http://www.ichapatientsafetycon.com/index.htm

India commits to reduce risks of health care – associated infections

To fight the spread of health care – associated infections, which affect millions of patients each year worldwide, the Ministry of Health and Family welfare, Government of India, in association with the World Health Organization (WHO) launched the Global Patient Safety Challenge and signed a pledge to acknowledge India’s commitment to address this problem.

Indian Confederation for Healthcare Accreditation (ICHA) began collaboration with World Health Organization’s “World Alliance for Patient Safety”; the objective being “Global Patient Safety”. The convention aims to build upon India’s existing efforts and initiatives to ensure safe healthcare for all.

Indian Confederation for Healthcare Accreditation (ICHA) is a National not-for-profit organization incorporated as a Company U/S 25 of the Companies act registered in NCT of Delhi. ICHA is the confederation of National Associations and Institutions of all stakeholders in healthcare. While National Associations are the owner members, it is appreciated that work has to be done by individuals and individual organizations who are enrolled as affiliates. This structure not only ensures credibility but also encourages apolitical contributions by all stakeholders.

Have you worked in hospitals in developing countries? Would you like to share your experiences?

THIS WEDNESDAY JOIN US AS WE START THE CONVERSATION ON…

“Quality Healthcare in Developing Countries”

10^th June 2009, 1:00 – 3:00 pm
UTSPH Auditorium E101

“Never doubt that a small group of committed people can change the world. Indeed, it is the only thing that ever has.” – Margaret Mead

To Physicians from developing countries:

You have been out there, at the frontline, you have seen errors happen, you have seen basic issues neglected and you all have stories to share from your internship or working days, some of these stories provide quite an insightful view of what goes on in our health systems. The idea is to create a collection of these narratives and form a short documentary. Let us share our stories lest they be forgotten.

To All the Rest:

Join us as we try to explain why quality healthcare is as important as access to healthcare. Listen to young physicians from developing countries share their stories and experiences. These are the people who have been in the system and each has stories buried in them which no books or journals reveal. Help them share, lend them your ear, give them your feedback. Come and be their audience.

Come and talk and be heard, or come just to listen and learn.

Everyone is welcome to attend, Light refreshments will be provided!

It will be helpful if you let us know in advance if you are planning to attend:
Contact: sonali.vaid@uth.tmc.edu

Event sponsored by Texas Public Health Training Center in collaboration with the Global Health Concentration

Sonali Vaid MD

http://www.qcin.org/html/nqc/qualityindia-sept/index.html

http://www.qcin.org/html/nqc/qualityindia-jan2008/page64.php

The question is what are the NABH standards? And how do they compare with the Joint Commision International standards.

Should India have an independent Healthcare Quality Body along the lines of the JC. Or is it ok to have it as a subsidary of the Quality council (perhaps that enables more inter-sectoral learning and partnerships).

Even archimedes needed help – needed a place to stand if he were to move the earth. So am I too idealistic is believing that one individual alone can initiate and create sustainable change.

I shall find a place and a time and I shall change the world.

Don Berwick – President and CEO, Insitiute for Healthcare Improvement and Professor Harvard School of Public Health asnwers the question – How can I speak up when hospital culture is so hierarchical?

http://www.ihi.org/IHI/Programs/IHIOpenSchool/AskTheExpertNov142008Berwick.htm

In another forum Dr. Beriwick has stated “To ask individuals to make change is a bankrupt idea”. Maybe if you ‘ask’ someone else to make change, it is a bankrupt idea. But what if the individual himself/herself is desirious of making the change and is self-driven, do you still think it is not possible. What happened to the age old adage ‘Where there is a will there is a way’.

I believe that in every system there are individuals who are crying out for improvement and change, scattered idealists craving for an outlet. But they all face obstacles – most do not get the outlet they seek, some do not have the resources to pursue their vision. Some lack the training or education to form a clear practical vision. Whatever be the reason these people do not find the place from where they can stand and move the world. And perhaps here Dr. Berwick is right in his assessment of the inability of individuals to create change.

But this is our greatest loss, all this idealism and human desire for change is being supressed and lost. I don’t know how, but it is our responsibility that we do  not supress idealism wherever we may chance upon it – be it in a colleague, in a child, in a student or in ourselves. Yes, there are barriers and obstacles, but sometimes all one needs is someone who believes in them. When I want to do something and then I see that Dr. Berwick thinks it won’t work, I genuinely think that it might not work. But if Dr. Berwick had said that it is individuals who are the cornerstone of change then perhaps I would not have lost faith.

Your faith in someone may indeed help them change the world someday. Let idealism live, let it breathe and let it shine forth in all its brilliance.

Is it really just the system that we need to look at? What about the human factor. The clinician who makes the diagnosis, the nurses who administer care and the patient who is the recipient of it all. What about feelings, emotions, the thought processes; don’t these impact the quality of care? And are we giving them adequate attention?

This thought was initiated by a book I have been reading – ‘How Doctors Think’ – the author of the book Dr. Groopman insists that most errors are not technical errors but are cognitive errors. He goes on to recount incidents from personal and gathered narratives where physicians have misdiagnosed or erred due to emotional prejudices or cognitive errors.

Although I have not explored the scientific literature that discusses the Physician thought process, it is perfectly reasonable to state that emotions and cognitive processes to play a part in the delivery of healthcare. So those of us working in healthcare improvement need to be aware of how the human factor will affect our improvement initiatives and also devise ways of analysing and minimizing the pitfalls caused by this human factor.

We should critically analyse whatever we read and not take it at face-value. Evidence Based Medicine has become the cornerstone of practice today – but are protocols and checklists our route to perfection in healthcare delivery?. The systems need to be designed to make healthcare error-free, but are we missing something? Healthcare is a complicated industry and there is no one solution to all its ails. Solution-exchange, openness to new ideas, critical appraisal of proposed theories and even challenging established theories are absolutely necessary for ensuring continual improvement in healthcare.

Consumers Advancing Patient Safety (CAPS) is a consumer-led nonprofit organization formed to be a collective voice for individuals, families and healers who wish to prevent harm in healthcare encounters through partnership and collaboration. CAPS is committed to exploring and contributing the wisdom and experience that consumers can offer to patient safety research, education of both consumers and providers, reporting of bad outcomes and near misses, development and implementation of solutions that can prevent harm, and policy making that will help create healthcare systems that are safe, compassionate and just.

While we champion the experience and collective voice of consumers who have experienced system failure, we embrace as partners those dedicated professionals and organizations who share our vision, mission and goals.  Our hope for the future is embedded in effective, appreciative collaboration among people and organizations committed to making a difference.

For a list of collaborating Healthcare Organizations – http://www.patientsafety.org/page/94917/;jsessionid=dog8crtkcdw

While I working as a resident at a hospital in India, an intern narrated an interesting experience from his rotation in the Gynaecology Ward. He was posted in the Family Planning Division which provides contaceptive counselling and care, and one of the services it provides is insertion of Intra Uterine Contaceptive Devices (IUD’s). These are small – usually copper containing devices which are inserted into the uterus and prevent pregnancy from occuring. This method of contraception is promoted by the government and they offer a small financial incentive to eligible women who come in for this method of contraception.

Sometimes during a womans menstural cycle this small copper peice can get dislodged from the uterus and can be expelled through the vagina alongwith the menstrual flow, women are advised to keep track of this and to come in for a new insertion in case they feel it has been expelled. Now this intern noticed that some women kept coming repeatedly saying that the device had come out. It turned out that they come and have it insterted at one clinic then have it removed at another saying that they are either having discomfort because of it or that they desire to get pregnant. And then they return to have it insterted again, cause they keep getting the monetary incentive every time they get it done.

This not only leads to waste of resources but also medical manpower. India does not have an information/registry system in place to keep track of patients so there is no way of determining whether a certain person has received the monetary incentive or not.

What this scenario demonstrates is the need for a common platform where everyone in healthcare – from medical students to nurses to lab workers and professors can present their experiences and raise issues of concern and discuss possible solutions. Even patients should have a forum where they can discuss their concerns in a collaborative and communicative manner with the healthcare body.

The functioning of any system – even the human body, or for that matter any living organism is dependent on a multitude of positive and negative feedback mechanisms. Even the earth and climate depend on feedback. Financial and political systems depend on cycles of feedback. Healthcare cannot even be called a system if feedback mechanisms do not exist.

Delfini Group specializes in applied, practical evidence- and value-based approaches to clinical improvement and medical decision-making.

Contains some very useful free resources regarding interpretation of Evidence Based Medicine and implementation of Quality Improvement.

http://www.delfini.org/index_Resources.htm

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The Reinertsen Group – http://www.reinertsengroup.com/

The Reinertsen Group is an independent consulting and teaching practice that helps health care leaders achieve breakthrough performance, organization-wide, in clinical quality and safety. We address some of the most difficult quality improvement problems faced by hospital and medical group CEOs, Boards, physicians and administrators—questions such as “How do we engage with our physicians?” and “How do we start getting real, measurable results?”

The Blog makes for interesting reading – http://www.reinertsengroup.com/rg-blog/page/1/

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HS-PROD is a database for health sector reforms being developed by the Central Bureau of Health Intelligence (CBHI), Ministry of Health and Family Welfare, Government of India.

Many States and Districts in India are experiencing similar problems in the health sector and are looking for ways to tackle them. There are many good examples of health sector reform, and lots of good ideas but until HS-PROD was developed, no easy way to share this information.

HS-PROD aims to be an easily accessible way to publicise successes and share reform know-how to solve common problems.

Introduction of a quality improvement program in a children’s hospital in Tehran: design, implementation, evaluation and lessons learned

International Journal for Quality in Health Care 2007 19(4):237-243; doi:10.1093/intqhc/mzm021

The “Partnership for Excellence in Critical Care” offers the following protocols as examples for institutions considering adopting protocols to improve patient care in the ICU. These protocols, on relevant critical care procedures, have been collected from a variety of medical institutions including academic hospitals, community hospitals and veteran’s administration hospitals for your information. The names and identifiers of the contributing institutions have been removed, and providing these protocols does not constitute support or endorsement of them by the Partnership for Excellence in Critical Care. They should be used as beginning points and references for discussion as each institution develops an appropriate protocol for its ICU.

- Mechanical Ventilation Protocols
- Ventilator Weaning Protocols
- Sedation Protocols

Quality improvement forum sets sights on developing countries and on patients

Jocalyn Clark BMJ

Doctors and healthcare researchers last week debated how to import the theories and methods of healthcare quality improvement into the developing world.

At the forum on quality improvement in health care in Bergen, Norway, speakers identified inadequate infrastructure, lack of local expertise and leadership, and language as the main barriers preventing the establishment of “first world standards of care” in developing countries.

Speakers focused on systems rather than individualised approaches to improving health care and treatment, an idea that is an essential part of the quality improvement movement.

“To ask individuals to make change is a bankrupt idea,” said Don Berwick, head of the US Institute for Healthcare Improvement and a plenary speaker at the forum. “This is the case in the North, but even more so in the South, where people face greater challenges to simply get through the day.”

Because “higher quality costs less,” the payoffs of quality improvement are even greater than those for wealthier nations, said Dr Berwick. …

http://www.bmj.com/cgi/content/full/326/7399/1110-b

http://intqhc.oxfordjournals.org/

Published by the The International Society for Quality in Health Care – http://www.isqua.org/index.html

The HRH Global Resource Center offers a global library of resources on the topic of human resources for health (HRH), focusing on developing countries.

A service of the Capacity Project (USAID funded initiative), led by IntraHealth International, Inc., the HRH Global Resource Center (GRC) provides essential HRH information in a searchable, online library and offers personalized support from an experienced knowledge management team.

Quality Improvement Resources – http://www.hrhresourcecenter.org/taxonomy/term/288

A growing number of WHO member states and the world’s political and international health leaders recognize the urgent need to make a major, sustained commitment to strengthening health systems. This renewed political interest presents the important opportunity needed to make sustainable improvements that benefit across disease areas and health programmes, and redouble global efforts to meet the challenge of achieving the Millennium Development Goals.

It is an independent international organization committed to demonstrating the essential role of research and innovation for health and health equity, benefiting poor and marginalized populations because health equity is a priority.

http://www.globalforumhealth.org/Site/000__Home.php

The South – Asian Cochrane Network and Centre

The SACN is also involved in disseminating and evaluating Evidence Update, two-page summaries of Cochrane reviews of interventions relevant to health care in low and middle-income countries. There are about 50 such summaries available and these have been disseminated to over 400 primary care practitioners and to medical colleges in India.

Michael R Reich, Keizo Takemi, Marc J Roberts, William C Hsiao

Lancet 2008; 371: 865–69

http://www.jcie.org/japan/j/pdf/gt/cgh-jc/lancetarticle080308.pdf

“Global efforts to improve health conditions in poor countries have embraced two different strategies in recent decades, one focusing on health systems, the other on specific diseases. The interactions of these two strategies have shaped where we stand today….”