Initiatives

SQIP (State Quality Improvement Programme)

An attempt to improve health services in public healthcare centers

For improving the functioning of the public health facilities and help in strengthening the processes for the providing quality public health care services throughout the State, Government of Gujarat is the first state in India which initiated for actively pursuing quality improvements in the public healthcare facilities through the network of Primary Health Centers (PHCs), Community Health Centers (CHCs), District Hospitals & Medical Colleges. In order to institutionalize Quality Assurance, Gujarat is the only state which has set up the District Quality Assurance cell & State Quality Assurance cell for implementation of this programme. It proposes to develop and institutionalize the use of the field based, practical and feasible indicators in quality assessment and to transform existing supervision practices into a more standardized and structured process. Any sustainable change in terms of institutionalization of Quality Assurance (QA) will come from within the system and not from outside. It is hoped that interventions from demand side (for example, community and individuals demanding better services) will also put pressure on the system to deliver quality services which will in turn give impetus for investing in QA.

Objective

  • To facilitate the improvement of systems and processes of service delivery in the healthcare facilities as per the standard technical protocol to meet the laid down standards (e.g. IPHS/ MCI/GOI guidelines) as appropriate.
  • To establish & develop quality management systems at the hospital level, leading to enhancement in service quality and leading to Quality certifications by the Quality assurance cell.
  • To implement & monitor quality of reproductive health services/ MCH services at health facilities and consequently improve service quality by focusing on and addressing the gaps identified during the assessment process.
  • To undertake periodic assessment visits through State and district quality assurance cell/ committees using specific tools and based on the gaps identified, to guide the service providers in addressing specific service quality elements and sub-elements.
  • To undertake such other GOI / State initiatives entrusted with the QAC from time to time (e.g. MDR, MCTS etc.)

Components

  • Quality Assessment
    Quality assessment helps Supervisors to identify the gaps in performance of healthcare facilities and other staff.
  • Quality Improvement
    Quality improvement helps in reducing the identified performance gaps.

Citizen Charter

As per the Accredited healthcare institutes (including Medical Colleges, District Hospitals, CHCs & PHCs) are well equipped with :

  • Clearly defined and displayed Vision, Mission & Objective elements
  • Well defined and displayed citizen charter
  • Well defined and displayed patient rights and responsibilities.
  • Well defined and displayed services available
  • There are proper grievance redressal policies to handle the staff and patient grievance. Complaint boxes & books are available. A committee also has been formed at all the levels to handle the grievance of the patient and staff.
  • Well defined and displayed doctor duty schedule.
  • Patient, Employee satisfaction survey being done regularly
  • All statutory requirements being fulfilled

Facilities under QIP

"A family friendly hospital is a public health facility where the service providers offer quality medical care by following evidence based protocols and check lists for all the beneficiaries with special focus on women and children to ensure patient safety. The hospital environment to be made conducive for the service providers to practice the skills and the beneficiaries to stay comfortably in the institution”

  • Total No. of Facilities undergone assessment -101
  • Total No. of family friendly hospital accredited - 28
  • The Kaizen method of continuous incremental improvements is an originally Japanese management concept for gradual, continuous (incremental) change (improvement).
  • Kaizen is actually a way of life philosophy. It assumes that every aspect of our life deserves to be constantly improved. The Kaizen philosophy lies behind many Japanese management concepts such as: Total Quality Control, Quality Control circles, small group activities, labour relations.
  • Key elements of Kaizen are: quality, effort, involvement of all employees, willingness to change, and communication.
  • Japanese companies distinguish between: Innovation, a radical form of change, and Kaizen, a continuous form of change. Kaizen means literally: change (kai) to become good (zen)
The five foundation elements of Kaizen
  • Teamwork
  • Personal; discipline
  • Improved Moral
  • Quality circles
  • Suggestions for improvement
The 3 key factors in Kaizen are
  • Elimination of waste
  • Kaizen 5-s teamwork
  • Standardization

Implementation of KIAZEN under Quality Improvement Programme was initiated and CQI Champion training is completed in all districts Total 1630 participants are trained as a CQI Champion. Two internal audits in all districts are also completed. Cleanliness is improve after the implementation of KIAZEN

5S is a system that is designed to ensure workplace safety, efficiency, cleanliness and increase quality.

  • 1st S-Sort Out–Separate out the things you use and remove the things you don’t.
  • 2nd S-Set in Order -Organize the things you use and place them where you need it.
  • 3rd S- Shine-Scrub equipment, machines, tools, work area and floors.
  • 4th S-Standardize-Create a system to maintain 5-S daily.
  • 5th S-Sustain-Follow the new system every day-make it a habit-and always look for improvement

Implementation of 5-S under Quality Improvement Programme was initiated in all the healthcare facilities, under which in first phase 1st S i.e. sort out, elimination of condemnable items were done and most of the health care facilities were registered under MSTC, A Govt. of India Enterprise for condemnation of items through e auction.

Till today total amount received by scraps disposal is 3261924/-

In view of a recent Mishap in which a horrific fire at one of Kolkata's posh facilities killed at least 89 people, the victims were patients in critical care units-suffocated to death, a pursuit had been started to ensure that the government-run hospitals have full-proof fire safety measures in place. A detailed activity checklist was sent to all hospitals, and accordingly work had been done. A safety committee was formed at all heath care facilities, and mock drills were conducted.

Total facilities have the fire safety facility with regular mock drill 686 PHCs, 213 CHCs, 25 Dist & 25 Sub Dist Hospitals and 6 Medical College Hospitals, Remaining facilities are in progress.

In all the health facilities under the Ministry of Health and Family Welfare, Gujarat, we have provided following equipments and infrastructure facilities in each health facility.

  • Adequate no. of colour coded BMW containers and bags as per BMW Guide line (Red, Yellow, Blue and Black).
  • Puncture proof Containers for Sharps.
  • Mutilators (Needle / syringe cutters).
  • Calibrated Weighing machine for BMW.
  • Personal protected equipments like Gloves, Caps, Masks, Aprons & Gum boots etc.
  • 1% fresh Sodium hypochlorite or Bleaching Powder Solution.
  • BMW Record Register.
  • Mercury Spill Management kit.
  • Blood spill Management kit.
  • Post Exposure Prophylaxis Kit.
  • BMW Storage Rooms with Lock & Key.
  • Different Forms & Formats (Needle Stick Injury & Annual Report etc.).

Summery

  • Each health facility has obtained authorization under Bio Medical Waste (Management and Handling) Rules, 1998 from Gujarat Pollution Control Board.
  • Each health facility is segregating and storing bio medical waste as per colour coded system and then sending bio medical waste to Centralized Bio medical Waste Treatment Facility (CBWTF).
  • We have signed MoU with Centralized Bio medical Waste Treatment Facility (CBWTF) for the transportation, treatment and final disposal of bio medical waste generated in each health facility for the entire State.
  • For the very small primary health centre in remote rural area, we are allowing them to dispose their bio medical waste by deep burial method.
  • We are organizing training programme for the heath care staff regarding the BMW Rules.
  • Gujarat Pollution Control Board (GPCB) is the regulatory authority for the implementation Bio Medical Waste (Management and Handling) Rules, 1998 for Gujarat State and GPCB is inspecting heath facility as per their schedule and issuing notices for the non compliance of BMW Rules. Any major violations of BMW Rules are not reported yet.

Under quality improvement programme, one day training was kept for each PHC, CHC, district hospitals and Medical colleges in the month of October and November. Training was given by two officers deputed from Gujarat Pollution Control Board. In this training was imparted to all the employees and assessment for compliance of BMW rules as per legal requirement was done by the GPCB officers.

Total facilities have the GPCB Certificate are 930 in PHCs, 251 in CHCs, 25 Dist & 25 Sub Dist Hospitals and 6 Medical College Hospital, Remaining facilities are in progress.

One month cleanliness drive was initiated in all the healthcare facilities of Gujarat including all the district hospitals, medical colleges, PHCs & CHCs. For the same region wise state level task force created for maintenance of Medical Colleges & District Hospitals, PHCs & CHCs. Co-coordinators of each task force was instructed to take the pre and post photographs, document all the process, held meeting on regular basis and co-ordinate between the State task force & Head of the Institutes. The progress thus made was submitted and presented at state level, and the programme was a great success in improving the cleanliness activity in all the health care facilities.

Till today total facilities provide the cleanliness report in proper formats are 295 in PHCs, 54 in CHCs, 29 in Dist & Sub Dist Hospitals, 6 Medical College Hospitals, 28 BHO offices, 2 Regional Deputy Director Offices & 3 DTTs, Remaining facilities reports are pending till today 6th Feb 2012.

Set up a "Directorate of Radiation Safety” (DRS) to Implement the radiological safety regulations. (AERB)

A Directorate of Radiation Safety is proposed to be setup as be an independent agency under the Health and Family Welfare department, Govt. of Gujarat. On technical matters, the activities of the directorate will be conducted as per the guidelines of Atomic Energy Regulatory Board.

The main functions of the Directorate will be to enforce the rules, regulations and guidelines of the Atomic Energy Regulatory Board. The Atomic Energy Regulatory Board will delegate to the Directorate, the authority to carry out the functions stipulated under rules 29, 30, 31 and 32 of the Radiation Protection Rules 1971. A Governing Body called the Radiation Safety Council is constituted by the Atomic Energy Regulatory Board to review periodically the working of the Directorate.

The Directorate will inspect Medical X-ray installation to ensure compliance with the mandatory requirements stipulated by the Atomic Energy Regulatory Board. It will be ensured that only equipments types approved by the Atomic Energy Regulatory Board are installed in the new installations. The old and unsafe equipment will be phased out if they do not satisfy minimum radiological safety requirements.

The layout of the installations will be carried out of under the guidance of Specialists in radiological protection to ensure that all radiological safety requirements are satisfied in every installation from the very beginning. Training programme for technologists and radiologists will be organized to ensure that they are enlightened about safe practice.

MoU is signed with AERB Mumbai & Government of Gujarat.

Total facilities have the AERB Certificate: - CHCs: - 6, Dist & Sub Dist Hospitals:- 12 and Medical College Hospital:- 6 Remaining facilities are in progress.

Capacity Building

For ensuring capacity building under Quality Improvement Programme

  • NABH lead assessor training (Total trained persons 290 for hospitals & PHC / CHC) & NABL Internal audit training (Total trained persons 238) to administrators, clinicians, paramedical & staff nurses etc.
  • Post Graduation Certificate Course in Quality Management and Accreditation of Health care Organization (PGQM & AHO) to the Additional Directors, Superintendents, Chief District Medical Officers, Clinicians and District Quality Assurance Officers (Total trained persons 217) etc.
  • CQI Champion training is completed in all districts Total 3254 participants are trained as a CQI Champion.
  • Other training as per requirement of NABH / NABL standards and mock drills are being conducted.

Patient’s feedback and grievance redressal

All the Accredited healthcare facilities has Feedback form for patients as well as staff, suggestion boxes. And on their basis expeditious grievance redressal Analysis of feedback for corrective action is being done. Documentation of grievance redressed is also done.

Register is assessed for complain and redressed at every 3 months.

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