QUALITY IMPROVEMENT INITIATIVE

. QUALITY IMPROVEMENT INITIATIVE. Dr. Adap Dr. Fuentecilla Dr. Lauron-Liboro Dr. Manor Dr Valeza-Ibana Dr. Zipagan.

[Audio] For a brief background, Cavite is part of the Philippines' largest island, in Luzon. Found in the southern portion, Cavite belongs to Region 4A ( CALABARZON) With 6 cities and 19 municipalities….

[Audio] Cavite has a 3,678,301 population as of August 2015 to a projected increase to 4,219,183 for 2019, Cavite was noted to be the most populous province in the province based on POPCEN 2015. By 2025, the population is expected to increase to 5,244,563.

[Audio] For the health profile, Cavite has 12 public and 43 private hospitals ( 1 level 4, 10 level 3). There is only 1 DOH hospital in region IV B which is located in batangas ( BMC). As for the Health manpower is approximately 59 doctors, 30 dentists, 181 nurses, 295 midwives, 3327 BHWs and 894 BNSs ( BRgy nutrition scholars). With this in mind, we came up with the following prioritization matrix for our QI initiative….

[Audio] Among the public hospitals in Cavite, there is one hospital that we consider as the referral hospital. This hospital was the first public hospital established in the province and currently the provincial office is situated here..

KAWIT KALAYAAN HOSPITAL. SHORT INTROUDCTION BED CAPACITY SERVICES OFFERED.

PRIORITIZATION MATRIX. ℅ doc mary jane.

[Audio] Let us now proceed with the statement of the problem. How do we make the appropriate level of care available to patients to decrease preventable morbidity and mortality? especially those that are due to lack of appropriate services, and lack of facilitated referral system.

abstract. BACKGROUND & CONTEXT. .

[Audio] For a brief context, I shall begin with figures from LuzonHealth in year 2015. LuzonHealth was a five-year health service strengthening project of USAID and Philippines. It provided technical assistance to integrate and scale-up best practices and innovations to increase utilization of maternal, neonatal, child health and nutrition, and family planning services at the LGU level. One of its strategies included improving health policies and systems through evidence-based interventions. So in 2015, they did a baseline assessment of the 21 partner hospitals in Luzon to identify the needs and gaps in the existing service delivery network then. And the results of the assessment indicated that only 20 percent or 4/21 of LuzonHealth project sites claimed to have written referral arrangements and agreements among the service delivery facilities, whereas 80 percent or 18/21 of the LGUs had none at all. It has also been estimated that 73 percent of maternal mortality could be averted if all women received appropriate emergency obstetric care and that timely identification and safe transfer of patients through the three tiers would have decreased the incidence of preventable maternal, neonatal, and child mortality.

[Audio] I would like to provide further context through this fish bone illustrating how interconnecting factors led to the matter of concern which is lack of effective and facilitated health referral system. A number of us are currently deployed in primary level hospitals, myself included. It is not uncommon that we encounter patients with complex diseases requiring a specialized or a higher level of care that cannot be sufficiently addressed in a primary health care setting due to myriad of reasons, some are flashed before you. One of these would be the recognizable lack of available equipment & medications, another would be the lack of an institutionalized referral system. Because of the factors that we listed in this fish bone, the level of care that we are able to provide becomes very limited. Even if we wanted to do more for our patients, we can only do so much. And this underscores the crucial role of our secondary, tertiary, and specialized hospitals. Having an effective and coordinated health referral system would guarantee access to a continuum of health services across political and geographical boundaries through a a unified delivery system. It would also allow complementation of different levels of health services. After all, across all span, our goal remains the same— to achieve better health outcome for all..

QI Action Plan. ℅ doc Mario. Necessary Actions Timeline Responsible person Resources needed Success indicator Remarks 1. Establish a dialogue with the medical center chief regarding establishing a facilitated and effective referral system. Telecommunication services Transportation services (Ambulance) Additional manpower 4th week of January, 2022 PRDP MCC Man hours Virtual platform Setup of the hospital phoneline Provision of hospital/duty phone with internet access Submitted request for recruitment of manpower (HCW and driver) Working and available ambulance Will include barangay ambulance Will include the following: 1. Municipal/Barangay Health Station Ambulance 2. Barangay patrol vehicle.

QI Action Plan. ℅ doc Mario. Necessary Actions Timeline Responsible person Resources needed Success indicator Remarks 2. Identify potential partner hospitals outside and within Cavite (e.g. primary/secondary/tertiary hospitals, specialty centers) 1st week of February 2022 HR Man hours Internet access Directory of hospitals with contact numbers Separate Uncoordinated referral logbook Coordinated referral logbook Separate incoming and outgoing referral logbook.

QI Action Plan. ℅ doc Mario. Necessary Actions Timeline Responsible person Resources needed Success indicator Remarks 3. Coordinate with hospital MCC regarding establishment of MOA with other hospital 2nd week of February 2022 PRDP MCC Admin Manhours Virtual platform link Set a meeting with other institution Agreement with the proposed guideline and communication platform Pagamutan ng Dasmarinas Ospital ng Imus Tertiary level hospital Secondary level hospital Primary/Infirmary hospital Birthing home.

QI Action Plan. ℅ doc Mario. Necessary Actions Timeline Responsible person Resources needed Success indicator Remarks 4. Establish a referral guideline and creating platform for communication to operationalize the referral system 1st week of February 2022 PRDP Manhours Virtual platform link Finalized process flow for coordinated transfers 5. Orientation of HCW regarding the newly established referral guideline 2nd week of February 2022 HCW PRDP Manhours Virtual platform link Set a meeting with involved personnels Attendance Sanctions and rewards 6. Implementation of the established referral system 3rd week of February 2022 PRDP MO3s Manhours Waiting time Successful coordinated transfer.

QI Action Plan. ℅ doc Mario. Necessary Actions Timeline Responsible person Resources needed Success indicator Remarks.

What worked well?. ℅ Doc Kara. .

[Audio] • Prioritization matrix is an important step to identify which problem is important to solve first because we can not do everything. There are many outstanding QI initiative project that could be quick wins but it is only a matter of prioritization which to accomplish first to increase the chances of implementation success. Better to start from simple issues before complicated ones. •Brainstorming and identifying underlying problem helps to improve the improvement process. Indeed, two heads are better than one. Team approach is the best way to get idea and views from different people. Identifying the root cause to address the issue is the key to in making successful action plan..

[Audio] Making a interhospital referral system between locally funded hospitals within cavite is impossible at this moment. Take for example the Pagamutan ng Dasmarinas MCC commented that Dasma as being one of the highest populated city in Cavite is only a 120 bed capacity which is not even enough to accommodate their own residents. Although, she said that they can accept non dasma patients every and now then if there is available bed and probably emergency basis. As we decided to change our project late in January, this leads to delay of implementation of our action plan..

Next step for QI within the healthcare setting. • Implementation of action plan 4-6 • Continue to apply the PDCA cycle to improve QI in healthcare. It is important to revise intervention based on the result and continue to monitor change. • Establishment of interhospital referral system within Cavite and other specialized institutions.

Next step for QI within the healthcare setting. • Follow up plan of setting up the telecommunication, transportation, and adding additional manpower for easy referral • Look for people that would continue this initiative ●Establishment of another provincial hospital which would serve as the primary referral center of the province.