Aster DM Healthcare – Best Quality Data Model FINALIST – 2017

The Organization is Aster DM Healthcare: Brief Description: From a single medical centre to a performance-driven healthcare enterprise spread across 280 establishments in 9 countries and growing, Aster DM Healthcare has transitioned into being a growing network across the Middle East and India. Currently one of the largest and fastest growing conglomerates in the MENA region, Aster DM Healthcare covers the full spectrum of healthcare services. An expansive portfolio includes hospitals, clinics, diagnostic centres, retail pharmacies and consultancy services. Please refer Annexure 1for number of facilities, staff and revenue numbers

We place emphasis on the focus of improvements being on systems and processes rather than on the individual; also that all function and employees have to participate in the improvement process. The Aster DM Healthcare Quality Model focuses on the customer (be they internal or external customers), supported by structures, processes, capability development, and outcomes.
The implementation of our Quality Model is done through various Quality Tools used at the units of Aster DM Healthcare: Few examples are: 
Project Numbers Project Name Quality Tools Used Annexure
Project 1: Medcare Hospital- Reduction in electricity consumption by Use of LED
FOCUS PDCA
Plan, Do, Check, Act Annexure 3
Project 2: Aster Hospital- Insurance Rejections 
FADE Model
Focus, Analyse, Develop, Execute Annexure 4
Project 3:
Aster Medicity- Increasing OT utilisation Six Sigma Annexure 5
Project 4:
Aster Medicity: Reducing waiting time in OPD services Six Sigma Annexure 6
Project 5: Aster MIMS- Kottakkal- streamlining Inpatient, ED, OP- Lab service process Lean Management Annexure 7
Project 6: Aster MIMS- Kottakkal- Evaluation of day care wastage emphasising the revenue and quality Process Improvement plan Annexure 8

How has it changed the way it collects and manages data?
• Total Quality Management (TQM), a discipline and philosophy of management which institutionalises planned and continuous improvement is instituted in our group. At Aster DM Healthcare, we subscribe to the view that quality is the outcome of all activities that take place within the organisation.
• We follow the methodology of the following to achieve the success of out Quality Model
– Plan Do Check Act (FOCUS-PDCA)
– FADE- Focus, analyse, develop, execute
– Six Sigma
– Root cause analysis
– Performance Improvement plan.
• Our Improvement Plans provides a framework for continuous improvement of processes and systems at Aster DM Healthcare. It is based on the vision and values of the organisation and is aimed at creating a sustainable quality improvement model for the hospital to continually improve its clinical practices, patient care, and service standards
• Involvement of all stakeholders is ensured in this plan and the framework provides an interdisciplinary approach to all improvement initiatives. This plan sets forth the strategy, structure, methodologies, and measurement system for the improvement of the overall performance of the organisation. It is hoped that by putting “Quality” centre stage the organisation will develop over time a strategic competitive advantage over other healthcare providers.
• Whenever staff are engaged in performance improvement and patient safety initiatives, they must begin by listening to all customers (the voice of the consumer), focus on the processes that these customers experience (the voice of the process), and then use statistical process control methods to evaluate the variation that lives within the processes.

GOALS AND OBJECTIVES OF THE PLAN

All the above-mentioned Performance Improvement Plans are focused on creating an organization-wide quality focused environment with an internal structure to support a comprehensive performance improvement effort throughout the Hospitals.
The major goal of this effort is to: meet or exceed the needs and expectations of all of its customers, most especially those of the patients, their families, and their support systems.

In order to meet these goals, the Hospitals would establish and maintain an effective structure to support the organization’s ability to gather, assess, monitor, evaluate and communicate the appropriate indicators of quality, timeliness, safety, respect, efficiency and efficacy of care throughout the unit, including data on risk management occurrences and information regarding the effectiveness and appropriateness of care.

This Performance Improvement Plan exists to identify opportunities to improve the care and services of the Hospitals by:
• Organising an approach to improve systems and continuously the quality of patient care
• Reporting to higher management committee the department-based indicators of quality, both internal and external
• Reporting information about incidents and occurrences within the organisation that cause an adverse outcome for patients or have the potential to cause an adverse outcome
• Establishing collaborative multi-disciplinary work teams to evaluate work processes and to identify opportunities to make improvements that will improve care, reduce expenses associated with unnecessary or inappropriate care and increase the patient satisfaction
• Providing to management and to the Medical Staff the necessary tools and information to take deliberate steps to plan appropriately the services, intervene in problematic processes, evaluate the effectiveness of the interventions and to work collaboratively to meet the needs of the internal and external customers
• Assuring dissemination of quality improvement information to the relevant parties within the organisation
• Reporting to senior management on the quality of care at the Hospital including safety of services within the Hospital
• Compiling information available from a multitude of sources including patient satisfaction instruments; reports from external regulatory, agencies and relevant benchmarking with comparative databases when useful

INTERNAL DATA COLLECTION
The important processes on which the organisation collects internal data to reevaluate and enhance the quality improvement priorities or resource allocation priorities and to evaluate the quality of services provided include, but are not limited to, the following:

• The operative and other invasive and non-invasive procedures that place patients at risk
• The use and management of medications
• Utilisation Management activities regarding the appropriateness of admissions and length of Hospital stay, including observation categories of patients
• The accuracy of diagnosis and effectiveness of therapeutic interventions
• The clinical pertinence and timeliness of medical records
• The effectiveness of the Infection control program
• The results of patterns and trends of risk management data on incidents and focused occurrences and other risk management data including the number and type of medical liability claims
• The effectiveness of the Safety Management Program
• The pharmacy and therapeutics function including adverse drug reactions, drug-drug and drug-food interactions, and medication errors
• The clinical laboratory function as well as the diagnostic radiology function
• The needs, expectations, and satisfaction of patients
• The staff views regarding performance and improvement opportunities; and
• The data from important processes and outcomes quality control activities
METHODOLOGY

Each Department/Service of the Hospitals would participate in the monitoring the Key Performance Indicators (KPI) using accepted methods of quality assessment, quality control as appropriate, continuous quality improvement and risk management. Each department, service or function would use a systematic and continuous process of planning, monitoring, evaluating, and improving the quality of care. Each department, service or function would:

• Designate an individual (s) responsible for departmental monitoring and quality improvement
• Identify the scope of services and essential Functions
• Evaluate resource allocation
• Identify the most important functional aspects of the department or service
• Identify measurable indicators to monitor the quality of important Functions of care such as incidents, sentinel events, patterns, comparative databases with other organizations, and rate-based indicators
• Collect data for indicators based on volume, problem-prone or high-cost or high-risk nature of the care utilizing the dimensions of performance that include efficacy, availability, effectiveness, safety, respect and caring, appropriateness, timeliness, continuity and efficiency
• Organize the data in a meaningful way, in order to effectively identify the need for further assessment or evaluation of the care to identify opportunities to improve the quality of care or services provided to patients
• Prioritize the need for corrective action{s) based on the volume of patients, the degree of risk to patients or staff; the extent to which the issue contributes to problems in patient care and the cost of quantity of resources required to correct the issue
• Take action or develop an intervention to improve the issue identified
• Develop corrective actions if the initial action is ineffective or continue monitoring if it is initially effective in correcting the problem
• Document and report meeting minutes
• Evaluate, at least annually, the effectiveness of quality improvement monitoring process and the effectiveness of the services provided
• Utilize evaluation science methodologies to perform the continuous quality improvement function throughout the organization

How has it changed the way it collects and manages data?

• The Performance Improvement Plans provided structural support by various working groups and Committees governed by medical staff bylaws.
• All committees will meet a minimum of once a quarter and brief of the minutes and action plan is presented to the higher management council.
• The Organization also encourages the use of clinical guidelines and care pathways to help in the standardization of care. The Clinical Guidelines is be made available to all relevant staff and training on the same is be provided by qualified personnel. These are developed under the guidance of clinical expertise.
• All hospitals within the organization have developed the Standard Operating Procedures (SOP) for all activities carried out by the respective departments. The Head of the Department reviews all the SOPs once in a year and as and when SOP requires a change. Aster DM group from the central board will review all the SOPs once a year and as and when the unit request for a change. The group is in the process of standardizing all policies and procedures across the units.
• A list of all documents coming from governmental or any other agency that is critical to the functioning of the department would be maintained in the document and data control system. The master copy of these documents would remain with the respective user departments. The authenticity of these documents shall be ensured by the respective departmental heads.
• Documents such as regulations, standards, policies, SOPs, manuals and other normative documents as well as drawings, software, and specifications, work instructions, form part of the Hospital Quality Management System.
The Master copy of all SOPs, policy, and procedures are maintained in the Quality department and a copy of each of these is provided to respective departments for further reference. The documents are maintained in paper or electronic media as appropriately required.
The Head of Quality ensures that:
• Authorised editions of appropriate documents are available at all locations where operations essential to the effective functioning of the Hospital are performed.
• Documents are reviewed and revised once in three years unless there is any immediate changes are required as per the good clinical practice or revised law and acts.
• Invalid or obsolete documents are promptly removed from all points of issue or use, or otherwise to assure unintended use.
• Master copies of the previous documents are retained as records for the changes.
• Any requests for change(s) must be submitted by written communication or via email to the Medical Director and Head of quality including section and page number(s), and the reason for the change and documented in the DCF.
All the documents are uniquely identified.
• SOP number
• Date of issue
• Identification of revision status
• Page numbering with the total number of pages
• Review status
• Identification of the process owner of the document

Each Hospital unit in the organisation establishes departmental goals and objectives annually and develops a department specific Performance Improvement Plan based on the major function and services within the unit and the additional parameters of high volume, high risk, high cost and problem prone nature of the issue. They would first define the core components for development of the plan by stating the Mission and Goals of the Department; current and planned services: patient population served; staffing patterns and quality monitoring and improvement initiatives. Each unit would then report on the results of its performance monitors or outcomes on a regularly scheduled calendar to the respective committees and core quality team. Each unit also reports the results of the departmental monitoring to the regularly scheduled department meeting and quality review meeting to facilitate the involvement of all staff members in the quality improvement process.

The Performance Improvement Plan will require that all departments submit an annual appraisal of the performance improvement activities conducted within the past year and to identify new goals for the performance improvement plan for the department for the next year.

What new quality data has the organisation created?

The Corporate Quality team has created about
• 56 clinical quality indicators and 33 nonclinical quality indicators.
• Nursing Dashboard consisting 23 parameters
• 10 clinical bundles
• Rapid response team – Process Compliance
Please refer Annexure 2 for more details
How has that new quality data been used to change the way that healthcare services are delivered?

Quality Outcome Indicators
• The organisation has defined quality indicators which are largely captured in the quality scorecard. The Quality Scorecard is collated and reviewed at the end of every month by the quality team.
• Each unit within the organisation has an internal validation process that ensures the data collected is –reliable, replicable & accurate.
• The scorecard is further reviewed and validated by the central corporate team. The group chief quality officer reviews the entire scorecard on a monthly basis.
• The endeavour is to monitor the process compliance so that we have better outcomes. The scorecard is also used for benchmarking data across the Network of hospitals. The quality scorecard has 56 clinical quality indicators and 33 nonclinical quality indicators.
The organisation also encourages quality improvement projects. The QIP teams are expected to work on projects with clearly defined objectives and measurable goals
The main emphasis during all improvement initiatives is to ensure a scientific approach by all concerned. To accomplish these objectives, QIP teams are formed to work in various interdisciplinary areas for process improvements. Criteria, for identifying opportunities for improvement, include the impact on:
• Quality outcomes
• Patient care operations
• Cost of care
• Customer Satisfaction (Internal and External customers)
• Safety
The sources of information, at a minimum but not restricted to, include:
• Patient satisfaction surveys (inpatient and outpatient)
• Quality measurement screens from administrative data
• Staff and employee feedback
• Incident reports

Month : March
Year : 2015

The organization has about 56 clinical quality indicators and 33 nonclinical quality indicators monitored across the group. Please find attached the Annexure 2 for the key indicators and also Annexure 9 for details on how it is monitored and discussed in the monthly /quarterly meetings.



• For any quality improvement program measurement is the central concept as it provides a means to define the compliance and also compares the original targets in order to identify opportunities for improvement. 
• We measure the success of our quality performance indicators based on the compliance reports from regulatory inspections, patient satisfaction surveys, third-party surveys /assessment –
Accreditation surveys, and statistical indicators and internal process review audits. 
• The compliance to regulatory Inspection which is done by health authorities helps us measure minimal requirements for the safety of patients and personnel. 
• We conduct Patient satisfaction surveys which help us address what is valued by patients and the general public including specific domains of patient experience and satisfaction. 
• Third party assessments /Accreditation Surveys help us know compliance with international standards for quality systems and supports our journey of continuous quality improvement. Statistical indicators which are captured under managerial indicators, clinical indicators and nonclinical indicators help us understand topics for performance management, quality improvement, and further analysis.