SINA HEALTH EDUCATION AND WELFARE TRUST ASIF IMAM, M.D. MARCH, 2011.
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Transcript of SINA HEALTH EDUCATION AND WELFARE TRUST ASIF IMAM, M.D. MARCH, 2011.
SINA HEALTH EDUCATION AND WELFARE TRUST
ASIF IMAM, M.D.
MARCH, 2011
THE ORIGINS OFSINA HEALTHCARE SYSTEMSSTARTED AS A PROTOTYPE PRIMARY HEALTH
FACILITY
IN BALDIA TOWN, KARACHI IN 1998
OBJECTIVES :
1. To evaluate the existing primary healthcare
systems in Pakistan
2. To develop an indigenous, practical, evidence-
based, quality-managed, auditable primary
healthcare system for developing countries
Vision
Quality primary healthcare should be
accessible to everyone in our society
SINA HEALTH EDUCATION AND WELFARE TRUST
Our quality mission
TO DEVELOP A STANDARDIZED, QUALITY-MANAGED,
INDIGENOUSLY COMPATABLE PRIMARY HEALTHCARE
SYSTEM FOR WIDESPREAD APPLICATION IN PAKISTAN
SINA HEALTH EDUCATION AND WELFARE TRUST
SINA HEALTH EDUCATION AND WELFARE TRUST
DEVELOPMENT OF QUALITY MANAGEMENT COMPONENTS
STANDARD OPERATING PROCEDURES
QUALITY MANAGEMENT DOCUMENTS AND PROCEDURES
TRAINING OF STAFF IN THE STANDARDIZED SYSTEM
QUALITY AUDITING PROCEDURES AND TOOLS
REMEDIAL AND REPRIMANDING POLICIES ON AUDIT RESULTS
SINA HEALTHCARE QUALITY-MANAGEMENT COMPONENTS
1. DOCTOR TO PATIENT HEALTHCARE DELIVERY QUALITY
2. PARAMEDIC TO PATIENT HEALTHCARE DELIVERY QUALITY
3. PHARMACY TO PATIENT SERVICE QUALITY
4. LABORATORY SERVICES QUALITY
5. INFECTIOUS DISEASE CONTROL / FACILITY HYGIENE QUALITY
6. MEDICAL INSTRUMENTS CALIBERATION / MAINTENANCE
7. FACILITY ADMINISTRATION / PATIENT SATISFACTION QUALITY
Recordkeeping System:Registration Card Patient Files
SINA HEALTH EDUCATION AND WELFARE TRUST
DOCTOR TO PATIENT HEALTHCARE DELIVERY QUALITY
1. DOCTOR RECRUITMENT CRITERIA
2. PRE-EMPLOYMENT ( INDUCTION) SYSTEM TRAINING
3. DOCUMENTING OF PATIENT CARE ON QUALITY MONITORING TOOLS
4. AUDIT OF DOCUMENTED PATIENT HEALTHCARE
5. ON-GOING ON JOB RE-TRAINING (CME)
6. REMEDIAL MEASURES OR REPRIMAND ON QUALITY AUDIT RESULTS
Employment System:Doctors Selection Criteria:
Family Medicine experienceFCPS / MRCGP, preferedEntrance Test
Pre-employment ( Induction) TrainingTo be system trained before doing
clinics
SINA HEALTH EDUCATION AND WELFARE TRUST
Candidate Evaluation Form
Place of Interview:
Screened by: Designation: Date:
1st Interview Date: Panelists 1 2 3
2nd Final Interview Date: Panelists 1 2 3
Required Position Profile of the Candidates: Instructions Please select one box per area. Selection should be based on:
1. Similarity to requirements as specified in the Position Profile 2. Interviewer’s understanding of candidate’s acquired level, skill or experience
Use the “Point Assessment” to rate the candidate level
1 Pre-Interview
Position Profile Candidate Exceeds Exact match Acceptable May be
considered
Required Actual 8-10 5-7 2-4 0-1
Age
Education/ Qualification
Industry Experience
Function Experience
Computer Skills
Required Competencies
Total
Total Score
Exceeds Exact match Acceptable May be
considered Score
50-60 39-49 28-38 17-27
HR Requisition Received:
Full Name (in block letters): First Name Middle Name Last name
Position Title: Grade:
Date of Birth:
Department: Division:
SINA HEALTH, EDUCATION & WELFARE TRUST Candidate Evaluation Form HRM-RS/4/003
Issue 1
SINA HEALTH EDUCATION AND WELFARE TRUST
CME CME SMS ServiceX3/ week
Monthly½ day
group teaching
Feedback onMCQ and SMSperformance
Learner-ledsections
Pre-readingmaterials
Pre and postSession MCQs
Half yearly 1-to-1 reviewand PDP development
Monthlyaudit and
1-to1 teaching
Recordkeeping SystemPatient FilesPatient Registration
Cards14 Algorithmic
Protocols
SINA HEALTH EDUCATION AND WELFARE TRUST
Compromise On
Quality
Sina Protoc ol FEVER
DATE: W / S / D of:
REG NO: TEL: ADDRESS:
AGE: HABITS: CIG. / NASW. / PAAN / GUTKA
CLINIC:
TEMP PULSE PAIN SCORE CURR MED:
BP Si/L/St RR
Ht Wt N . A NAME & SIGN:
C HIEF C OMPLAINT
Fever Nasal Cong. Earache Other Symptoms
HI / LO
SORETHROAT HOARSENESS
WT. LOSS
BODYACHE RASH
FOC USED EXAM Other Findings
Eye Nose Abdomen
Ears Neuro
Lungs Joints
Throat Heart Skin INVESTIGATION Red Flags
CP / ESR MP UDR SDR ALT/ LFT CXR US ABDOMEN Fits
BLOOD C/S URINE C/S Shortness of breath
DIAGNOSIS TREATMENT Altered consciousness
Viral More than 10 days
Wt loss
Neck stif fness
Bacterial: Hyperpyrexia
Pharyngitis Complicated P.falc. Malaria
Tonsillitis Sinusitis Pneumonia
Otitis Media Heat stroke
Bronchitis Other
Pneumonia
UTI
Enteric Fever
Liver abscess REFER
Malaria
Meningitis
Encephalitis
T.B T MYPF RIF3/RIF4 ETHA
Heat Stroke COOLING MEASURES
I / V FLUIDS REFER
Drug Reaction
Other
Diagnosis
PATIENT EDUC ATION / ADVIIC E
T / C AMOX / AUGM / AZIT
Rx / Days FUP REF : Yes / No ZF Pnemonic& Sign:
T/ C NITR / CIPR / CEFI
SINA HEALTH, EDUCATION & WELFARE TRUST
NAME:
OCCUP:
Rash
ALLERGIES:
T / I CEFI / CIPR / CEFT
Sorethroat
Lymph Nodes
DIFF. BREATH. NIGHT SWEATS
CHEST CONG. / WHEEZE
CHILLS / RIGORS MENTAL CONFUSION
ABOVE +
T / C AMOX / CEPR / AUGM / AZIT
EAR PAIN L / R / B
CONT / INTER.
COUGH DRY / CLR / YEL. / BLOOD
T CHL / PROM / LORAT
S DEXT / DXCP
DIFF. SWALLOWING
COOLING MEASURES / STEAM INHALATION / GARGLES
Neck/ Tender Thyroid
CH. DIS: DM / HTN / ASTHMA / TB
JOINT PAIN / SWELLING
ABD. PAIN / DIARRH.
URINE BURN. / FREQ. / YEL.RUNNY NOSE CLR / YEL / NASAL CONG.
FEVER ×
NAUSEA / VOMT.
HEADACHE
T/I METO/ CEFU/CEFT
NAD-√ Not Done-— Abnormal- Description
STOP Rx, CHL / PROM / LORA / PRED
T PYRA PYRI
REFER
T CHLQ / ARTS + T PRIM (FOR VIVAX)
C DOXY / CLIND
INJ CEFT / CEFO / AMPI
INJ CEFT / AUGM / LEVO
T PC / IBU
FEVER PROTOCOL
SINA HEALTH EDUCATION AND WELFARE TRUST
Monthly Doctors’ Audit:Protocol based audits
Clinic based audits
Proper one to one feedback to every
doctor
Review for improvement every month
Proper record keepingSINA HEALTH EDUCATION AND WELFARE TRUST
Doctors name_________________ Clinic___________________ Month of Audit______________
Well Done=2 Adequate=1 Inadequate=Below 0
Fever respsys backpain chestpain GIT headache skin dizziness gynae injury other Comments
Protocol history
Physical exam
Diagnosis
Investigation
Treatment plan
Patients advice
Appropriate=1 Inappropriate= 0
Antibiotic usage
Followup
Referral
Sign documentation
Red FlagsMarks Obtained
Total score __________________ out of 16No of patients seen __________________
Receivers comments_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Providers comment_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_______________Discussed:Yes_______ No:________ Receiver's Signature
Next audit:______________________Provider's Signature
Doctor Audit Form
Description
Clinic Based Audit CONTINUITY OF CARE AUDIT FORM
Doctor: _____________________________ Clinic: _______________________________
Medical Record No: ____________________ Patient Visit Dates:_____________________
Date Of Audit: ______________ Patient: Initial: ____ FUP: ____ Protocol: _____________
0 = Inadequate 1 = Adequate 2 = Well done NA = Not aplicable 0 1 2 NA
Protocol history
Physial examination
Patient education / advice
Follow up plan
Referral
Sign documentation
0=Inadequate 1= Adequate 2=Welldone NA = Not Applicable0 1 2 NA
Diagnosis consistent with H / PAppropriate diagnostic investigationAppropriate treatment planAntibiotic UseAppropriate Continuity of Care
Overall Score : __________________/ 22
Reviewer's comments:
Recommendations:
Corrective measures taken from previous audit:
Corrective measures not taken from previous audit:
__________________________Discussed: Yes: ____No: _____ Assessee's SignatureNext Audit: _________________ ___________________________
Reviewer's Signature
COMMENTS
COMMENTS
Half Yearly Evaluation Of DoctorsEvery six months
Record of the last 6 months performance
One to one feedback
Discuss about the weaknesses and
solutions for improvement
Personal development planning forms SINA HEALTH EDUCATION AND WELFARE TRUST
Half Yearly Evaluation FormDOCTORS HALF YEARLY EVALUATION FORM Doctor's name_________________________
0 1 2 3Knowledge
Average CME posttest scores <60% 60-69% 70-79% >80%Audit scores <70% 70-74% 75-79% >80%SMS-CME scores <70% 70-74% 75-79% >80%CME attendance <70% 70-79% 80-89% >90%
ProfessionalismPunctuality <85% 85-89% 90-95% >95%Patient volume 10pts/hr InadequateAdequateClinic attendance <80% 80-84% 85-89% >90%Patient satisfaction scores <60% 60-69% 70-79% >80%
Communication SkillsPatient communication skills Poor CompetentGood ExcellentInterpersonal relationship with the health team Poor SatisfactoryGood Excellent
Referral Comprehensive written notes No YesAppropriate referrals No Yes
Over all scores /30Previous Performance /30Unsatisfactory <16 Satisfactory=16-19 Good=20-22 Excellent>22
Suggestions for improvement (to be formed into SMART targets on PDP overleafand reviewed in the next evaluation)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Constraints that are holding up change or progress_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Comments ______________________________________________________________________________________________________________________________________________________________________________________________________________________________
Name of evaluator_________________ Name of Doctor________________________Signature of evaluator_____________ Signature of doctor_____________________Date___________-
PDP formPDP FORMDr_____________________
Development needs How to address
Date to achieve the goal
Outcome I plan to see
e.g. gain greater skills in managing common gynae problems
e.g. use MCQs to develop knowledge on management, try 1 or 2 on line learning modules e.g. 1/1/11
e.g. increased scores on gynae protocol audits
SINA HEALTH EDUCATION AND WELFARE TRUST
SINA Health Manpower Training Program : Internal
Lack of quality human resource
Training upon employment
Continuous education
Periodic exams & evaluation
Performance feedback
SINA HEALTH EDUCATION AND WELFARE TRUST
PARAMEDIC OSCE CHECKLIST
Name_____________________ Clinic__________________ Date________________Examiner Name__________________ Examiner Sign_________________________
Proper Uniform Y/N Wearing ID card Y/N Watch Y/NNails cut Y/N
BLOOD PRESSUREYes No
Blood Pressure Positioning appropriateCuff Applied ProperlySystolic BP measured properlyCuff deflated slowly
Pulse Approproate pulse used Yes=2Time duration appropriate No=0
Temperature Thermometer cleanedPt asked about place of measurement
Resp Rate Measurement appropriate
Weight Measured appropriately
Total Marks Obtained _______/ 20
INJECTION Yes No
Gloves wornYes=2
Needle filled appropriately No=0
Positioning of needle appropriate (IM inj)
Positioning of needle appropriate (SC inj)
Needle discarded appropriately
Total Marks Obtained________/ 10
PHLEBOTOMYYes No
Gloves worn
Positioning of patient appropriate Yes=2No=1
Appropriate blood vessel used
Needle discarded appropriately
Saniplast applied
Total Marks Obtained________/ 10
DRESSINGYes No
OSCE CHECKLI
ST
TPR Station:
Dressing station:
Dispensing station:
SINA HEALTH EDUCATION AND WELFARE TRUST
SINA Pharmacy Services
Standard Formulary GMP Certified Medicines Central PurchasingFIFO Inventory ControlHygienic PracticesTrained StaffQuality Control
SINA HEALTH EDUCATION AND WELFARE TRUST
SINA HEALTH EDUCATION AND WELFARE TRUST
LABORATORY QUALITY CONTROL
Internal Assessment
Continuous quality improvement
External Assessment
Monthly comparative testing with AKUH lab
Adherence to SOP manuals
Quarterly audits
SINA HEALTH EDUCATION AND WELFARE TRUST
Medical Centre Audit:Monthly audit by head office staff
Follow proper checklist
All registers and written
documentations are checked
Medical equipments checking
Corrective actions takenSINA HEALTH EDUCATION AND WELFARE TRUST
CLINIC:________________ DATE:_________________
Auditor:_________________ Designation:_____________
Yes No Corrective ActionAttendanceSignatureTime in & Time outAbsent / Late
Reception WindowTimelinessPatients file searchableToken GivenRegister Prepared properly
Financial statusMantainance of manual cash registerCash TallyRegular Cash Deposit Filing of documents
EquipmentsEquipments repairableEquipments RequiredCalibrationEmergency KitSterilization of EquipmentsO2 cylinder status
Laboratory CollectionProper Blood SamplingRegister EntrySlip Book TallyUltra Sound Register MaintaindX- Ray Register Maintaind
Yes No Corrective ActionCleanlinessBed SheetsWallsFloorWash BasinInstrumentsEquipmentsCabinetsWash Room
ComputerWorking properly
Data updated
MEDICAL CENTER AUDIT CHECK LIST MEDICAL CENTRE AUDIT CHECKLIST
SINA HEALTH EDUCATION AND WELFARE TRUST
Standard Operating ProceduresInstrument Sterilization
Clean the dirty instruments with cotton swabs.Wash with tap water.Dip the instruments in antiseptic solution for
5-10 min.Wrap the instrument in cotton and keep in the
instrument tray Keep the tray in sterilizer at 150 F for 20 min.
SINA HEALTH EDUCATION AND WELFARE TRUST
Clinical Waste Segregation
Red Bags Hazardous Waste
Danger BoxSharps & Needles
Green Bags General Waste
SINA Waste ManagementSINA Waste Management ServiceService
SINA HEALTH EDUCATION AND WELFARE TRUST
SINA Waste Management Service
78 km twice a week
BALDIACLINIC MACHAAR CLINIC
HIJRAT CLINICSABZIMANDI CLINIC
CDGK INCINERATOR
SINA HEALTH EDUCATION AND WELFARE TRUST
SINA HEALTH EDUCATION AND WELFARE TRUST
SINA HEALTH EDUCATION AND WELFARE TRUST
SINA Management System
Monthly Meeting of Clinical Coordinator and Clinic
Manager
Minutes By Clinic Managers
Clinical Coordinator Trustees and
Operation Manager
Solutions Provided To
Clinic Manager
SINA HEALTH EDUCATION AND WELFARE TRUST