Compliance of devolved government hospitals to the PhilHealth Benchbook standards A Rapid Assessment

1. Compliance of devolved government hospitals to the PhilHealth Benchbook standards(A Rapid Assessment) Amador R. Catacutan, MD, MHA, MPhil-IPH Adviser, Local Health Systems Development Ferdinal M. Fernando, MD, MDM Senior Technical Coordinator German Technical Cooperation

2. 02.08.2012 Introduction Quality assurance in health Brings greater client satisfaction Achieves better health outcome Increases effectiveness and efficiency Assessment of quality performance Establish baseline studies For continuous quality improvement Objective self-assessment process

3. 02.08.2012 Introduction Section 50 of the Revised Implementing Rules of the National Insurance Act (RA 7875) as amended by RA 9241 � mandates the Philippine Health Insurance Corporation to implement the Quality Assurance Program for hospitals PhilHealth Circular No. 12, s 2005 � adopted PhilHealth Benchbook on Performance Improvement of Hospital Services to assess and evaluate the performance of the facilities based on quality standards PhilHealth Circular No. 12, s 2006 � requires all hospitals applying for accreditation to have a Continuous Quality Improvement Program beginning January 2007

4. 02.08.2012 PhilHealth Benchbook

5. 02.08.2012 Objectives of the Study To assess the compliance of devolved government hospitals in operationalizing the PhilHealth Benchbook To enumerate the most common causes of partial and non-compliance to the standards To evaluate the applicability of partial and non-compliant standards

6. 02.08.2012 Methodology Rapid Assessment: Population samples 11 provincial hospitals (4 from Luzon, 3 from Visayas, and 4 from Mindanao) � 6 are categorized as level 3 facilities; 5 are level 2 facilities 10 district hospitals (4 from Luzon, 2 from Visayas and 4 from Mindanao) � 7 are level 2 facilities and 3 are level 1 facilities Survey using Benchbook criteria Percentage of compliance: full, partial, none Percentage of applicability of the partial and non-compliance to the hospital setting

7. 02.08.2012 Presentation of results Percentage compliance to the Benchbook criteria, Provincial Hospitals, 2007:

8. 02.08.2012 Presentation of results Percentage compliance to the Benchbook criteria, District Hospitals, 2007:

9. 02.08.2012 Presentation of results Reasons for partial and non-compliance to the PhilHealth Benchbook standards:

10. 02.08.2012 Presentation of results Policies and procedures � not written, not monitored Organizational processes � lack of planning, implementing, managing, monitoring, evaluating, informing/feedbacking/reporting, and completing requirements Structural components � lack of forms, deficiencies in patient rooms, passageway, directional signs, information on services, equipment maintenance, program/management structures and plans, record keeping, agreements/contracts, relevant licenses, and resources Human resource factors � deficiencies on qualified personnel, training, team processes, skill mix, capability, recruitment, selection, appointment, training, roles and responsibilities Patient aspects � deficiencies in patient involvement in health, understanding of their roles and responsibilities, how they are accommodated to access services, patient safety, and observing patient rights.

11. 02.08.2012 Presentation of results Percentage applicability of partial and non-compliant criteria to the Provincial Hospitals, 2007:

12. 02.08.2012 Presentation of results Percentage applicability of partial and non-compliant criteria to the District Hospitals, 2007:

13. 02.08.2012 Presentation of results Criteria not applicable to hospital setting and reasons for non-applicability:

14. 02.08.2012 Recommendations in addressing the gaps Organizing the quality management structure Quality TWG / Quality Circle Identification of QC roles and responsibilities Integration of QC in the organizational chart

15. 02.08.2012 Recommendations in addressing the gaps To deal with ownership and organizational issues, the Quality Circle is guided by: Buying-in after the orientations Putting local flavor to Benchbook standards Working on existing structures and resources Capacity building for leadership and Quality Circle Advocating quality culture � view QAP as program of self-assessment and development, not a program of requirement

16. 02.08.2012 Recommendations on addressing the gaps 2. Writing the Manual of Quality Policies and Procedures The Manual serves as a reference document and guide for the quality assurance program of the hospital The Manual contains: Vision-Mission statements General Organizational Quality Policy and Quality Goals Quality Policies and Procedures for (1) the Benchbook standards and (2) the clinical and non-clinical service areas Monitoring and Evaluation Tool � Indicators, Targets, Document Source, Responsibility and Monitoring Frequency

17. 02.08.2012 Recommendations on addressing the gaps 3. Other recommendations (supporting structures) PHIC Re-visit, re-validate, re-evaluate non-applicable standards and criteria PRO Continuous advocacy to implement Benchbook standards DOH National policy on quality integrating the internationally acceptable dimensions of quality (e.g. effectiveness, efficiency, equitability, safety, accessibility, acceptability) CHD Training of trainers for quality management system of the Benchbook Monitoring and evaluation of QAP

18. 02.08.2012 Conclusions (Over-all Messages) Feasible to operationalize the Benchbook standards and criteria Better understanding of partial and non-compliant areas as areas for improvement Guidance for capacity building (orientation, methods, tools) on quality assurance and continuous quality improvement to create quality culture Policy/ enabling environment Institutional/ organizational environment Human resources

19. 02.08.2012 Thank you very much!