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June 2018
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The one-day symposium involved 60 participants including health professionals, health administrators, educators, and students. They discussed best practice models to improve and sustain high quality health care, and heard interesting panel discussions on quality in health systems, health education, patient care and diagnostic services. Dr Vishwanath Partapsingh, Acting Chief Medical Officer at the Ministry of Health, attended. Dr Edwin Bolastig who is Health Systems and Services Advisor for the Pan American Health Organization, spoke on behalf of the Director General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus. Dr Joshua Tepper, CEO of Health Quality Ontario (HQO), gave an impassioned and inspiring presentation on delivering quality healthcare across a vast geographic area to a diverse population with socioeconomic challenges. He said in Ontario this is mandated by a government bill called “Excellent Care for All”, requiring accessible, appropriate, effective, equitable and safe health care for all citizens. Dr Tepper highlighted the approaches taken by Ontario’s HQO to realise this goal through nine key activities: (1) Create the conversation (a culture of quality); (2) Public Reporting; (3) Provider Reporting; (4) Quality Improvement Plans; (5) Quality Standards; (6) Patient Engagement; (7) Skill Building; (8) Large Scale Improvement; and (9) Clinical Engagement. Davlin Thomas, CEO of the North Central Regional Health Authority (NCRHA), spoke on “Improving Quality at the Edge of Chaos”. Through the lens of disruptive innovation, complexity management and health systems theory, he provided recent examples of improvements in service quality at the NCRHA, such as significantly reduced waiting times for emergency care and the Walk-The-Talk initiative. The latter, he said, empowers communities to take ownership of their health issues. Dr Henry Bailey of the Arthur Lok Jack Graduate School of Business gave an insightful presentation on his research in patient-reported outcomes, and how tools such as the EQ-5D can aid clinical decision-making through patient involvement in health care. He also highlighted the shift in the use of patient-reported outcomes from population studies towards collecting this type of data as part of healthcare delivery in oder to improve quality of care. The important issue of monitoring the quality of medicines was given focus by Dr Rian Extavour of The UWI School of Pharmacy, in particular post-marketing surveillance of the quality of medical products. She highlighted the global prevalence of substandard and/or falsified medical products and practical approaches used to monitor the quality of medical products, which were pivoted on prevention, detection, response. Quality in health educationProfessor Joseph Branday, who is Director of Medical Education at UWI’s Mona campus, traced the history of medical education in the Caribbean and highlighted the development of accreditation systems and standards. He described quality assurance in education as a continuous process of reviewing how students are taught and assessed, whereas accreditation, he said, is intermittent and focuses on evaluation of the product offered. The participants were reminded that robust quality improvement systems may facilitate both global recognition and local relevance. Dr William Smith and Dr Shivaughn Marchan led the audience through the steps involved in acquiring and maintaining accreditation for the postgraduate residency at the School of Dentistry. The School is the only non-US dental school to be accredited by The American Dental Association’s Commission for Accreditation for this programme, offered by NYU-Langone. To describe the need for quality in optometry and eye care, Dr Subash Sharma pointed out the approaches applied in the areas of patient services, and research at the Unit of Optometry, including the National Eye Study of T&T. The latter grew out of a collaboration with the Ministry of Health and Anglia Ruskin University in order to identify areas for quality improvement and is used to guide policy and practice. Quality in patient & diagnostic servicesDr Steve Weaver, Director of The School of Nursing (UWI, Mona) outlined the importance of policies, practice guidelines, leadership and management in quality improvement for clinical practice in the Caribbean. This principle was echoed during the presentation by Professor Chief Patrick Akpaka, Clinical Microbiologist, who emphasized the need for laboratory services that produce results that are accurate, reliable and timely to support optimum patient care. Dr Michael Morris of the School of Veterinary Medicine discussed services of veterinarians at his School who support small animal health, milk and meat production and aquaculture. Participants left the symposium satisfied, and called for more forums to discuss and plan quality improvement in healthcare. Opportunities for supporting quality improvement initiatives in healthcare are available with the recent establishment of the Caribbean Centre for Health System Research and Development at the Faculty of Medical Sciences. The mandate of this Centre includes the strengthening of health systems through the conduct of research relevant to the needs of the Ministry of Health and the Regional Health Authorities, and communicating the findings to them in a format that facilitates uptake in policies, programming and practice. In order to understand areas for improvement, benchmarks and objective measures or indicators are needed to assess all levels of care, particularly patient engagement. Unless we know where our weaknesses lie, how can we develop our strengths? |
Defining and achieving quality in health care remains a challenge to health systems locally, regionally and internationally, as “quality” carries different meanings for different people. The UWI Faculty of Medical Sciences held its second healthcare quality symposium recently, on April 21 at the University Inn and Conference Centre.