Main description:

Patient safety and quality improvement in health care remain a global priority. Subpar performance in health care, however, is still common more than a decade after the christening of patient safety in Africa. The core principle of safety and quality improvement systems is to identify and assess the root cause of failures in order to learn from them and devise a means to improve and to avoid recurrence. This book is designed to encourage, facilitate and empower healthcare workers in the development and implementation of strategically driven patient safety and quality improvement initiatives for safer healthcare systems and healthcare facilities in low- and middle-income countries (LMICs) of Africa. It also highlights some of the profound challenges and barriers to designing and implementing patient safety and quality improvement interventions or programmes in the region and reiterates the need to remain focused and determined to work out solutions with confidence and overcome these barriers.
In the book, chapters highlight six essential components crucial for achieving evolutionary progress in safety and quality improvement in a healthcare system:

Standard operating procedure
Audit
Research
Safety management
Quality management
Evaluation

Practical steps in planning and conducting these six essential components are outlined with some specific features to aid learning and facilitate their implementation.
The authors have experience and expertise in the medical practice gained in Africa and a decade of knowledge and experience from consultancy work in safety and quality improvement in health care within and outside the region.

Essentials for Quality and Safety Improvement in Health Care: A Resource for Developing Countries is authored for both medical professionals and those from other professions who are interested in and enthusiastic about patient safety and healthcare quality and therefore willing to build a career in this field. It is relevant to all health institutions, health and non-health workers, and can be used as a checklist while rendering quality and safe health care.

Contents:

Chapter 1 - Concept of Quality and Safety Improvement in Health Care. 16

Introduction. 16

Healthcare and Healthcare System in Africa. 16

Impact of Medical Errors and Adverse Events in the Healthcare System in Africa. 17

Patient Safety. 18

Patient Safety in the African Healthcare System.. 19

The Importance of Patient Safety. 19

Quality and Safety Improvement in Healthcare. 20

The Costs of Poor Quality of Care and Services in Africa. 20

The Challenges of Safety and Quality of Care Improvement in Africa. 21

Poor Infrastructure. 22

Workforce Shortage. 22

Health Policies, National and Local Guidelines. 22

Weak Legal Mandates, Accreditation, and Administrative Regulations. 23

Weak Legal and Judicial System.. 23

Organisational and Institutional Influencing Factors. 23

Poor Quality Data in Healthcare. 24

Leadership and Governance Problem.. 24

Prerequisite for the Essentials for Quality and Safety Improvement in Healthcare. 24

Creating and Sustaining Patient Safety Culture. 25

Secure Organisational Supports at all Levels. 26

Create Safety and Quality Department (SQD). 26

Effective Healthcare Management. 27

Conclusion. 30

References. 31

Chapter 2 - Standard Operating Procedure. 37

Introduction. 37

Standard Operating Procedure. 37

Development of Standard Operating Procedure (SOP). 38

Testing and Reviewing of Standard Operating Procedure. 42

Implementation of Standard Operating Procedure. 42

Benefits of Standard Operating Procedure in Healthcare Settings. 42

Optimising Healthcare Data Quality and Documentation. 43

Improving Healthcare Facility and Environment. 45

Improving of Procurement Management. 45

Enhancing Training and Development. 47

Barriers and Enablers to Implementation of SOPs in Healthcare in Africa. 47

Conclusion. 47

References. 49

Chapter 3 - Audit. 52

Introduction. 52

Audit. 53

Remote Audit. 53

Remote Audit in African Healthcare Settings. 54

Audit Design, Conduct and Implementation of Findings. 54

Step 1: Choosing a Topic. 54

Step 2: Defining Standards. 56

Step 3: Data Collection. 58

Step 4: Data Analysis. 60

Step 5: Finding Presentation. 60

Steps 6: Change Implementation. 62

Step 7: Re-Audit. 62

Benefits of Audit in Healthcare in Africa. 63

Encouraging the use of Modern Medicine in the Region. 63

Evaluating Health Policies and Guidelines. 64

Designing Educational and Training Programme. 64

Improving the Quality of Medical Records. 64

Barriers and Enablers for Effective Audit in Healthcare in Africa. 65

Conclusion. 66

References. 67

Chapter 4 - Research. 71

Introduction. 71

Healthcare Research. 72

Research Ethics, Governance and Integrity Training. 72

Planning, Designing, Conducting, Recording and Reporting Healthcare Research. 75

Planning and Designing Healthcare Research. 75

Identification Research and Framing a Question. 77

Determine and Evaluate Literature. 78

Research Team and Responsibility. 78

Research Sponsor and Responsibility. 79

Feasibility Assessment and Evaluation. 80

Ethical Review of Healthcare Research. 80

Composition of Ethics Committee Members. 81

Ethical Considerations in Healthcare Research. 82

Science and Society. 82

Protection of Research Participants. 83

Consent. 83

Vulnerable Groups. 87

Consent in Emergency Research. 88

Confidentiality. 88

Voluntary Participation. 89

Dissemination of Findings and Publication. 90

Preparation and Submission for Ethical Review.. 90

Submission of Research Application for Ethical Review.. 92

Conducting and Recording Healthcare Research. 93

Data Collection, Analysis and Management. 94

Study Amendment. 95

Research Oversight Management. 96

Research Reports. 97

Annual Progress Report. 97

Annual Safety Report. 97

Final report. 97

Benefits of Research in Healthcare in Africa. 98

Improving Healthcare Outcomes. 98

Improving Economy. 99

Strengthening Partnership for Healthcare Service Development and Improvement. 99

Barriers and Enablers to Effective Research in Healthcare in Africa. 100

Conclusion. 101

References. 102

Chapter 5 - Safety Management. 107

Introduction. 107

Safety in Healthcare. 108

Safety I and Safety II Concepts. 109

Safety Management System in Healthcare. 110

Elements of a Safety Management System.. 110

Risk Control System Components. 111

The Organisation Arrangements to Support Safety. 112

Safety Policy, Process and Procedure. 113

Safety Plan. 113

Learning Systems Components. 114

Means of Measuring and Monitoring Safety Performance. 114

Sources of Information for Safety Performance Measurement 115

Past Harm.. 116

Treatment Specific Harm.. 116

Harm due to over Treatment. 116

General Harm from Healthcare. 116

Harm due to Failure to Provide Appropriate Treatment. 117

Harm Resulting from Delayed and Inadequate Diagnosis. 117

Psychologically Harm and Feeling Unsafe. 117

Reliability. 117

Sensitivity to Operations. 119

Anticipation and Preparedness. 119

Integration and Learning. 120

Other Sources of Safety Performance Review Information. 120

Safety Audit and Survey. 120

Medical Records and other Administrative Data Source. 120

Means of Reviewing Safety Performance. 121

How Incidents Happen. 121

Human Errors and their Causes. 123

Skill-Based Errors. 123

Knowledge and Rule Based Mistakes. 123

Violations. 124

Incident Reporting System.. 125

Incident Investigation. 127

Basic Elements of a Good Incident Investigation. 127

Understanding of the Purpose and Scope of the Incident Investigation. 128

Incident Investigation Team.. 128

Open and Fair Safety Culture. 129

Unsafe Acts. 130

Human Behaviour. 130

Contributory Factors. 131

Feedback to Improve Safety Performance. 132

Feedback Routes and Timeline. 132

Unknown Elements. 132

Conclusion. 132

References. 134

Chapter 6 - Quality Management. 140

Introduction. 140

Quality in Healthcare. 141

Elements of Quality in Healthcare. 142

Structure. 142

Process. 143

Outcomes. 143

Quality Management System in healthcare. 143

Elements of Healthcare Quality Management System.. 144

Quality Planning. 144

Quality Control 144

Quality Assurance. 144

Quality Improvement. 144

Quality Improvement in Healthcare. 144

Principles of Quality Improvement. 145

Quality Improvement Approaches and Methods in healthcare. 146

Plan-Do-Study-Act (PDSA) 147

Use of PDSA Cycles in Healthcare. 148

The Component of PDSA Cycle in Clinical Quality Improvement. 148

Designing and implementing effective PDSA quality clinical improvement. 149

Knowledge and Understanding of Principles of PDSA.. 150

Data Management, Monitoring and Documentation. 150

Other Quality Improvement Approaches and Methods. 153

Experience-Based Co-Design (EBCD). 153

Statistical Process Control (SPC). 153

Lean. 153

Business Process Re-Engineering (BPR). 154

Six Sigma. 154

Total Quality Management (TQM). 154

Failure Mode and Effect Analysis (FMEA). 154

Quality Improvement Interventions. 155

Legislation and regulatory interventions. 155

Professional regulation. 155

Accreditation. 156

Inspection. 156

Clinical governance healthcare quality strategies. 156

Patient, families and carers engagement. 156

Healthcare information communication and technology System (HICTS). 157

Teamwork and collaboration. 157

WHO African Region initiatives. 157

Education, training and supervision of workforce. 157

Incentives programmes. 158

Morbidity and Mortality Reviews. 158

Conclusion. 158

References. 160

Chapter 7 - Evaluation. 166

Introduction. 166

Evaluation. 166

Purpose of Evaluation. 167

Types of Evaluation. 167

Formative Evaluation. 167

Summative Evaluation. 168

Evaluation Design and Planning, Conducting and Reporting. 168

Evaluation Planning and Design Process. 168

Logical Model of SOP Intervention. 168

Assumptions. 169

Inputs. 169

Outputs. 169

Outcomes. 170

External factors. 170

Evaluation Questions and Measurable Outcomes. 171

Evaluation Plan. 172

Evaluation Team.. 173

Conducting Evaluation. 174

Evaluation Design. 174

Types of Evaluation Designs. 174

Experimental Designs. 174

Quasi-randomised. 174

Non-randomised Trial/Quasi-experimental 175

Observational Designs. 175

Controlled Before-and-After Study. 175

Historical Cohort Study. 175

Case-Control Study. 175

Cross-Sectional Study. 175

Cohort Study. 175

Case Series Study. 175

Evaluation Methodology. 175

Quantitative Methods. 176

Questionnaires. 176

Qualitative Methods. 177

Interviews. 177

Focus Groups. 179

Observation. 179

Tools and Techniques for Data Collection in Healthcare Setting in Africa. 180

Data Analysis. 181

Evaluation Reporting. 181

Ethics and Standards for Conducting and Reporting Evaluation. 183

Benefits of Evaluation in Healthcare in Africa. 183

Barriers and Enablers to Evaluation. 184

Conclusion. 185

References. 186