BENGKEL QUALITY

ASSURANCE 2014

PEJABAT KESIHATAN DAERAH DUNGUN

DR SENTHIL KUMAR,
PEGAWAI PERUBATAN DAN KESIHATAN,
KLINIK KESIHATAN PAKA
 HISTORY
 The roots of QA Initiatives originated from the time of Florence
Nightingale’s work in the Crimean War (1854-1856)
 The death rate in war hospitals were significantly reduced from 43% to
2 % with the introduction of proper nutrition, sanitation and infection
control.
QUALITY
GOAL OF QUALITY ASSURANCE
1. Customer Satisfaction
2. Cost Savings
3. Increase Efficiency
4. Reduce Discomforts/ Morbidity/ Mortality
QA ACTIVITIES IN MOH
Perinatal and Maternal Mortality Reviews
Committee Meetings - Infection Control
Morbidity and Mortality Reviews
Investigation of serious complaints
Investigation of sentinel event
QCC/KMK
Utilization Review
Medical Audit
CPC
PKPA
HTA
 QA IN MOH

To improve the quality, efficiency

and effectiveness of the delivery of
health services
To facilitate the planned and
The MOH had committed itself to
systematic evaluation of quality
QA by the launching of National
process
Quality Assurance Programme in
1985
Patient Care Services - started
the ball rolling
PROBLEM IDENTIFICATION
PROBLEM IDENTIFICATION
Problem
Identification
Problem
Prioritisation
Re-evaluation of
the Problem Quality Assurance Problem
Cycle Analysis

Implementation of
Remedial Actions Quality
Assurance
Study

Identification of
Remedial Actions
 SUMBER-SUMBER MASALAH
Cadangan & pandangan Isu dari Mesy JK lain
daripada anggota - Kawalan infeksi
- JK Perolehan Ubat
Masalah / isu yang - JK Dewan Bedah
dibangkitkan semasa
mesyuarat Rekod Perubatan

Laporan Tahunan
Aduan pesakit / komuniti
Sesi ‘Brainstorming’
Kesimpulan daripada Mesy
Morbiditi & Mortaliti Maklumbalas NIA
PROBLEM PRIORITIZATION
 SMART CRITERIA
PROBLEM PRIORITIZATION METHOD

S SERIOUSNESS/ SPECIFIC

M MEASURABILITY

A APPROPRIATENESS

R REMEDIABILITY

T TIMELINESS
BASIS OF RANKING – SMART
CRITERIA
SERIOUSNESS / SPECIFIC
NYAWA TERANCAM? MENYEBABKAN
KECACATAN ? KESAKITAN?

CAUSING DISTRESS TO PATIENT?

IMPAK KE ATAS PESAKIT, KOMUNITI ,

IMEJ HOSPITAL / PEJABAT KESIHATAN
DAERAH
BASIS OF RANKING - SMART CRITERIA
MEASURABLE (BOLEH DIUKUR)
BOLEH KUMPUL DATA
BOLEH BUAT PERBANDINGAN SEBELUM & SELEPAS

APPROPRIATENESS (KESESUAIAN)
RELEVANT (RELATES TO YOUR CORE BUSINESS)

REMEDIABLE (BOLEH DIBAIKPULIH)

TIMELINESS (KETETAPAN DENGAN MASA)

IMPROVEMENT DIPERLUKAN SEKARANG JUGA/ TIDAK
MENGAMBIL MASA LAMA
BASIS OF RANKING - SMART CRITERIA

BERKAITAN PENJAGAAN PESAKIT?

IMPAK ATAS KOS & SUMBER (RESOURCES)
KEKERAPAN KEJADIAN WALAUPUN TIDAK BEGITU
SERIOUS
RUANG UNTUK PEMBAIKAN (IMPROVEMENT)
BERAPA JURANG ABNA - WORTH A STUDY?
ADA PENYELESAIAN?
SOSIAL, POLITIK, AGAMA, ETIKA
PROBLEM-PRIORITISING TECHNIQUE
NOMINAL GROUP TECHNIQUE
THE GROUP
COMMON INTEREST QUALITY
IMPROVEMENT

NUMBER : 7 - 12
< 7 : INADEQUATE EXPERTISE
>12 : TOO MANY
UNSATISFACTORY GROUP DYNAMICS
FEW LOUD-MOUTH, MANY NODDERS &
SLEEPERS
PROBLEM-PRIORITISING
TECHNIQUE
NOMINAL GROUP TECHNIQUE
THE CHAIRMAN
SENIOR PERSON WITH INTEREST & AUTHORITY
CAN SOLVE THE PROBLEM

SOURCE OF INFORMATION
SURAT KHABAR, HEARSAY, MAJALAH, PESAKIT,
PENGALAMAN AHLI KUMPULAN
NOMINAL GROUP TECHNIQUE
1. CHAIRMAN REQUESTS COOPERATION OF
EVERYBODY

2. FOCUS ON PROBLEM IDENTIFICATION & NOT

PROBLEM SOLVING

3. SILENT GENERATION OF IDEAS

NOMINAL GROUP TECHNIQUE

4. LIST DOWN ALL PROBLEMS IN EXACT WORDS

5. SERIAL DISCUSSION:
CLARIFY, ELABORATE, DEFEND, DISPUTE

6. PROBLEMS MAYBE :
REWORDED, GROUPED, DELETED OR MODIFIED
NOMINAL GROUP TECHNIQUE

7. RANK THE PROBLEM - VOTE (1 - 5)

8. ANNOUNCE RESULT
9. DISCUSSION OF VOTE, REPRIORITISE
10. REVOTE

FINAL CHOICE MAY NEED APPROVAL FROM PEOPLE WITH

FINANCIAL & ADMINISTRATIVE AUTHORITY
LITERATURE REVIEW
 LITERATURE REVIEW
SUMBER : BUKU, JOURNAL, LAPORAN, STATISTIK, CPG,
GUIDELINES

KEGUNAAN :
1. MENJELASKAN MASALAH
2. MENYATAKAN OBJEKTIF KAJIAN
3. MENYATAKAN PENGALAMAN DITEMPAT LAIN
4. MENENTUKAN STANDARD YANG MUNASABAH[REALISTIC]
5. MENUNJUKAN METODOLOGI KAJIAN
6. CADANGAN PENYELESAIAN
7. ELAKKAN DUPLICATION
OPPORTUNITY STATEMENT
OPPORTUNITY STATEMENT
(PENYATA MASALAH)
OPENING STATEMENT OF THE PROJECT
EXPLAINING WHAT IT IS – EVIDENCE IF ANY
WHAT ARE THE EFFECTS
WHAT ARE THE POSSIBLE CAUSES
WHY WE WANT TO DO WITH THE STUDY
CAUSE EFFECT ANALYSIS
 PROBLEM ANALYSIS
CAUSE EFFECT ANALYSIS
WHAT WHAT IS THE AREA OF CONCERN

WHO PERSON AFFECTED OR INVOLVED

WHERE PLACE OF INCIDENT

WHEN DATE OR TIME FRAME FOR PROBLEM

WHY CAUSE OF A PROBLEM

HOW EFFECT OF A PROBLEM

PROBLEM ANALYSIS
PROBLEM ANALYSIS
PROCESS OF CARE
PROCESS OF CARE

SEQUENTIAL STEPS OF ACTIVITIES WHILST PROVIDING A

PARTICULAR HEALTHCARE SERVICES.

THE STEPS IS ADOPTED FROM THE PROFESSIONALLY

ACCEPTED STANDARD OR NORM , GUIDELINES, CIRCULARS,
CPG ETC.
MODEL OF GOOD CARE (MOGC)
 DEFINITION

 THE PROTOCOL AND SEQUENTIAL OF ESSENTIAL

ELEMENTS OF THE PROCESS OF CARE WITH THE
PRESET CRITERIA AND STANDARD SO THAT THE
CARE IS GOOD.

 PROCESSES IS THE STEPS HEALTHCARE WORKERS

- SHOULD UNDERTAKE
- GET INFORMATION ABOUT
- SHOULD RECORD
- DO WHEN DIAGNOSE, TREATING, F/UP
 USAGE OF M.O.G.C
ASSESSMENT OF THE ACTUAL QUALITY OF CARE

- THE EXTENT TO WHICH ACTUAL CARE IS IN

CONFORMITY WITH PRESET CRITERIA FOR
GOOD CARE

- MEASURABLE DIFFERENCE WHAT IS

REALISED AND WHAT SHOULD BE
REALISED
ABNA
CONCEPT IDEAL LEVEL OF CARE
WITH UNLIMITED RESOURCE OPTIMAL ACHIVEABLE LEVEL
100 ACTUAL LEVEL
IDEAL LEVEL OF CARE
90
OPTIMAL ACHIEVABLE LEVEL 80

- TARGETTED LEVEL WITHIN 70

60 ABNA
MEANS
50
ABNA: 40
30
DIFFERENCE BETWEEN OA&
20
PRE-SET LEVEL 10

QA AIMS AT NARROWING OR 0

ELIMINATING THIS GAP

Category 1
RESEARCH OBJECTIVE
OBJEKTIF KAJIAN
GENERAL/UMUM
BERKAITAN DENGAN TAJUK
1-2 AYAT
MEMBERI HALATUJU PROJEK
SPECIFIC/KHUSUS
MENGGARISKAN APA YANG HENDAK DILAKUKAN
DALAM KAJIAN
PERSOALAN YANG AKAN DIJAWAB DALAM
CONCLUSION/RUMUSAN
CRITERIA
 CRITERIA

INCLUSION CRITERIA EXCLUSION CRITERIA

VARIABLES
 VARIABLE

CHARACTER THAT CAN BE MEASURED

I.E. SOME VALUE IS GIVEN

E.G.
HIGH RATE : EXCEEDING ? %
TALL : > 175CM
POOR : INCOME < RM200/MONTH

jamil
 VARIABLE

CHARACTER THAT CAN BE MEASURED

I.E. SOME VALUE IS GIVEN

E.G.
WAITING TIME : TIME BETWEEN
REGISTRATION & SEEING A DOCTOR
LONG WAITING TIME : > 45 MINS
POOR DATA : CERTAIN DEFINED
EXPECTED DATA NOT RECORDED

jamil
CONCEPTUAL VARIABLE

NEEDS TO BE CONVERTED TO OPERATIONAL VARIABLE

CV OV
ATTITUDE ATTITUDE QUESTIONNAIRE
COMPLIANCE DRUG IN URINE
EXPERIENCED NO. OF YEARS IN THAT FIELD
RENAL COLIC CERTAIN SPECIFIC FINDINGS

jamil
 OPERATIONAL VARIABLE
BY BEING OPERATIONAL, IT ASSUMES A CERTAIN SCALE OF
MEASUREMENT

EG. TEMPERATURE CENTIGRADE

HEIGHT CENTIMETRES

jamil
 OPERATIONAL VARIABLE
VARIABLES INITIALLY PUT IN A NEGATIVE MANNER MUST BE
REPHRASED SO THAT THEY REMAIN NEUTRAL
I.E. CAN TAKE POSITIVE OR NEGATIVE VALUES

EG. FACTORS VARIABLE FORM

LONG WAITING TIME WAITING TIME
LACK OF SUPERVISION SUPERVISION
JUNIOR DOCTORS GRADE OF DOCTORS
HIGH INFECTION RATE INFECTION RATE

jamil
INDICATORS
DEFINITION

A MEASURABLE
VARIABLE
RELATING TO THE
STRUCTURE,
PROCESS OR
OUTCOME OF
CARE
 INDICATOR (MEASUREMENT OF
QUALITY)
CLINICAL INDICATOR

AN INSTRUMENT TO ASSESS A MEASURABLE ASPECT OF

PATIENT CARE

ACTS AS A GUIDE TO ASSESSING THE PERFORMANCE OF A

HOSPITAL, DEPARTMENT OR INDIVIDUALS WITHIN IT

EG. - HEAD INJURY DEATHS AS AN INDICATOR OF

HEAD INJURY MANAGEMENT
- BOR AS AN INDICATOR OF BED UTILISATION

jamil
OUTCOME INDICATOR
GENERAL OUTCOMES
- TOO INSENSITIVE TO PIN-POINT THE QUALITY OF
CARE
- FOR EVALUATING THE QUALITY OF HEALTHCARE
SYSTEM
EG; GROSS MORTALITY RATE

jamil
OUTCOME INDICATOR
DISEASE-SPECIFIC OUTCOMES
I) TRACER METHOD: TO DEFINE QUALITY OF CARE TO A
DEFINED POPULATION
EG; ANAEMIA AMONGST ANTENATAL MOTHER

II) SENTINEL EVENTS: PREVENTABLE BAD OUTCOME OF

CARE, THAT SHOULDN NOT HAPPEN IF EVERYTHING
GOES FINE
EG; ECLAMPSIA, ANAESTHESIA DEATH, WOUND INFECTION

jamil
 PRIORITY IN SELECTING
INDICATOR

• FOCUS ON OUTCOME RATHER THAN PROCESS OR

STRUCTURE ( INPUT )

• GENERIC ( PROXY ) THE OTHER ACTIVITIES

• IMPACT ON MORTALITY / MORBIDITY

• FEASIBLE INTERVENTION

• EXISTING / MINIMUM EXTRA DATA COLLECTION

jamil
STANDARD
STANDARDS

SOMETHING SET UP & ESTABLISHED BY AUTHORITY

AS A RULE FOR THE MEASURE QUANTITY, WEIGHT,
EXTENT, VALUE OR QUALITY
 STANDARDS
MINIMUM LEVEL OF ACCEPTABLE PERFORMANCE

EXCELLENT LEVELS OF PERFORMANCE

RANGE OF ACCEPTABLE PERFORMANCE

SOURCE OF STANDARD
• OWN SITUATIONAL ANALYSIS / STUDY
• PAST EXPERIENCE / PERFORMANCE
• NATIONAL, INTERNATIONALLY ACCEPTED STD.
• EXPERT PANEL OPINIONS
• TEXTBOOK, SCIENTIFIC JOURNALS
• CONCENSUS OPINIONS AMONG HEALTHCARE
PROVIDERS.
DATA COLLECTION
STUDY TYPE
STUDY

EXPERIMENTAL NON-EXPERIMENTAL

DESCRIPTIVE ANALYTICAL

QUANTITATIVE RETROSPECTIVE

QUALITATIVE COHORT
STUDY TYPE
DESCRIPTIVE STUDY:
SYSTEMATIC COLLECTION AND PRESENTATION OF DATA TO
GIVE A CLEAR PICTURE OF A PARTICULAR SITUATION

ANALYTICAL STUDY:
AIMS AT DETERMINING AND TESTING THE RELATIONSHIP
BETWEEN SEVERAL VARIABLES TO SUGGEST POSSIBLE CAUSES
OF PROBLEM
SAMPLING
BETTER TO GET INTENDED INFORMATION FROM A CERTAIN
POLULATION ( ALL )

BUT LIMITED WITH PROBLEMS OF LOGISTICS, COSTS, TIME

ETC.

THUS, WE HAVE TO DO SAMPLING; A REPRESENTATIVE

SAMPLE WITH ALL IMPORTANT CHARACTERISTICS OF THE
DRAWN POPULATION
METHODS OF SAMPLING

CHANCES OF BEING SAMPLED UNKNOWN

A.CONVENIENCE SAMPLING

B.PURPOSIVE SAMPLING
METHODS OF SAMPLING

CONVENIENCE SAMPLING

STUDY UNITS THAT HAPPEN TO BE AVAILABLE AT TIME OF

DATA COLLECTION

E.G. ALL ENT PATIENTS LISTED FOR OP

METHODS OF SAMPLING
B.PURPOSIVE SAMPLING

TARGET A CERTAIN GROUP

E.G. MEDICAL BHTS

METHODS OF SAMPLING
A. SIMPLE RANDOM SAMPLING

B. SYSTEMATIC SAMPLING
METHODS OF SAMPLING
A. SIMPLE RANDOM SAMPLING

HOW:
i) MAKE A NUMBERED LIST OF ALL STUDY UNIT IN
POPULATION FROM WHICH TO DRAW SAMPLE

ii) DECIDE ON SAMPLE SIZE

III) SELECT REQUIRED NUMBER OF SAMPLING UNITS

USING A “LOTTERY METHOD” OR A TABLE OF
RANDOM NUMBERS
 METHODS OF SAMPLING

B. SYSTEMATIC SAMPLING

SAMPLE UNIT CHOSEN AT REGULAR INTERVALS

FROM SAMPLING FRAME

NOTE: RISK OF BIAS

SAIZ SAMPEL YANG SESUAI ?

KOMPROMI ANTARA APA YANG DIKEHENDAKI (DESIRABLE) DAN APA

YANG BOLEH DIPEROLEHI (FEASIBLE)

FEASIBLE DESIRABLE
MASA JANGKA VARIASI DALAM DATA
ANGGOTA BIL SEL DALAM X-TABULATION
PENGANGKUTAN
PERUNTUKAN
SAIZ SAMPEL YANG SESUAI ?

 Minima = 30

 Kalau boleh = 50 - 100

DATA COLLECTION
TECHNIQUES

• REVIEW OF RECORDED SOURCES

• OBSERVATION
• INTERVIEW
• WRITTEN QUESTIONAIRES
PLAN FOR DATA COLLECTION
• WHAT TO COLLECT
• WHERE TO GET THE DATA
• HOW TO COLLECT THEM
• WHO WILL COLLECT THE DATA
• WHEN WILL THE DATA BE COLLECTED
• HOW LONG WILL IT TAKES
• QUALITY CONTROL OF THE DATA
DATA ANALYSIS
MENGAPA PERLU ADA PELAN
UNTUK MEMPROSES DAN
MENGANALISA DATA
INFORMASI YANG DIPERLUKAN DIKUMPUL SECARA
STANDARD

DATA YANG TIDAK DIPERLUKAN TIDAK AKAN

DIKUMPUL
BAGAIMANA HENDAK
MEMPROSES DAN MENGANALISA
DATA
AMBILKIRA ISU-ISU SEPERTI :

• SORTING DATA

• MENJALANKAN PEMERIKSAAN KAWALAN KUALITI

(QUALITY CONTROL CHECKS)

• MEMPROSES DATA

• MENGANALISA DATA
SORTING DATA
PENTING UNTUK MEMPROSES & MENGANALISA
DATA

MERANCANG DI MANA HENDAK MENGHANTAR

DATA

SIAPA YANG AKAN MENERIMA DATA

BAGAIMANA IA AKAN DINOMBOR / LABEL /

SIMPAN
KAWALAN KUALITI

1. SEMASA MENGUTIP DATA

- PASTIKAN INFORMASI YANG DIKUMPUL

DIKUTIP DAN DIREKOD DENGAN BAIK

2. SEBELUM MENGANALISA DATA

- SEMAK SEMULA UNTUK KELENGKAPAN

DATA DAN KONSISTENSI DATA
APA PERLU DIBUAT JIKA
INFORMASI TIDAK
KONSISTEN
1. KESILAPAN OLEH INTERVIEWER

- SEMAK SEMULA DENGAN INTERVIEWER

2. KESILAPAN SEMASA MEREKOD

- SEMAK SEMULA DENGAN RESPONDENT

UNTUK MENDAPATKAN PENJELASAN
 MEMPROSES DATA
TEKNIK MEMPROSES DATA

1. SECARA MANUAL

- GUNA DATA MASTER SHEET

- KOMPILE SOALAN SECARA MANUAL

 MEMPROSES DATA

TEKNIK MEMPROSES DATA

2. KOMPUTER

- GUNA SOFTWARE SEDIAADA

- EPI INFO, DBASE, SPSS, LOTUS 1-2-3

 MEMPROSES DATA
MEMPROSES DATA MELIBATKAN

1. KATEGORIKAN DATA

2. KOD DATA

3. RINGKASAN DATA
- MASTER SHEET
- KOMPUTER
TERIMA KASIH

BENGKEL QAP
BULANAN

5 MARCH 2014

KK KUALA
DUNGUN