Roadmap towards development of Quality Improvement Policy and Accreditation Framework in Kenya By

Transcription

1 Roadmap towards development of Quality Improvement Policy and Accreditation Framework in Kenya By Dr Lucy Musyoka Deputy Director, Medical Services 9/26/ Dr Lucy Musyoka

2 Presentation Outline Introduction Importance of Quality Improvement Policy Process of QI Policy Development Progress to date Proposed Steps Observed Characteristics of the QI Development process in Kenya 2

3 Introduction Kenya Constitution mandate -To Address the citizens expectations of the right to the highest attainable standards of health including reproductive health and emergency treatment as enshrined in the constitution(article 43) Kenya Development Blue print-vision 2030 Social pillar - intends to improve the overall livelihoods of Kenyans by providing an efficient and high quality health care system with the best standards. 3

4 Population: 40 million Introduction Kenya: Health Indicators Key health indicators improving but Maternal Mortality remains stagnant Disparities in access to care both regionally and across wealth quintiles Quality of care remains a challenge to achieving better health outcomes Key quality processes and practices still being institutionalized 4

5 Introduction- What is the Kenyan strategic response?? 5

6 Introduction What is the Kenyan Operational response? Development and Institutionalization of Kenya Quality Model for Health The Kenya Quality Model for Health (KQMH) is a conceptual framework for an Integrated Approach to improved quality of health care Evidence-based Medicine/Health with Total Quality Management and Patient Partnership Development/innovation and recommendations for use of clinical and public health products and technologies, Development/revision and dissemination standards and guidelines that are evidence-based Application and integration of QM principles into the organization Input > Process > Outcome: Use of the Checklist (Level 2,3,4,5&6) Patients/Clients are co-producers of health outcome Promote community involvement and participation Respect patients rights and views 6

7 Introduction What is the Kenyan Operational response? Journey to Quality Improvement 7

8 Importance of Quality Improvement Policy Create common vision for QI in line with Vision 2030 and constitution 2010 Article 43. Legitimize the systematic and holistic approach to an integrated quality improvements as envisaged in KQMH framework Legitimize the continuum of Quality Improvement Establish authority to act Legitimize QI programs, QI approaches /Methodologies Facilitate coordination of QI activities among the diverse stakeholders Guide action plans Provide basis for resource mobilization Set framework for program evaluation in particular Impact evaluation of diverse QI approaches Provide basis for further action 8

9 Process of QI Policy Development Problem Identification Policy Development Policy Implementation Policy Monitoring and Evaluation (originally from Lasswell, 1951) 9

10 Key Inputs into the Policy Process People/Places Policy Stakeholders and Institutions (government and nongovernment) Process Policy Development (problem identification, issue framing, agenda setting, dialogue and formulation) Political, Social, and Economic Setting/Context Problem Issue Price Resource Allocation Programs/ Performance Policy Implementation (including organizational structure, resources, and evaluation) Paper (or Paperless) Policies, Laws, Regulations (Laws, explicit or implicit national and operational policies, resource allocation plans) 10 Source: Hardee, et al. 2003

11 Problem Identification-what has been done Design and Feasibility Study on Accreditation of Health Services, 2009-Options for the Accreditation of Health Services in Kenya- Study Objectives 1. Provide a stock take of quality/accreditation situation in Kenya 2. Recommend a roadmap towards a full health facilities accreditation system Study carried out by evaplan GmbH Commissioned by Ministry of Health with Support Support from GIZ 11

12 Problem Identification -what has been done Policy seminar organized by Department of Standards and Regulatory Services with support of URC with the theme of Thoughtful Conversation on National Improvement Strategies and Infrastructure for Improving Health Care on February 19th tofebruary21st2013., Attended by local and international players in Quality Improvement The Policy seminar was guided by the following questions? How did the improvement effort(s) you have experienced start? What improvement approaches were used? What is the role of accreditation? What are the next steps and directions for accreditation in Kenya? What would you advise the MOH of Kenya related to national improvement strategy? 12

13 Second step-policy Formulation Develop policy goals, objectives and policy options proposed solutions to the identified problem are articulated, debated and drafted into policy language Development of one or two goals: Summarize the ultimate direction or desired achievement of QI policy Objectives: What are the desired impacts or effects? Policy options: Analyze several and justify the selected policy option, link the selection to its potential in realizing the policy goals and objectives 13

14 Policy seminar-way forward Define client oriented Quality Policy and Regulatory framework Approaches Build consensus with all stakeholders and with Top leadership commitment Legislate Quality Improvement in the draft Health Bill DraftRegulations to support the reinforcement Institutional Arrangements Define institutional roles in the health law The health systems- National and county The proposed professional council Inspectorate bodies KENAS KEBS Independent accreditation bodies through a PPP arrangements 14

15 Policy seminar-way forward Approaches Define priorityareas(tracer conditions) to focus quality improvements for both private and public sector -Review and update KQMH tobe the National Quality model to be legitimized through a regulation for all implementors to use Adapt a multi-approaches that align to KQMH. Have an M/E Framework with one agreed national checklist, Quality indicators which all implementors will use. Institutional Arrangements Departmentin health to be given mandate to coordinate QI interventions Health sector coordinating structure to be utilized toreinforce compliance with DPs KQMH Quality standards to be recognized through KEBS as national standards 15

16 Policy seminar-way forward Approaches Set timelines and progress indicators Communicate with clients Principles agreed on Leadership commitment System approach Process orientation Involve all stakeholders and people Shared learning to create learning organization Patient/client centeredness Empowering problem solving teams Embrace multiplicity of QI approaches thatallignto a national framework Invest more on changing organizational culture towards Quality Improvement Institutional Arrangements Departmentin health to be given mandate to coordinate QI interventions Health sector coordinating structure to be utilized toreinforce compliance with non-governmental institutions and projects 16

17 Policy seminar-way forward Approaches Embracequality assessments methodologies such as Peer review,audit,checklists, Introduce quality prizesfor top performers Institute Quality improvement in performance contracting of all health managers Make it mandatory submission of progress reports by all health institutions and programmesof the QI activities and how they have caused change to health Institutional Arrangements Pilot Volunteer certifications(star rating Health sector coordinating structure to be utilized toreinforce compliance with non-governmental institutions and projects 17

18 Policy seminar-way forward Accreditation framework Need for legislation Need to interrogate Draft accreditation bill and health bill to ensure it reflects on accreditation Independent body preferred that has a linkage with KENAS Independent body to benefit from the public private partnership Independent body should have participatory from professional bodies,private institutions etc, 18

19 Policy seminar-way forward Evaluation of KQMH checklist as an Accreditation Model KQMH is a strong, structured and qualitatively sound approach to quality management in health care facilities 19

20 ..and The Price Tag? Financial, physical, and human resources that are needed to implement policies, plans, and programs Identify Resource Requirements Allocate Resources Estimate Revenue & Expenses Budget Prioritize Resource Use 20

21 Policy advocacy, consultations and dialogue Identify, analyze and build support of decision makers and influencers Understand the people (or stakeholders) who participate in the process of policy making, their views on the problem, and the various roles they play in policy making Determining the stakeholders, and their layers and levels. It is a complex process. Some groups would even be negatively affected by the policy change eg 21

22 Example of Policy Kenyan Stakeholders Civil Societies, Associations Unions International Agencies Government -National Government,County Governments,CIC,AGoffice,,Regulatory bodies, Parastatals-NHIF Support groups Politicians- Parliamentary Health Committees, NGO & Academic Community organizations Providers-Public and Private sector,fbos 22

23 Stakeholder Analysis and Political Mapping Technique Who are the key players? Are they affected in a positive or negative way by the issue? What is their power/influence in the sector? To what extent are they applying their influence for or against the issue? How easily can their applied influence be changed? What significant relationships exist among the key players? 23 P

24 Stakeholder Map Importance A: High Importance Low Influence C: Low Importance Low Influence B: High Importance High Influence D: Low Importance High Influence Influence 24

25 Write or revise policy Clarity in the purpose, goals and objectives of the policy Description of regulations and sanctions if they apply A plan for promoting and disseminating the policy A plan for monitoring and evaluating the policy Be prepared to revise as many times as practical 25

26 The Paper: Policies, Laws and Regulations Rationale Goals and objectives Program measures (broad categories of activities) Implementation and institutional arrangements Funding and other sources Indicators of success Monitoring and evaluation plan 26

27 Policy Implementation Legitimization, or getting the policy accepted as important, desirable, and worth achieving. Constituency building, or gaining active support from groups that see the policy as desirable and beneficial. Adequate resource availability for policy implementation 27

28 Policy Implementation..contd Organizational structure involves adjusting the objectives, procedures, systems, and structures of implementing agencies Mobilizing action, or marshalling committed constituencies to develop action strategies to translate into result Monitoring impact to assess the progress of implementation

29 Policy Implementation Programs are put in place to implement policies Strategic plans Implementation plans Operational policies 29

30 Policy monitoring and evaluation Enables determination of long term effectiveness, feasibility and support for policy measures Early identification of problems and timely policy amendments for changes occurring over the period Note that policy M&E is engulfed with;» Long timeframes» Moving targets» Possible external influence» Continued relevance and level of interest may fade among stakeholders 30

31 Notable Characteristics of policy process in Kenya Dynamic process of decision making that includes a range of stakeholders with diverse interests Evidence-based policy may be the ideal but Politics has been playing a central role just as quoted below Sometimes we are told, this is what we want to do. Make up a rationale. (Howard, 2005). Lack of top leadership commitment-no Budgetary allocation Long timeframes and erratic rhythms-process started in to date no much progress 31

32 LET US ENJOY OUR STAY IN KENYA Thank you very much! QUALITY SAFETY 9/26/2013 Dr Lucy Musyoka 32