QAP in KKM

QAP in KKM
Dr Suhazeli Abdullah
Family Medicine Specialist
Klinik Kesihatan Marang
Courtesy slides from Dato’ Dr Abdul Jamil

Abdullah, Head of Surgery Department, HSNZ
What is
QUALITY?
 Excellence, goodness
 mutu - baik buruk sesuatu
Kamus Dewan
Vision for Health
Malaysia is to be a nation of healthy
individuals
families and
communities,
through a health system that is
equitable
affordable
efficient
technologically appropriate
environmentally adaptable and
consumer-friendly
,
MOH’s vision……
with emphasis on
quality
innovation
health promotion and
respect for human dignity,
which promotes
individual responsibility and
community participation
towards an enhanced quality of life

Quality activities of MOH
 Registration
 Doctors & Paramedicals
 Licensing
 Hospital, Pharmacy
 Accreditation
 Credentialling
 Code of conduct, code of ethics

 Morbidity & mortality reviews

 Perinatal MR, MMR, POMR
 Committee meetings
 Infection control, OT, Drug
 Audits
 Medical, Nursing
Reviews
Utilisation, Peer, CPC
Investigations
Sentinel events, public complaints
Guidelines
 CPG, SOP, checklist
ISO, QCC, TQM, PKPA, HTA

QA milestone in KKM
 Up to 1980’s - coverage, target & goal
 1985 - introduce element of Quality in

Healthcare:
 QAP for In-Patient Care Services
 14 pilot Hospitals & 12 indicators

 19 indicators for all Hospitals
 Two approaches : NIA & HSA

Bil. Programme Year of Current No.
Implementation of Indicators
1. Patient Care 1985 19
Services
2. Pharmaceutical 1990 7
Services
3. Public Health 1990 13
Services
4. Engineering 1992 7
Services
5. Dental Services 1992 9
6. Laboratory Services 1992 11
7. Training & 1996 5
Manpower
8. Planning & 1998 3
Development
Aims
 To improve the quality, efficiency
and effectiveness of the delivery of
health services
 To facilitate the planned and

systematic evaluation of quality
process
QA - KKM definition
“Securing optimum achievable result
for each patient,
avoidance of iatrogenic complications
and giving attention
to the patient
and family needs
in a manner
that is cost effective
and reasonably documented
Adapted from Thomson

QA APPROACHES
National Indicator Approach (NIA)
Hospital Specific Approach (HSA)

Features HSA NIA
Problem identification Hosp level KKM level
Specificity of problem Specific to hosp Common to all
Priority for hospital High Variable
Setting of standards Hospital level KKM level
Problem verification Related data Data collected
in hospital for indicator
QA study Similar approach
Re-evaluation Decided by Once a year
hospital
NIA
NIA
* MOH set & provides:
- a standard for each indicator
- monitoring format for data collection ,

analysis & reporting
- protocols & format for SIQ investigation.
* Hospital has to carry out remedial actions &

relook of its effectiveness.
NIA Indicators
Indicator Std.
1. Typhoid CFR 0
2. Elective cholecystectomy deaths 0
3. Death due to haemorrhage of pregnancy 0
4. Eclampsia CFR 0
5. Gross death rate 2.13%
6. POP cast complication <5%
7. Clean Wound Infection <4%
8. Pressure sores in bed-ridden pts <5%
9. BOR 50 - 80%
10. ALOS 3 - 6.3 days
NIA Indicators
Indicator Std.
1. AMI CFR <34.7%
2. AGE CFR in children <0.6%
3. Head injury CFR <7%
4. ARI CFR <3.1%
5. Lab specimen rejection rate <0.86%
6. Proportion of urgent lab test <19.6%
7. Proportions of Ops undergoing x-rays <8%
8. Proportions of Ips undergoing x-rays <70%
9. Proportions of x-ray films rejected <10%
Communicable Disease
 TB Sputum Conversion Rate 85%
 Average Notification Time Index for Typhoid

<14 days
 Morbidity Index for Typhoid <2

Vector Borne Disease
 Dengue Notification Time Index
80% within 24 hours
 Dengue Outbreak Control Index

100% controlled within 14 days of 2nd case
 Dengue Law Enforcement Index

80% positive premise taken legal action
 Malaria Death No death

Family Health
 Incidence Rate of Eclampsia
8 per 10,000 deliveries
 Incidence Rate of Severe Neonatal Jaundice
< 100 cases per 10,000 live births
 Incidence Rate of Tetanus Neonatorum

0 case per 10,000 live births
HSA
HSA
 Hospital/Unit/Dept. identify own

areas of weakness to remedy
 Idea of local people solving local

problems
 Useful tool in improving quality

services
General Objective
To ensure that the patient, family and

community obtain the optimum
achievable benefit from the services of
MOH within the available resources
ABNA
Ideal With unlimited resource

ideal level of care
}
100 
Optimum
Optimal Achievable Level
75
ABNA  targeted level within means
50
Actual ABNA
25
 difference between OA &
present level
 QA aims at narrowing or
0 eliminating the gap
Problem
identification
Problem
Prioritisation
Re-evaluation of the
Problem
Quality Problem
Assurance Analysis
Cycle
Implementation of
Remedial Actions Quality
Assurance
Study
Identification of
Remedial Actions
QA
Organisatio
n
QAP - Organizational Structure
The
The MOH
MOH Steering
Steering Committee
Committee
Programme
Programme Level
Level QAP
QAP Committee
Committee
State
State QAP
QAP Steering
Steering Committee
Committee
State
State QAP
QAP technical
technical sub-committee
sub-committee
Hospital
Hospital // District
District QAP
QAP Committee
Committee
Hospital/District QA Committee
 Hospital / District QAP Committee

Chairman: Pengarah Hospital / MOH
Secretary: AMRO (*)
Members: - Clinical co-coordinator (*)
- Unit / Dept. Head
- M&HO /Matron / Supervisors
- Co-opted members
(*) for hospital
Functions…
To meet at least once in 3 months to:
 Inform & motivate staff of the need

and implementation of QA
 Plan & initiate QA activities
 Monitor & evaluate the implementation &
remedial actions
 Identify problems for QA studies
 Appoint investigators for QA studies
…Functions
 Appoint appropriate members

 Discuss & forward relevant reports /
recommendations to State Committee
 Co-ordinate, train and support QA activities
planned & conducted by the individual units.
QA APPROACHES
Structure Process/system Outcome
•Organizations •Protocols •Mortality review

•Personnel •CPGs •Morbidity
•Licensure •Policies •NIA/HSA
•Registration •Incident Reporting
•Certification
•Accreditation
WHO define
QUALITY?
These may seem varied, but
they almost sound similar;
the requirements of the

customer are always a
consideration in a valid
definition of quality
Patients/Relatives
 Pleasant Staff &
Environment
 Responsiveness
 Reliable
 Competence
KKM Definition
Securing optimum achievable result
for each patient,
Avoidance of (MINIMISE) iatrogenic complications
and giving attention
to the patient
and family needs
in a manner
that is cost effective
and reasonably documented
Adapted from Thomson
ASSURANCE
Implies one party is

convincing another that
certain standards will be
maintained
Quality Assurance
 In general terms means that
 all the measures are taken in order that

the customer or interested party will be
consistently provided with quality.
 (show them what you are doing)
Why
we need Quality
Professional Need
 related to the fundamental responsibility of all
professionals – appropriateness & necessity
 for the highest standards of excellence.
 Effectiveness
 Standardization (reduced variance)
 Safety
A Social Need
 related to the accountability of every
profession to the society
 from which the profession obtain authorization

and economic support to practice their skills
 Ethical
A Practical Need
 The need for continuous improvement
 Where errors are costly
Costs
Quality
is never an accident
“, it is always the result of
high intentions, sincere
effort, intelligent direction
and skillful execution”
Quality is a
journey, not
a destination

QAP in KKM

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QAP in KKM

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QAP in KKM

Courtesy slides from Dato’ Dr Abdul Jamil

 mutu - baik buruk sesuatu

towards an enhanced quality of life

 Code of conduct, code of ethics

 Morbidity & mortality reviews

ISO, QCC, TQM, PKPA, HTA

 1985 - introduce element of Quality in

 QAP for In-Patient Care Services

 14 pilot Hospitals & 12 indicators

 Two approaches : NIA & HSA

 To facilitate the planned and

Adapted from Thomson

National Indicator Approach (NIA)

Hospital Specific Approach (HSA)

- monitoring format for data collection ,

- protocols & format for SIQ investigation.

* Hospital has to carry out remedial actions &

 Average Notification Time Index for Typhoid

 Morbidity Index for Typhoid <2

 Dengue Outbreak Control Index

 Dengue Law Enforcement Index

 Malaria Death No death

 Incidence Rate of Severe Neonatal Jaundice

< 100 cases per 10,000 live births

 Incidence Rate of Tetanus Neonatorum

 Hospital/Unit/Dept. identify own

 Idea of local people solving local

 Useful tool in improving quality

To ensure that the patient, family and

Ideal With unlimited resource

 Hospital / District QAP Committee

 Inform & motivate staff of the need

 Appoint appropriate members

•Organizations •Protocols •Mortality review

the requirements of the

Implies one party is

 all the measures are taken in order that

 for the highest standards of excellence.

 Standardization (reduced variance)

 from which the profession obtain authorization

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