2017 Mutu Sesi 16 AU Kerangka Mutu Kebutuhan Pengembangan di Indonesia

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Kerangka Kerja Mutu:

Penguatan Proses Pengembangan di Indonesia

1

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Struktur

• Mengapa dibutuhkan Kerangka kerja mutu?

• Kerangka kerja mutu:

Indonesian National Quality Framework

Pemikiran mengenai langkah pengembangan

Mengapa dibutuhkan Kerangka kerja mutu?

Kerangka kerja mutu:

Indonesian National Quality Framework

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Mutu: Perubahan Paradigma

Service Excellence

Clinical Excellence

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Global Burden of Unsafe Care

(Jha et al., 2013)

• In every 100

hospitalisations, there were approximately 14.2 of these adverse events in HICs and 12.7 in LMICs.

In every 100

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Is Safety-Quality important?

Lit review (Sandars & Esmail 2003)

• Medical errors: 5 80x in 100,000 consultations

• Prescribing error: 11% of total prescriptions

Lit review (Sandars & Esmail 2003)

Medical errors: 5 80x in 100,000 consultations

Prescribing error: 11% of total prescriptions

Primary care clinics, Malaysia (Khoo et al, 2012):

• 3.6% diagnostic errors

• 41.1% medication errors

• 39.9% of errors had the potential to cause serious harm.

• 98.0% illegible handwriting

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Structure

What resourcesdo you use:

Resources

Personnel, Equipment, drugs, finance

etc.

Donabedian’s framework of quality care

Process

How to use the resources: Care

processes

Standards, Guidel ines, SOP

Outcome

result?What is theResult

Result of care: Disability, death, dissatisfaction, cli

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Apa yang perlu dimiliki Indonesia

untuk membangun Mutu?

Struktur

Direktorat Mutu dan Akreditasi

Regulasi Mutu dan Keselamatan Pasien Kerangka Kerja Mutu Komite nasional

Proses

Perijinan Akreditasi

Sistem manajemen mutu Panduan Praktek Klinis Standar, prosedur, norma dll.

Outcome

Indikator

Peningkatan mutu Pengalaman pasien Direktorat Mutu dan

Akreditasi

Regulasi Mutu dan Keselamatan Pasien Kerangka Kerja Mutu Komite nasional

Perijinan Akreditasi

Sistem manajemen mutu Panduan Praktek Klinis Standar, prosedur, norma dll.

Indikator

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Quality framework

• Quality framework is a framework that is

applied as a foundation for improving quality of services (at geographical level, institutional level, service level, professional level etc)

• Quality framework represents the

stakeholder s commitment toward quality dimensions and their priorities,

measurements, regulations and quality management system

Quality framework is a framework that is

applied as a foundation for improving quality of services (at geographical level, institutional level, service level, professional level etc)

• Quality framework represents the

stakeholder s commitment toward quality dimensions and their priorities,

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Quality Framework

A. How do we achieve Quality?

Kerangka kerja nasional

Tata kelola Klinis Sistem manajemen mutu Akreditasi RS Akreditasi Pkm Dll.

B. What level of quality are we committed to provide to our patients, families and communities?

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Six quality aims

(Institute of Medicine, USA)

•

Safe

•

Effective

Patient centered

•

Timely

•

Efficient

Equitable

Safe

•

Effective

•

Patient centered

Timely

•

Efficient

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National Strategy for Quality

Improvement in Health Care (US)

3 Aims

• Better Care: Improve the overall quality, by making health care more

patient-centered, reliable, accessible, and safe.

• Healthy People/Healthy

Communities: Improve the health of the U.S. population by

supporting proven interventions to address behavioral, social

and, environmental determinants of health in addition to delivering higher-quality care.

Affordable Care: Reduce the cost of quality health care for

individuals, families, employers, a nd government.

6 Priorities

• Making care safer by reducing harm caused in the delivery of care.

• Ensuring that each person and family are

engaged as partners in their care.

• Promoting effective communication and coordination of care.

Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with

cardiovascular disease.

Working with communities to promote wide use of best practices to enable healthy living.

Making quality care more affordable for individuals, families, employers, and

governments by developing and spreading new health care delivery models.

Better Care: Improve the overall quality, by making health care more

patient-centered, reliable, accessible, and safe.

• Healthy People/Healthy

Communities: Improve the health of the U.S. population by

supporting proven interventions to address behavioral, social

and, environmental determinants of health in addition to delivering higher-quality care.

• Affordable Care: Reduce the cost of quality health care for

individuals, families, employers, a nd government.

Making care safer by reducing harm caused in the delivery of care.

Ensuring that each person and family are

engaged as partners in their care.

Promoting effective communication and coordination of care.

• Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with

cardiovascular disease.

• Working with communities to promote wide use of best practices to enable healthy living.

• Making quality care more affordable for individuals, families, employers, and

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Tanzania: 2011-2016

• Acceptability/patient centeredness

• Technical competence

• Access

• Interpersonal relations

• Effectiveness Equity

Efficiency Safety

Continuity of care Choice of service

Physical infrastructure & Amenities Acceptability/patient centeredness Technical competence

Access

Interpersonal relations

• Effectiveness

• Equity

• Efficiency

• Safety

• Continuity of care

• Choice of service

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Dimensi Mutu:

Indonesia

Dari beberapa dokumen kebijakan:

• Akses

• Continuity of care Cost of care

Infrastruktur fisik

Ketersediaan obat-alkes Kompetensi teknis SDM Dari beberapa dokumen

kebijakan: Akses

• Continuity of care

• Cost of care

• Infrastruktur fisik

• Ketersediaan obat-alkes

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Dari Kerangka Kerja Mutu ke Indikator:

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• Clinical indicators

• Patient safety indicators

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Indeks

Kepuasan

Masyarakat Indikator Klinis

Indikator Mutu

Indikator dari beberapa

lembaga: Indikator

Kinerja Individu

Indikator Mutu Pelayanan RS

Mutu beberapa

lembaga:

KARS, BPJS, Kemenkes

Indikator Keselamatan Pasien

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Quality Improvement

– We need to improve and a system to

improve

– Every system is

perfectly designed to achieve exactly the results it gets.

The first law of improvement

We need to improve and a system to

improve

– Every system is

perfectly designed to achieve exactly the results it gets.

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Akreditasi di negara-negara lain

• Kyrgyztan • India • Mongolia • Philippines • Albania Jordan Thailand

Bosnia (AAQI, AKAZ) Colombia Serbia South Africa Germany • Brazil • Lithuania • Poland • Croatia Saudi Arabia Czech republic South Korea Portugal Taiwan England Japan France Denmark Switzerland New Zealand Spain Canada Australia USA Netherlands Kyrgyztan India Mongolia Philippines • Albania • Jordan • Thailand

• Bosnia (AAQI, AKAZ)

• Colombia

• Serbia

• South Africa

• Germany

Brazil

Lithuania Poland

• Croatia

• Saudi Arabia

• Czech republic

• South Korea

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Perbandingan antar lembaga akreditasi

menurut:

• Fokus organisasi • Struktur organisasi

• Jumlah RS terakreditasi • Histori

• Tata kelola dan kepemimpinan

Persyaratan akreditasi Proses survei

Frekuensi survei Surveyor

• Proses skoring

• Kategori akreditasi • Biaya akreditasi • Proses keputusan

akreditasi Support akreditasi Advokasi Keselamatan pasien Peningkatan mutu Dll. Fokus organisasi Struktur organisasi

Jumlah RS terakreditasi Histori

• Tata kelola dan kepemimpinan

• Persyaratan akreditasi • Proses survei

• Frekuensi survei • Surveyor Proses skoring Kategori akreditasi Biaya akreditasi Proses keputusan akreditasi

• Support akreditasi • Advokasi

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Apa dampak akreditasi?

• Brubakk et al., Systematic review of hospital accreditation: the challenges of measuring complex intervention effects. BMC Health service research, 2015, 15:280

• Dorongan terus menerus untuk akreditasi, akan tetapi

bukti yang menunjukkan efektivitas dan efisiensinya minimal, sehingga tidak dapat ditarik kesimpulan tentang dampaknya.

• Sebagian besar studi tidak melaporkan konteks

intervensi, implementasi ataupun biaya

Tantangan dalam menilai dampak Akreditasi dan sertifikasi yang merupakan contoh intervensi yang kompleks dan beragam

Diperlukan studi untuk menjawab: Apa aspek akreditasi yang dapat bermanfaat untuk

meningkatkan keselamatan pasien dan kinerja organisasi?

Brubakk et al., Systematic review of hospital accreditation: the challenges of measuring complex intervention effects. BMC Health service research, 2015, 15:280

Dorongan terus menerus untuk akreditasi, akan tetapi bukti yang menunjukkan efektivitas dan efisiensinya minimal, sehingga tidak dapat ditarik kesimpulan tentang dampaknya.

• Sebagian besar studi tidak melaporkan konteks

intervensi, implementasi ataupun biaya

• Tantangan dalam menilai dampak Akreditasi dan

sertifikasi yang merupakan contoh intervensi yang kompleks dan beragam

• Diperlukan studi untuk menjawab: Apa aspek

akreditasi yang dapat bermanfaat untuk

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Remaining questions on accreditation

• Improving clinical outcomes?

• Improving participation of clinician? • Improving patient satisfaction?

• Improving patient experience? Improving patient safety?

Improving departmental quality improvement initiatives?

Efficient quality improvement strategy? Improving clinical outcomes?

Improving participation of clinician? Improving patient satisfaction?

• Improving patient experience? • Improving patient safety?

• Improving departmental quality improvement initiatives?

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Quality Framework

A. How do we achieve Quality?

Tata kelola Klinis Sistem manajemen mutu Akreditasi RS, Pkm Dll.

B. What level of quality are we committed to provide to our patients, families and communities?

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Usulan: Lima Tahap Pengembangan

Kerangka Kerja Mutu (KKM)

Desk review

Berbagai dokumen kebijakan

Dari berbagai lembaga (Kemenkes, KARS, BPJS, d ll) Output: Kompilasi dimensi mutu Eksploratori Menggali dimensi prioritas Memetakan berbagai peran lembaga Mengidentifikasi

indikator dan strategi Output: Usulan kerangka kerja

Formulasi

Merumuskan Quality Framework

Menyusun indikator dan strategi QI

Output: Kerangka Kerja Mutu Pelayanan

Kesehatan Indonesia Berbagai dokumen

kebijakan

Dari berbagai lembaga (Kemenkes, KARS, BPJS, d ll) Output: Kompilasi dimensi mutu Menggali dimensi prioritas Memetakan berbagai peran lembaga Mengidentifikasi

indikator dan strategi Output: Usulan kerangka kerja

Merumuskan Quality Framework

Menyusun indikator dan strategi QI

Output: Kerangka Kerja Mutu Pelayanan

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Usulan Tahap Pengembangan

Kerangka Kerja Mutu (KKM)

Implementasi Pilot Ujicoba Kerangka Kerja Mutu Ujicoba indikator Sistem pemantauan indikator Penyusunan Panduan Panduan pengembangan lanjutan kerangka kerja mutu di tingkat

propinsi, kabupaten, fask es dll

Guideline penerapan kerangka kerja

Guideline pengukuran indikator

Ujicoba Kerangka Kerja Mutu

Ujicoba indikator Sistem pemantauan indikator

Panduan pengembangan lanjutan kerangka kerja mutu di tingkat

propinsi, kabupaten, fask es dll

Guideline penerapan kerangka kerja

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Quality Improvement

We have two jobs: our job and the

job of improving our job

Donald Berwick

We have two jobs: our job and the

job of improving our job

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