The Burden of Poor Quality & Safety and how to improve the same and thereby improve patient satisfaction & outcomes and thereby the performance of the healthcare organization.

1. 1
CONSULTECH
HELPING YOU ACHIEVE YOUR GOALS
Quality & Safety in Healthcare
Importance & Execution

2. • Upto 25% of all
patients, or 5 crore+
in numbers, are harmed
or injured every year
by the healthcare
system!
• 2.5 crore+ disability
adjusted life years are
lost every year!
As per Harward School of Public Health, due to lack of safety
and quality at hospitals / healthcare facilities, globally, -

3. A patient admitted to a hospital can be harmed due to an adverse drug event or
during medication by any of the following reasons :
Causes of Harm In An Hospital
1 2 3
4 5
Patient can
develop a
pressure ulcer
Patient could
have a surgical
complication
Patient could
have a DVT
(DeepVenous
Thrombosis)
Patient could
have a fall
Patient can have
hospital acquired
infection
10-25% of patients who come to a hospital have something bad happen to them
as the result of the hospitalization.

4. 4
70% of Adverse drug
events are preventable
AreThe Dangers Preventable ?
80% of infections are
preventable

5. Types of Infections & Method of Prevention
Catheter-
Related
Bloodstream
Infection
Catheter-
Related
UrinaryTract
Infection
Surgical Site
Infection
Clostridium
Difficile
Infection
Ventilator-
Associated
Pneumonia
The primary and general method of prevention of
Infections by
Washing Hands Regularly

6. • Fall among hospital inpatients are common
among confused and elderly patients
• Patients can incur serious physical injuries
resulting in fractures, subdural hematomas
and sometimes fatal
Prevention:
• Profile people according to the risk of fall
• For people with higher risk, create a Fall
Precaution protocol which should include
whole set of things that tries to decrease the
likelihood of fall and if they do fall, the risk of
hurting themselves to be reduced
Falls & Method of Prevention

7. Methods of Prevention for Other Harms
Pressure Ulcers or Bed sore
• Use of sensors or technologies to track
whether or not patient is moving
• Patients who are not moving to be
monitored and manually turned
Surgical Complications
• Plan-do-study-act
• Visual controls
DeepVenousThrombosis (Blood clot)
This can be prevented through various
medications and usage of mechanical
devices
Hospital Acquired Infection
Hygiene and Cleanliness of superior quality
needs to be maintained within the
premises
01
02
03
04

8. Other Clinical Causes of Harm
Counterfeit
Drugs
Unsafe
Injections
Fetus and
Maternal
Mortality and
Injury Rates
Ambulatory
/Outpatient
Care Failure
Medication
Errors

9. • Major reason for high maternal mortality rates is that women do not have deliveries in medical
facilities
• Getting pregnant women out of the unhygienic conditions of their home and into the health
system for delivery is the key to improve their chance of survival.
Maternal and Child Health
 What Can Healthcare Providers Do for Maternal &
Child Health?
 Outreach programs to reach out to families
 Keeping proper supplies and equipment
 Ensuring essential drugs are not out of stock
 Better selection of people who are not just skilled, but also
motivated
 Proper training to staff to give confidence and comfort to the
pregnant women who come to the hospitals
 UseWHO’s mobile phone based Maternal Health Checklist

10. Medication errors are any error in the process of giving a medication as opposed to Adverse
drug events which causes injury or harm to the patient due to a medication.
Medication Errors & Methods of Prevention
• Proportion of adverse drug events due to medication errors
is around 70%, which are preventable because there are
pre-defined.
• There are some errors which also occurs when a
prescription is sent to pharmacist physically:
– Errors at the prescribing stage – around 10%
– Pharmacy errors account for about 10% of errors
– Errors at the administration stage are 30%
For reducing medication-error frequency and reducing the number of preventable adverse
drug events, computerizing order entries and prescription is important

11. • Technologies such as smart pumps which can be told what medication is to be administered and how.
• The pump checks to make sure that the patient is getting the right drug
• If the nurse tries to administer too high a dose, a warning is given
• Creating a library of drugs that is specific to the given location
• Making reference materials available via the web or on mobile
• Concentrated drug can be added into clinical setting
• Using mobile technology for ordering medications
Prevention of Medication Errors
A very simple ordering
system reduces the
serious error rate by 55%
Bar coding system to the
medications can reduce
the error rates by 30%
Administering drugs at the
point of care decreases
the error rate by 50%

12. • One major problem in healthcare is over
treatment
o e.g. if someone has cough then instead of
suggesting gargling with warm water having salt,
straight away an antibiotic is prescribed
• Many times, doctor’s income is linked to
treatment and so there is incentive for over use
• Similarly, tests may be prescribed even if they are
not required
• On other hand, many times doctors are not
trained to recognize symptoms of typical
problems
• If someone comes with typical symptoms of
heart attack, the doctor may completely miss
out the diagnosis.
Over and Under Use of Medication &Tests

13. 13
CONSULTECH
HELPING YOU ACHIEVE YOUR GOALS
Quality – Measurement &
Improvement

14. Importance of Quality
Quality is important in regards to:
 Infrastructure
 Types of medicines used
 Equipment used to give medicines
 The way in which Patient;
o is explained and communicated
o is made to participate in the whole healthcare
process
 Planning treatment journey of the Patient
Instances of Poor Quality:
 Records not kept separate
 Record out of reach from doctor’s office; previous
records also not available
 Staff and doctor do not know the right thing to do.
 Doctors do not listen to patient carefully
 Work being done in broken system

15. In the US and
some other high
income countries,
quality-monitoring
programs are
undertaken
Various metrics
are used to ensure
that physicians and
hospitals are
delivering care at
a sufficient quality.
A lot of
billing, claims
information
and other
data is used
But quality data is
not readily available
in low- and middle-
income countries
like India
Quality Measurement Metrics

16.  The first step is to assess questions such as:
o Where you are as an organization?
o What the clinicians and other staff members know?
o How they feel about these things?
o And then start from there!
 The patient satisfaction or experience survey is one
important component.
 Necessary to identify what is happening in the
organization at different managerial levels & clinicians
 To know about awareness, attitude and performance
of old clinicians towards patient experience
 Increase the awareness about patient experience
 Careful listening with compassion is an important
part of this
 Train clinicians about the different tools and
techniques, Empathic listening, and treating patients
with dignity & respect
 Improvement in the broad policy environment.
Process Improvement

17. Things that really matter for quality of care by doctors:
Consultation time & its quality
Number of questions the doctor asked about your health
Number of physical exams that he or she conducted
Whether any standardized checklist is used?
Important Don’ts for
Physicians:
• Talking on cell phone
while examining a patient
• Keeping the television on,
or such distractions
• Sending away the patient
after a cursory
examination, of say less
than a minute or two
Quality of Care By Doctor
The above metrics for quality of care works for a large number of cases.

18. How Mobile technology becomes a potentially interesting
tool to gathering information from patients for quality and
monitoring?
Text messages may be sent asking:
 How much time did the doctor spend?
 How many questions did the doctor ask?
 Overall satisfaction and outcomes
Using Mobile for Monitoring Quality
Given that mobile technology is widespread throughout the globe, it
becomes potentially a strong tool to get information from patients.

19.  Rating a hospital or a doctor in the same way as a hotel
 Building a website that allows people to rate and review
the hospital and its services
 This increasing transparency and provides users a voice in
the system
 Removes traditional boundaries that existed between
patients and the doctors & clinicians serving them
 However, such a system can also be open to abuse
 People may sometimes write fake reviews about hospitals
and its services
Role of Social media In Improving Quality
The new world of Social media, where people go online and create their own content, and voice
their feelings and opinions, presents interesting ways to understand how well a service performs.

20. IT technology enables analytics and improve the performance of the healthcare system. Data can help to
identify where the problems are, identify who is doing well, and how they are doing it.
InformationTechnologyTools
IT tools for electronic health records or patient service could be:
Mobile service
Health Information
Exchange
Decision SupportClinical Notes
Results
Management
Electronic Ordering

21. Telehealth Example
Teleradiology, enables to
send images that can be
read by radiologists off site.
Telemedicine is used to share
information about those patients
with ICU physicians, who are sitting
somewhere else to enable them to
care for those patients remotely.
Clinical decision support
systems can make prescribing
safe, and helps finding other
errors that could result in
adverse drug events.

22. The model for improvement (PDSA cycle)
 Plan: Make plan for early recognition or diagnosis of
the disease. Know the aim and what to do.
 Do: Make preparation for treatment according to plan
and execute.
 Study: Study the problems faced during the diagnoses:
whether it is practical or not.
 Act: If it is practical, then apply the same.
Get nurses and physicians together i.e. all caregivers and
talk with them about, what is your aim, and help them to
see that early recognition or diagnosis is critical and
reduce cycle times in each subsequent processes.
Plan-Do-Study-Act (PDSA)

23.  Makes sure that hospital is actually running and kept safe.
 Checks that Standards for Care of Patients are followed.
 Implementation of measure for Infection Control and Quality Assurance
 ChecksWard Management and Quality Indicators set off.
 Checks Fire Safety Plan, Ambulance Standards and whether ICU / OT /
Pharmacy Best Practices are followed or not.
 Checks how air flow pattern is in certain areas.
 Checks availability of two-patient identifiers.
 Examines Management of Hospital Formulary and Medication.
 Examines hoods where medications are made.
 Looks at some of the clinical processes in terms of how hand offs are
done.
 Also looks at other aspects such as making sure that medications are
properly stored for eg. checks that potent medications are not stored on
the floor, because if the wrong one is used for the patient then there can
be adverse consequences.
What are the kinds of things that go into accreditation for a hospital?
KeyThings that NABH Accreditation Requires?

24. Tools and Standards for Quality and Safety
5S for Hygiene Total Productive
Maintenance
Total Quality
Management
Operative Equipment
Efficiency (OEE)
Kaizen
(Continuous
Improvement)
Value Stream
Mapping
PokaYoka
(Mistake Proofing)
Visual Management
Kanban
(Pull System)
IT Excellence ISO Standards Digital
Transformation

25. 25
CONSULTECH
HELPING YOU ACHIEVE YOUR GOALS
Quality of Management

26. Challenges in Service Delivery
01
02
03
Due to short term and linear thinking, people starts to get going and then
afterwards worry about the quality of care. This creates massive problems in
terms of expectations for users, as well as workload management.
Due to lack of strategic thinking very less emphasis is laid on the health
workforce which badly affects the service quality and patients’ experience
Establishing fractured or non-integrated systems, that are specialist based which
Lacks integrated and people centered care system.

27. The advanced management in health care is about:
Management in Health Care
Measuring
everything
that happens
within the
organization
Good HR
practices
including
motivating and
rewarding
employees
Setting targets
and
communicating
them
effectively
Clear norms &
procedures
and their
communication
& training to
people
Measurement
metrics and
benchmarking
against other
healthcare
providers

28. • How do you select your employees?
• How do you reward employees, and how do you deal with under-
performance?
• Dealing with under-performance is not about how fast such
people are fired.
• If an employee has problems, they have to be meaningfully
addressed and he/she needs to trained as necessary.
• For the performance checking, random interviews can be taken
and scored accordingly.
• After that a very systematic training in terms of what need to be
asked and how to ask the questions, digging deeper into the
reality of the organization and on this basis at the end of the day
assign scores.
• Every question on this 10-20 questions grid can be scored on a
scale that goes from 1 to 5.
• The average score across all these questions is what is called the
management score, and it is a proxy for the adoption of very
basic managerial processes.
Quality of HR Management

29. Quality of Information & Communication
There is reduction in frustration when
better communication is there
Collection of information about
performance and using the same for
betterment
Some organizations are not very
proactive in using the collected data
Quality of Communication between
the health professional, the patient &
its family is also very important
Information management is very important
in determining quality
Lack of communication can result in mis -
interpretation among patient or any other
stakeholder

30.  The role of leadership is very important in quality
improvement
 Ensuring that the patients who trust them and trust
their institutions get the best care possible
 Leaders need to get out every day and see what the
care is, what the care can be, and make that
improvement happen
 Self-awareness and Self-evaluation are very
important
 Setting a benchmark for improvement
Role and responsibility of Leadership

31. 31
CONSULTECH
HELPING YOU ACHIEVE YOUR GOALS
Patient Experience & Satisfaction
Patient Centered Care

32.  Can we really measure patient experience?
 Are there good tools? Are good instruments
available?
 And then, what are the components of patient
experience that should be measured?
Answers to above questions are :
 Valid tools are there, such as the HCAHPS in the
US, which contains 32 questions about various
hospital domains.
 These are the questions that are important to
the patient while he is in the hospital
 Patient experience survey is used rather than
patient satisfaction survey.
 The primary determinants of patient experience
are the interaction between the patient and the
clinicians
Measuring Patient Experience

33. One of the myths is that patient experience is about having a nice lobby, and having nice food. But the
most important thing that really matters the most is the clinician-patient experience.
Key determinants of Patient Experience
The main determinants are related to
clinician-patient interaction:
i. Attentiveness of clinicians to the patient
needs.
ii. Attentiveness towards the concerns of the
patient and engagement of the patient in
the decision-making.

34.  Patients are more likely to come back
 Patient feels comfortable
 Will recommend to friends and family
 Results in marketing for the health organization
 The financial outcomes of the organization will be much better
 It reduces unnecessary utilization down the line
 Patient less likely to file a lawsuit
All of above go on to affect outcomes in the long run.
Benefits of Great Patient Experience

35. Conclusion
Issues Of Safety & Quality
in Healthcare –
• Lack of strong
commitment to
health and safety
• Lack of quality
measurement
• Poor Processes
• Technology not
used fully
• Old fashioned
people practices
• Financial planning
& resources
Improvement in Safety &
Quality –
• Can improve patient
satisfaction and outcomes
• Can improve the financial
& overall performance of
the organization
• Digital transformation,
and focus on people &
processes is important
• Good management
practices and external
assistance can generate
extraordinary efforts and
save lives!

36. 36
CONSULTECH
HELPING YOU ACHIEVE YOUR GOALS
About Us

37. Group Profile
Leading consulting & technology service provider specialized in a host of value added
services to various manufacturing and service industries worldwide including G&J,
Healthcare, Pharma & Chemicals, BFSI etc.
Vision
To offer innovative and creative
services for the beneficiation of our
customers worldwide such that our
services enable them to transform the
way in which they do business.
Mission
To deliver excellence in all our services to
enable our esteem customers to excel in their
own business.We do this by providing value-
added services leveraging our vast domain
knowledge, blending of IT with various business
domains, specialized multi disciplinary skills and
international professional expertise

38. Multi-disciplinary team of CAs,
CPAs, Company Secretaries,
MBAs, LLBs, Engineers and other
professionals
Staff of 1700+ personnel
across 14 offices
Client base includes Pharma,
Lifesciences, Healthcare &
Hospitality industry along with
other manufacturing and
service industries
Specialized in providing host of
value added consulting &
professional services
Enormous experience
serving large corporates,
multinationals, NGOs,
family owned companies,
semi-govt. organizations
and MSMEs
Innovative and creative solutions,
all under one roof
Our Strengths

39. Accounting/Financial
Process Outsourcing
Transfer Pricing
Direct / Indirect (GST)
Taxations Advisory
IFRS/IND-AS
Advisory
cGMP/ FDA/ NABH &
Other Industry Standards
GMPR Manufacturing
Excellence Review
Operations Consulting-
Lean/ ISO
Company Formation &
Secretarial Services
Labour Law Compliance
Commercial
Documentation Service
Recruitment & HR
Solutions
Corporate Advisory
Structuring
Financial Services /
Wealth Management
Succession Planning &
Wills
Internal-Management Audits &
Systems-Process Audits
Our Services
Digital Transformation, ERP-Web-
Mobile applications, Robotic
Process Automation

40. ExpertTeam For Healthcare QMS
Nirav Jogani
Vice Chairman
RSM-Lemon Consultech
B.Com, F.C.A, ISO Lead
Auditor & Lean Expert,
PH555x from HarvardX on
Quality & safety in
Healthcare
Experience of 25+ years r
Dr. Dineshbhai Jogani
Mentor
Medical Expert
Practicing Physician
M.B.B.S with rich
experience of 50+ years
Mr. Jatin Patel
GM- Pharma Quality,
Compliance & Standards,
RSM-Lemon Consultech
M.Pharm with 10+ years of
experience and key expertise
in cGMP implementation and
establishment of Quality
Management System as per
Regulatory Requirements
Mr. Murali Mohan
GM – Operations
Consulting,
RSM-Lemon Astute
MBA, B.E. with total
experience of 35+ years and
expertise in Management
Consulting, Business Advisory
and Quality Assurance

41. 41

42. 42
CONSULTECH
HELPING YOU ACHIEVE YOUR GOALS
Contact Details –
info@lemonconsultech.com
+91 90992 08000
THANKYOU