. The basic function of health insurance can be summarized as provision of access to care with financial risk

protection, within which are 3 core sub-‐components:

• Collection of funds • Pooling of funds • Purchasing of services

All forms of insurance perform these functions, and

since there is no universally acceptable “best practice” mechanism or system, each country adopts a system that fits its socio-‐economic, political and cultural

environment. There is however some deciding factors for achieving successful implementation of social health insurance, and they are:

• Size of the informal sector and labor market

• Socio-‐economic status of the people and level of income

• Health care infrastructure • Design of the insurance scheme (including its

administration, provider payment mechanism,

quality assurance process, and level of solidarity within the society.

• Support by government (to guide and regulate

a process of compulsory health insurance for all)

The NHIS has developed a blueprint for the

implementation of community based Social Health Insurance Programme, which is at the verge of being flagged off in 37 pilot, sites all across Nigeria.

He went on to discuss the challenges encountered in

the implementation of the Programme and how they were overcome. He also stated that although the NHIS started off as the implementing agency of the Formal

Sector Health Insurance Programme, the role has gradually evolved to that of regulation (Protecting consumers and the promotion of public health

objectives of equity, affordability and access to qualitative health services) of the industry in line with the law setting up the organization. The main

stakeholders (HMOs and Healthcare facilities) are taking over the implementation. He stressed that quality of care cannot be measures unless there is

something to measure with, and this is known as standards. Standards are the vehicle by which the general concept and attributes of quality are

translated to actual measurements, and the attainment of standards forms the basis for accreditation of the facility and the determinants of

its quality. These standards address issues of who can sell insurance, who can be covered, what should be covered, how providers of healthcare facilities should

be paid and how the prices can be set.

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Speaker 1 – Professor Emmanuel Otolorin – FRCOG Country Director JHPIEGO-‐ Nigeria Topic: The National Health Bill and its Impact on the Quality Agenda

The presentation was outlined in 3 stages namely:

• Challenges to quality of care in Nigeria • An overview of the National Health Bill • The way forward

He started his presentation by stating that there are many barriers to accessing Health services in Nigeria some of which are:

• overcrowding in hospitals which usually leads to long turn-‐around time, stock out of medical supplies and drugs, dissatisfaction, overworked health workers

• Poor emergency preparedness • Inadequate supervision which results in

medical negligence and increased risks of adverse events.

• Low standards and unsafe practices which are highly prevalent

• Inappropriate waste disposal • Lack of security

He continued by explaining the role of the National Health Bill in Nigeria by explaining the different parts of the Bill. Part I – Part VII of the National Health Bill which range from the responsibility for health and eligibility for health services and establishment of National Health System; Health establishment and technologies; rights and duties of users and healthcare personnel; national health research and information system; human resources for health;

control of use of blood, blood products, tissue and gametes in humans; regulations and miscellaneous provisions; He also went on to identify the partners in the National Health System (NHS) and they are:

1. Federal Ministry of Health (FMOH) 2. State Ministries of Health (SMOH) in the every

State and the Federal Capital Territory (FCT) 3. Parastatals under the federal and state

ministries of health 4. All LGA’s 5. Ward Health Committees (WHCs) 6. Village Health Committees (VHCs) 7. Private Health care providers 8. Traditional and alternative health care

providers He further explained Section 10 which states the establishment of National Primary HealthCare Development Fund, also referred to as “the Fund” which shall be financed from the consolidated fund of the Federation (not less than 2 % of its value), by grants from international donor partners and funds from any other source. The Fund should be disbursed by: facility improvements, Human Resources for Health, essential drugs and Basic minimum package of health services. The following bodies shall be responsible for disbursing the funds:

• National Primary Health Care Development Agency (NPHCDA) shall disburse through State Primary Health Boards for distribution to Local Government Health Authorities

• State Primary Health Care Development Agency (SPHCDA)

• LGHA Professor Otolorin also went through other important sections of the National Health Bill and concluded his presentation by identifying the next steps to be taken with emphasis that the 2015 MDG deadline is very much around the corner. He advocated for the Nations president to sign the National Health Bill immediately to resolve the issues within the health sector.

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Speaker 2 – Dr. Carmen Audera-‐Lopez from WHO Patient Safety Topic: WHO Patient Safety Programme

Dr. Audera-‐Lopez introduced her topic by defining patient safety as the absence of avoidable harm to patients during the process of healthcare, the reduction of risk of unnecessary harm associated with health care to an acceptable minimum. (An acceptable minimum is a collective notion of given current knowledge, available resources and the context through which care was delivered) She identified 2 types of problems:

• Problems related to commission • Problems related to omission

Data shows that every year, tens of millions of patients worldwide suffer disabling injuries or death due to unsafe medical care, and one in 10 patients is harmed while receiving hospital care, usually caused by a range of errors. Dr. Audera-‐Lopez went on to explain adverse events in health care in developed and developing countries using the following as a basis for comparison;

1. Health Care Associated Infections 2. Unsafe surgery 3. Blood safety 4. Injection safety 5. Counterfeit drugs

She went on to quote a statement by Dr. Lucian Leape that human beings make mistakes because the systems and processes they work in are poorly designed. The Swiss Cheese Model was used as an example having 2 sides: Defenses (Risk management plan, Clinical policy, essential equipment, skilled staff)

and the gaps (poor handling of emergency, interventions ill defined, monitoring unavailable, inadequate staff knowledge). 10 domains in order of relevance in developing countries are given as:

1. Health care associated infections (HCAI) 2. Preventable adverse drug events 3. Adverse events in mother and/or baby

related to prenatal, labor and postnatal care period

4. Adverse events due to surgical and anesthetic care

5. Adverse events related to wrong and/or late diagnosis

6. Adverse events related to injection practices 7. Adverse events related to unsafe use of blood

and blood products 8. Adverse events related to medical device use 9. Patients falls and injuries due to falls 10. Pressure ulcers

The following risks to patient safety were also identified

• Poor test follow-‐up • Misdiagnosis • Poor safety culture • Inadequate use of protocols • Organizational/system failures • Poor health system accountability • Poor patient identification • Poor training of healthcare staff • Workload pressures • Stress and fatigue of health care staff

Sir Liam Donaldson, the Former Chief Medical Officer, UK said the Patient safety problem also affects the lives of doctors, nurses and other healthcare staff who become the ‘second victims’ in a chain of events. She further said the mission of patient safety is to coordinate, facilitate and accelerate patient safety improvements around the world. She identified 10 useful strategies for safer care and gave data and statistics to buttress the importance of safe practices in health care.

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The Patient Safety Situation in Africa

• Most countries lack national policies and plans on safe and quality health-‐care practices

• Inappropriate funding of healthcare systems and unavailability of critical support systems, strategies, tools and guidelines

• Weak health care delivery systems, poor management capacity and under-‐equipped health facilities

• Overuse, underuse or misuse of medicines • Lack of adequate infection control within

healthcare facilities • Unsafe surgical care as very few countries use

the safe surgery save lives check-‐list recommended by WHO

• Risk infection from blood borne pathogens for healthcare workers

• Shortage of human resources, low level of staff preparedness and lack of continuing medical education

• Lack of partnership involving patients and civil society in improving patient safety

• Inadequate data on patient safety issues

• Challenge in implementing of blood safety

• Inability to understand patient safety as a new concept, or as a priority when the health systems are faced with other pressing health issues

• Blame culture • Fatality mentality…”things are like this here”

The WHO Patient Safety Programme is proposing the following:

Simple solutions that make a change (hand washing, checklists, protocols, standard procedures, local solutions)

Change in Patient Safety Culture (communication, leadership, learning from errors, commitment)

Integration of patient safety into all aspects of Health care (patient safety as a cross cutting issue)

Integration of patient safety into training curricula of health professionals

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Speaker 3 – Drs. O Mosuro, O. Ohiosimuan, R. Akintola and N. Osakwe from Shell IA Hospital, Ogunu Topic: Quality Improvement at the Shell Hospital, Warri

Dr. Olufemi Mosuro began the presentation by stating the focus of the Shell Health Plan (which is to “protect and preserve the health of staff ensuring a healthy workforce) and the objective-‐ to deliver effective and quality Health strategies and services in order to optimize the health of the stakeholders (employees, dependants, contractors and neighbors). He identified critical success factors

• Quality of staff • Quality of infrastructure and equipment • High quality drugs and consumables • Ready access to quality information, whilst

maintaining confidentiality • Quality of procedures and controls • Timely emergency response capabilities • Visible management commitment and

adequate funding • Good communication processes in place

He went on to give a history of the Shell IA Hospital. Before the year 2000, there were Health and Safety audits, Site and facility inspections, audits and TQM process, external clinical audits every 2 years. By 2005, the UK IHC (SAQ) was used to access the quality of care offered. In 2007, In-‐House quality improvement programs were initiated with the partogram in labour review. In May 2008, Shell IA Hospital enrolled in the COHSASA (ISQua) quality improvement and accreditation program, and by

2010, the Hospital was awarded a Certificate of Accreditation for 27 elements of the Hospital Services. This was possible through the QA/QIP Strategies which include:

• Awareness lectures • Individual tasks and targets for yearly

assessment • Development of a written guideline for

implementation of QA and QI process • Defined roles and responsibilities

(organization chart) • Training in the use of IT tools (excel,

PowerPoint) and PDSA cycle Areas for improvement were identified by

• Gap analysis of status quo against identified goals

• Quality Data collection process • Data analysis and reporting • Audits • Tools and training to use these tools

The benefit derived from using the above processes include:

• Improvement in team work • Better focus on work processes and outcomes

as well as on appropriate skills and competences

• Ownership of hospital processes by the grass root

• Continuous improvement of services and outcomes

• Faster response to quality issues • Externally assures quality of service

Challenges faced in the process include:

• Erratic IT Tool – which encouraged manual data collection

• Inadequate budget for learning and development

• Business continuity challenges

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Speaker 4 – Dr. Alexander Dimoko, Consultant Surgeon from Shell IA Hospital, Ogunu Topic: Attaining the Gold Standard in Nosocomial Infection Control

The objective is to achieve a zero percent Hospital infection rate through the following:

• Hand washing campaign • Theatre procedure guide • Wound care protocols • Hospital antibiotic policy • Increased critical area surveillance • HAP Compliance audits • Collation of data from the wards on surgical infections, pneumonia and UTI on a monthly basis and

calculation of hospital infection rate every quarter. He further explained the policies and protocols available in the Hospital with data. The achieved objectives are:

1. Attainment and maintenance of Nosocomial infection rate of zero 2. Reduced duration of hospital stay 3. Reduced expenditure on dressings, antibiotics and other drugs

He concluded by saying that the control of Nosocomial infections requires an integrated approach driven by a functional infection control unit, and anchored on global best practices. A low rate of Nosocomial infection can be achieved in all hospitals, and cost implications of this effort is usually quite modest. Also, hand washing is the single most important intervention which can be instituted at very little cost.

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Speaker 5 – Dr. Olujimi Coker, Chief of Surgery & Group Clinical Adviser from Lagoon Hospitals Topic: JCI-‐ The Lagoon Hospitals Experience

Dr. Coker began his presentation by explaining the vision and mission of Lagoon Hospitals as well as the I CARE Culture, which the Hospitals had imbibed. He explained Accreditation to be a process where an independent entity assess the health care organization to determine if it meets a set of requirements designed to improve safety and quality of care; voluntary or mandatory; has standards usually regarded as optimal and achievable; has effective quality evaluation and management tools. The Hospital considered 3 types of accreditation

• International Standard Organization (ISO 9000)

• Kings Fund • Joint Commission International (JCI) -‐ which it

eventually went for. He explained that for Lagoon Hospitals, the Road to Accreditation began in 2004 with collaborations from Apollo Hospitals of India, to the decision in 2005 to achieve internationally recognized quality

accreditation, the set up of the Quality improvement department (with trainings, baseline assessment of standards), audit of the hospital facilities, policies and procedures in 2006 as well as mock audit about 6/12 months before accreditation, repeat assessment of JCI Standards in 2007 and structural modification of the hospital as well as organization-‐wide training sessions. In 2008, there were monthly progress reports, upgrade of the hospitals facilities to meet international standards, inclusion of safety features and hand hygiene, staff engagement (regular poster campaigns on group standards, the creation of Dr. J C Isaac, and weekly quizzes on knowledge of JCI Standards with prizes which were featured in the HYNews bi-‐monthly Newsletter for the Hygeia Group). By 2010, we had a JCI Mock survey for over 3 days where it was agreed that the hospitals were ready. The accreditation survey started on the 26th of October 2010 and the preliminary result was out in December 2010 and we had 45 citations out of 1033 standards. By April 19th and 20th, 2011, we had passed all standards and gotten the JCI Accreditation. There were major challenges along the way such as:

• Team work and enhanced communication • Development and adherence to standard

operating procedures • Delivery of care as an integrated team • Transition from a “physician-‐centered” care to

a “patient-‐centered” care • Acceptance of the idea of continuous

performance evaluation

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Speaker 6 – Dr. Olutoyin Abitoye from Virtua Medical Group Topic: The Use of Standardized Clinical Core Measures in Comparing Hospital Standards in the United States: A case for a similar strategy in future health delivery in Nigeria

Dr. Abitoye identified the objectives of the study as: • Introduce the methods of using core measures to compare quality of health care US hospitals provide

• Have knowledge of certain basic clinical, hospital practice requirements referred to as the standards of care in US hospitals

• Understand the advantages of adopting process of care measures that can be used to compare hospital quality

• Understand the need for Nigeria to have a body similar to the Joint Commission or the Agency for Healthcare Research and Quality (AHRQ) in the US or the National Institute of Health and Clinical Excellence (NICE) in the UK

He explained Core measures to be quality measures hospitals report to for Medicare and Medicaid services to compare hospital quality standards in the US with the goal of improving healthcare quality. Core measures are also used to report how often patients with specific conditions receive care that are scientifically proven and evidence based. He also explained quality in healthcare to be the degree to which health services for individuals increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Dr. Abitoye moved on by giving the Core Measure Sets (Acute Myocardial Infarction, Heart Failure, Pneumonia, Surgical Care, Children’s Asthma Care, Venous Thromboembolism, stroke), which he backed up with statistics and data, obtained from

medical records and transmitted to CMS and Joint Commission. Benefits of core measures in comparing hospital quality • Increasing the drive by hospitals to improve quality

in healthcare • Improving health outcomes • Improving adherence to medical practice based on

standard of care and evidence-‐based medicine. • Stimulating improvements of internal process

mechanisms of hospitals • Serves as a means of constantly educating

healthcare providers on standards of care and evidence-‐based medicine

• Reduces costs of healthcare The disadvantages • Gaming: when hospitals invent methods to

circumvent care processes to achieve high scores • Focus of care on assessed conditions alone thereby

reducing the attention on other disease conditions • Cream skimming: when hospitals invent ways of

not admitting sick patients that can potentially reduce their scores.

Adopting the Process in Nigeria This can be done if the following are put in place: • The establishment of a national body similar to the

Joint Commission that can accredit and certify all hospitals in Nigeria

• A tertiary hospitals commission that can focus on tertiary hospitals alone

• The public display of names of certified hospitals in a national registry.

• Institutions will be subject to audits by the body with sanctions /severe fines to fraudulent hospitals

• Constant involvement of all stakeholders (general public, healthcare providers, patients and the government)

• Constant communication of the goal of the program to improve quality in health care

• Periodic assessment of the program and its revision when and where applicable.

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Speaker 6 – Dr. Christy Okoromah – Associate Professor, Dept. of Paediatrics, College of Medicine, University of Lagos Topic: Dr. Welby or Dr. House? Medical Professionalism the Vanishing Core Competency

Dr. Okoromah began her presentation by defining Medical Education and relating it to the quality if Healthcare. She stressed that poorly trained medical doctors practice medicine poorly and ultimately contribute to the dismal national health indices. She went ahead to define the conceptual frameworks that are very critical to Medical Training Programs and said that the design and redesign of training programs is serious research and must be based on the following:

• Best available evidence • Best theoretical/Educational models • Current global trends in medical education • Rigorous process

She made the session interactive by asking the participants to:

1. List 5 broad core competencies critical for physicians in the 21st century

2. Compare the list with neighbors and report commonalities and differences

Ten broad/ generic core competencies identifies were:

1. Medical knowledge 2. Professionalism 3. Communication and interpersonal skills 4. Practice-‐based learning and professional

development 5. System-‐based practice 6. Population health/health systems 7. Leadership and management skills 8. Interdisciplinary collaboration 9. Research and scholarship 10. Patient care

Dr. Okoromah went on to define medical professionalism as the “adherence to ethical practice principles, including but not restricted to: honesty/integrity, confidentiality, moral reasoning and respect privileges and codes of conduct. Why is Medical Professionalism Vanishing?

• Lack of a consensus definition with measurable elements, limiting the teaching & assessment of medical professionalism

• Outdated training programs/curricula in medical schools

• Outdated education strategies • Compartmentalized training with little or no

integration • Poor learning environment (infrastructure &

training resources) • Faculty development (inadequately prepared

medical teachers/role models) • Disconnect between the written and hidden

curricula (Environment, practices, role models, mentors)

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Friday 14th of October 2011

Time Activity Co-coordinator

9:30 – 10:00 am Safety and Cost Correlations in Diagnostics Dr. Wole Edwin Executive Director, Quality & Regulatory Affairs, Quest Diagnostics Incorporated

10:00 – 10:30 am Patient Safety

Dr. Carmen Audera-Lopez Patient Safety Programme, WHO

10:30 – 11:00 pm Tea Break

11:00 – 12:00 am The SafeCare Initiative – Implications for Quality

Improvement Outcomes

Professor Tobias Rinke de Wit Director Advocacy, Technology and Research, PharmAccess Foundation

12:00 – 12:30 pm The May Clinics Experience Mr. Abisola Aworinde Executive Director, May Clinics Ltd.

12:30 – 1:00 pm Questions and Answers

1:00 – 1:15pm Presentation of Plaques

1:15 – 2:15 pm Lunch

2:15 – 3:30 pm Annual General Meeting All Members of SQHN

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Speaker 7 –Mr. Wole Edwin from Quest Diagnostics Incorporated Topic: The Role of Diagnostics as a Driver of Standards, Patient Safety & Cost

Mr. Edwin begins by saying that Healthcare is a right for all citizens, and every one (including the Government, physicians, healthcare workers and providers, insurance providers and even citizens) has a role to play in it. He went ahead to explain that in the past, patient diagnosing was based on trial and error and this lead to premature death for some people. Currently, patients receive more accurate treatment by diagnosing precisely leading to a reduction in the untimely and unnecessary death of patients. This has also led to improved life expectancy, reduced healthcare costs, use of only needed drugs, thus boosting drug resistance and safety of the patient. He said diagnosis is when the physician knows what is normal and can measure the patient’s current condition against those norms, the physician can then determine the patient’s particular departure from homeostasis and the degree of departure with the help of a medical diagnostic test. He went on to explain clearly the following terms: Medical diagnostic tests, medical screening, medical evaluation and who should perform the diagnosis.

5 reasons for a diagnostic test are: • To establish a diagnosis in symptomatic

patients • To screen for disease in asymptomatic

patients • To provide prognostic information in patients

with established disease • To monitor therapy by either benefits or side

effects • To confirm that a person is free from a

disease. He further went on to identify the reality of the Nigerian healthcare system in the world. Nigeria ranks as the 7th most populated country with a population of 158 million people; our life expectancy is 47.2 years and 70% of Nigerians live below the poverty line, to mention a few. Based on the data presented, something needs to happen fast in the country in terms of

• Giving appropriate diagnosis • Appropriate therapy must be administered • Proper monitoring must be done

Characteristics of a good diagnostic test include

• Test specificity • Test accuracy • Equipment reliability, maintainability ad ease

of use

The role of Government in all of this • Regulate all laboratories and ensure that

standards are followed, laboratories under go accreditation and training is continuous.

• Regulate medical devices, and ensure they comply to set standards

• Regulate health insurance companies • Establish universal healthcare programs • Ensure adherence to regulations and enforce

the law

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Speaker 8 – Professor Tobias Rinke de Wit from PharmAccess Foundation Topic: Committing Healthcare Providers To Quality Improvement: Working Towards Safecare

Professor Tobias began by explaining the Health Insurance Fund, HIF, which is a not-‐for-‐profit Foundation founded in 2007 by the Dutch Government, World Bank and USAID, to support programs in Nigeria,

Tanzania and Kenya by subsidizing health insurance premiums of target groups and improving quality healthcare provision by performance-‐based financing. In Nigeria, the HIF targets Market women, ICT workers, Farmers in Kwara North and Central. Since 2007, the assessment of Healthcare providers is done by using a tool (on Track) that quantifies according to assets, processes and skills depending on the type of service required in a facility, or by a team of professionals (doctors, laboratory technicians, IT personnel as well as quality managers. Questions are grouped in different modules to facilitate assessing and reporting. Continuous quality improvement is encouraged through staffing and training, documentation of guidelines maintenance, infrastructure equipment and the use of assets, skills and processes. Professor Tobias went on to explain the (On Track) setup and how it works in Nigeria.

The way forward African healthcare systems are stuck in a vicious cycle of low demand and supply, access to basic healthcare among the poor is low in quality (relational, technical, functional and organizational quality), but can be improved by the following:

1. Purchase of assets and supplies 2. Training of staff and implementation of continuous education processes 3. Implementation of standard operating procedures 4. Implementation of safe systems and processes 5. Local and long distance technical assistance 6. External quality control and proficiency testing

The impact of Quality can be seen from the following:

• Appropriateness – the right care at the right time for the right patient • Access – willingness to pay, trust and availability • Transparency – benchmarking and accountability • Cost effectiveness – sustainability of quality improvement

Safecare is very important because

1. Patients know where to go at all times and this increases revenue for private providers as well 2. Healthcare providers can have better access to loans, insurers and patients 3. Banks can provide loans based on quality plans and can rely on external validation 4. Donors can allocate their funds to opportunities and monitor results easily 5. The Government can have a basis for a legal framework to monitor and regulate the healthcare industry 6. Insurers can chose or reward better performing providers.

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Speaker 9 – Mr. Abisola Aworinde from May Clinics Ltd. Topic: The May Clinics Experience: The importance of Accreditation to the improvement of quality in healthcare practices

Mr. Aworinde began his presentation with the Vision and Mission Statements of May Clinics Ltd., and how the aim of improving quality meant providing better service. An overview of the service sector and the key challenges was conducted over a 24-‐month period to try to identify the sources of pressure for change within and outside the organization. Recommendations were made to enable employees work better as well as how the plan will be implemented and evaluated over time. There was a need to have an external body to evaluate the clinic and give concrete feedback on services and facilities in line with international standards, hence the entry of PharmAccess in association with Hygeia Community Health Plan. We were given a detailed report about our service delivery and every member of staff was carried along to achieve the objective. The guidelines helped improve patronage, revenue and positive feedback from customers and patients. The initiative aligned with our corporate mission and vision and added an opportunity to be a major player in the healthcare industry in Nigeria. Advantages of the PharmAccess M&E

• The provision of a framework to help create and implement systems and processes that improve operational effectiveness

• Improved communication and collaboration with internal and external stakeholders

• Strengthened team effectiveness

• Credibility and commitment to quality and accountability

• Decrease liability costs

• Mitigates risk of adverse events

• Sustained improvement in quality and organizational performance

• Promotes the sharing of policies, procedures and best practice among health care organizations

• Promotes the understanding of how each person’s job contributes to the organization’s mission and services

• Improves patients health outcomes

COHSASA’s guidelines showed very clearly how to capitalize on our strengths and work on our weaknesses. We were able to create a quality department to ensure the creation and maintenance of quality products and services, as well as collect data that will be helpful in forecasting and formulating policies and procedures. May Clinics Ltd currently invest in IT Infrastructure to aid in data collection and easy communication. Training and employee development has become an integral part of the organizations culture, and all staff are involved in decision making processes Mr. Aworinde concluded by saying that

• Patients will choose the hospital where they are least likely to suffer adverse outcomes.

• Accreditation improves patient services, so the standards that a facility is assessed against should be patient centered

• Accreditation is much more than a marketing tool and shows how an organization works and how patient and staff risks can be minimized

• Accreditation is in the ability of the process to alter the culture of a healthcare setting into one of continual improvement in quality.

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Overview of Presentations S/N SPEAKERS ORGANIZATION TOPIC 1 Dr. Dogo Mohammed National Health

Insurance Scheme Importance of Standards in a Demand Driven Health Insurance System

2 Professor Emmanuel Otolorin

JHPIEGO Nigeria The National Health Bill and its Impact on the Quality Agenda

3 Dr. Carmen Audera-‐Lopez

World Health Organization

WHO Patient Safety Programme

4 Dr. Olufemi Mosuro Shell IA Hospital, Ogunu Quality Improvement at the Shell Hospital Warri

5 Dr. Alexander Dimoko Shell Hospital Attaining the Gold Standard in Nosocomial Infection Control

6 Dr. Olujimi Coker Lagoon Hospitals JCI-‐ The Lagoon Hospitals Experience 7 Dr. Olutoyin Abitoye Virtua Medical Group The Use of Standardized Clinical Core Measures

in Comparing Hospital Standards in the US: A Case for a Similar Strategy in Future Health Delivery in Nigeria

8 Dr. Christy Okoromah Lagos University Teaching Hospital

Dr. House or Dr. Welby – Where did we miss it?

9 Mr. Wole Edwin Quest Diagnostics Incorporated

The Role of Diagnostics as a Driver of Standards, Patient safety and Cost

10 Professor Tobias Rinke de Wit

PharmAccess Foundation Committing Healthcare Providers to Quality Improvement: Working towards Safecare

11 Mr. Abisola Aworinde May Clinics Ltd. The May Clinic Experience: The Impact of Accreditation to the Improvement of Quality in Healthcare Practices.

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