New Mowasat Hospital – Best Quality Data Model FINALIST – 2018

A family run, 100 bed hospital in Kuwait with 2017 revenue of $75m.

New Mowasat has created a Clinical Governance and Quality Framework to integrate all processes and activites which impact patient care into one strategy. Only in place since March 2017, it has already achieved improved outcomes in multiple areas. Select improvements include reducing unplanned admission after day surgery from 4% to beneath 2%. It has also successfully reduced medication errors in its pharmacy from 1.2 to less than 0.75%.

New Mowasat Hospital (NMH) is a family owned hospital and one of the first private hospital in Kuwait. New Mowasat healthcare also owns New Mowasat Clinics providing premiere healthcare services for more than 12 specialties in the areas surrounding the Ahmadi Governorate in the south of Kuwait with superb medical care. The hospital is 100 beds with 800 employees and is among the leading private providers of inpatient and outpatient care in Kuwait with the revenue of over USD 75 million in year 2017.

New Mowasat Hospital (NMH) Clinical Governance and Quality Framework place emphasis on the focus of improvements being on systems and processes rather than on the individual; Clinical governance is a framework which helps clinicians – including nurses and Allied Health Professionals- to continuously improve quality and safeguard standards of care. It aims to integrate all the activities that impact on patient care into one strategy. Clinical Governance combines risk management with quality management. This involves improving the quality of information for patient care, promoting collaboration, team working, and partnerships, as well as reducing variations in practice, and implementing evidence-based practice.CGQC data Model focuses on the customer (be they internal or external customers), supported by structures, processes, capability development, and outcomes. CGQC Model Annexure 1.The implementation of CGQC data model is done through various Quality Tools used by Quality Systems Management at NMH. Under this model NMH has completed selected various Quality Improvement projects (Clinical and Non-Clinical).
Few examples for the projects under CGQC data model are:
Project 1: Reducing waiting time for MRI, CT scan and Ultrasound. Annexure 3
Project 2: Implementation of Doctor’s Scorecard to monitor ongoing physician performance Annexure 4
Project 3: Reducing Medication Errors through Pharmacist Interventions. Annexure 5
Project 4: Reducing unplanned admissions after day surgery. Annexure 6
Project 5: Administering Aspirin on Arrival and Discharge for all patients with MI.Annexure 7
Project 6: Stat Turnaround time for Cretinine and Electrolytes. Annexure 8

New Mowasat Hospital (NMH) Clinical Governance and Quality Framework place emphasis on the focus of improvements being on systems and processes rather than on the individual; Clinical governance is a framework which helps clinicians – including nurses and Allied Health Professionals- to continuously improve quality and safeguard standards of care. It aims to integrate all the activities that impact on patient care into one strategy. Clinical Governance combines risk management with quality management. This involves improving the quality of information for patient care, promoting collaboration, team working, and partnerships, as well as reducing variations in practice, and implementing evidence-based practice.CGQC data Model focuses on the customer (be they internal or external customers), supported by structures, processes, capability development, and outcomes. CGQC Model Annexure 1.The implementation of CGQC data model is done through various Quality Tools used by Quality Systems Management at NMH. Under this model NMH has completed selected various Quality Improvement projects (Clinical and Non-Clinical).
Few examples for the projects under CGQC data model are:
Project 1: Reducing waiting time for MRI, CT scan and Ultrasound. Annexure 3
Project 2: Implementation of Doctor’s Scorecard to monitor ongoing physician performance Annexure 4
Project 3: Reducing Medication Errors through Pharmacist Interventions. Annexure 5
Project 4: Reducing unplanned admissions after day surgery. Annexure 6
Project 5: Administering Aspirin on Arrival and Discharge for all patients with MI.Annexure 7
Project 6: Stat Turnaround time for Cretinine and Electrolytes. Annexure 8

Focused Areas for Data Collection
The important processes on which the organization collects internal data to re-evaluate 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 use and management of medications
• Utilization Management activities regarding the appropriateness of admissions and length of Hospital stay
• 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
• The effectiveness of the Safety Management Program
• The pharmacy and therapeutics function including adverse drug reactions, drug-drug and drug-food interactions, pharmacist interventions 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
This data is monitored analyzed and made available through various tools such as Hospital Balance scorecard ( Annexure 9), Quality Indicators ( Annexure 2) and doctors’ scorecard ( Annexure 4).

METHODOLOGY
Each Department/Specialty services 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 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
• Evaluate the effectiveness of quality improvement monitoring
• Present reports to the relevant committee
Each department /specialty services in the organization 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 concept called Clinical Governance and Quality Framework is implemented to measure medical outcome over the whole treatment process.
Starting from initial conditions and indication criteria, to treatment processes and complications/mortality during the hospital stay and outcome from patient and expert view. All these numbers and results are aggregated and presented in the monthly CGQC meetings.
Firstly, the quality data model ensures that all data is comparable (because of explicit definitions and defined data collection processes) and benchmarking (internal or external, national or international) is possible (which is one of the most important requirements to drive quality improvements).
Secondly, data collection is totally integrated into care and treatment processes. Relevant data will be collected in real time at the point of care. So initial demographics like age, gender etc. are collected only once during the first encounter while data like pain scoring or wound observations are collected every day on the wards by nurses. This process makes it possible to collect data in a very efficient way, reduce double documentation and improve data validity.
Most of the data management is automated, all the relevant data is extracted, merged, transformed, analyzed and visualized automatically through our HMIS system.
When we implemented CGQC framework at NMH it took us some time to get implement accurate valid databases for some of the indicators selected by department. But with time a clear strategy for defining and collecting useful quality data and indicators was provided, lot of emphasis was put on staff training for collecting and presenting valid and accurate data. The team designed standardized format for reporting each indicator and QI project. Each QI project was driven by a team leader for regular discussion and further developments with our expert teams, the effects started from the time we started reporting data within the hospital.
A second aspect, which stimulates these focused discussions in our expert groups, was the voluntary publication of outcome measures at hospital website.

• Month : March
• Year : 2017

The main key performance indicators are all included in the Quality Indicators List for 2017-2018 (Annexure 2) with a focus on the following key topics:

• Patient outcome (e.g. Code Blue outcome, surgical site infection, etc.),
• Patient safety (infection control, safety of high risk medication etc.)
• Patient experience (e.g. complaint management, patient satisfaction survey score etc.).

Several best practice projects (e.g. pharmacist interventions to reduce medication errors, reducing unplanned admission after day surgery, Aspirin on Arrival and at Discharge for MI patients.) or significant changes in treatment pathways after analyzing and discussion outcome during our Multidisciplinary Specialty Groups meetings show the success of CGQC framework data model at New Mowasat Hospital.

In addition, 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.