Author: Div Mutu

Hari 1

Time	Activities	Responsible person
09.00 – 09.15	Welcome Address Self introduction Introduction of the Program	Dr. Suwit, Dr. Winai, Dr. Viroj, Dr. Anuwat, and Dr Piyawan
09.15 – 10.30	Overview of UHC UHC movement at the global, regional and national levels Thai Experience on UHC and its outcomes Q&A and interactive discussion on UHC movement of participants’ countries	Presentation by Dr Suwit Wilbulpolprasert, the senior advisor to Thai MOPH
10.30 – 10.45	Coffee break
10.45 – 12.00	UC Scheme Management of UC Scheme by National Health Security Office (NHSO) focusing on governance structure, provider payment mechanisms, information system and auditing system An independent assessment of the first 10 years (2001-2010) UC Scheme  Q&A	Dr Viroj Tangcharoensathien, Senior Advisor of International Health Policy Program (IHPP)
12.00 – 12.45	Lunch
12.45 – 13.30	Move from the hotel to NHSO
13.30 – 15.30	Study tour at NHSO – the organization which operates the UC Scheme for 47 million population or 75% of total Thai population Short presentation of NHSO organization and its functions on UC Scheme Study tour at NHSO 3 groups:- call center, data center and HA Summary of the study tour of 3 groups, clarification, Q&A and discussion	Ms Wilailuk Wisasa, and NHSO staff
15.30 – 15.45	Coffee break
15.45 – 17.00	NHSO and application of HA How to apply HA for UC Scheme	NHSO

Hari 2

Time	Activities	Responsible person
09.00 – 09.15	Recap of Day 1	A representative of participants
09.15 – 09.30	Introduction and welcome on HA An overview of where we are now, and where we are going in the next three days	Anuwat Supachutikul, MD. Piyawan Limpanyalert, MD.
09.30 – 10.00	Concept of quality & accreditation	Anuwat Supachutikul, MD.
10.00 – 12.00	How to: Standard setting From basic to advance	Anuwat Supachutikul, MD.
12.00 – 13.00	Lunch
13.00 – 13.30	Café-style storyboard session Learning standard across the Group	Piyawan Limpanyalert MD.
13.30 – 14.30	Scoring guideline: Step by step for assessment	Anuwat Supachutikul MD.
14.30 – 14.45	Break
14.45 – 15.45	Group discussion: Applying lessons to your context	Anuwat Supachutikul MD. Kittinan Anakamanee MD. Piyawan Limpanyalert MD.
15.45 – 16.30	Talk about surveyor: Competency & Training	Anuwat Supachutikul MD. Kittinan Anakamanee MD. Piyawan Limpanyalert MD. Phongpan Tana
16.30 – 17.00	Group discussion: Where we are now, and how to walk together	Anuwat Supachutikul MD.

Hari 3

Time	Activities	Responsible person
09.00 – 09.15	Recap of Day 2	Anuwat Supachutikul, MD. Piyawan Limpanyalert, MD.
09.15 – 10.30	Survey Process: Concept, system thinking, tracer, report, decision	Anuwat Supachutikul, MD.
10.30 – 10.45	Break
10.45 – 11.30	Panel Session: Sharing of surveyor experience	Anuwat Supachutikul, MD. Somjit  Cheejareon, MD. Phongpan Tana
11.30 – 12.00	Group discussion: Where we are now, and how to walk together
12.00 – 13.00	Lunch
13.00 – 14.00	Café-Style Storyboard Session Models and Innovations of quality tools across the Group
14.00 – 15.00	Quality Improvement support	Anuwat Supachutikul, MD. Duangsamorn Bunpadung
15.00 – 15.15	Break
15.15 – 16.15	Organization management: Leadership, strategy, human resource, information and technology	Anuwat Supachutikul, MD. Piyawan Limpanyalert, MD
16.15 – 16.45	Group discussion: Applying lessons to your context Action-Planning at the Country-Level	Anuwat Supachutikul MD. Kittinan Anakamanee MD. Piyawan Limpanyalert MD.
16.45 – 17.00	Briefing on Day 4 Study visit to Siriraj Medical School Hospital

Hari 4

Time	Activities	Responsible person
09.00 – 09.15	Group photo in front of Prince of Mahidol Statue
09.20 – 10.30	VCD presentation of Faculty of Medicine Siriraj Hospital
09.30 – 09.35	Welcome by Dean
09.35 – 10.00	Lecture on “Universal Health Coverage at Siriraj Hospital”
10.00 – 10.30	Lecture on “Hospital Accreditation Program Realization at Siriraj Hospital”
10.30 – 11.00	Sharing and Discussion
11.00 – 11.30	Group A: –  Visit OPD of Pediatrics Group B: –  Visit Siriraj Primary Care Division (PCU)
11.30 – 12.00	Group A: –  Visit Siriraj Primary Care Division (PCU) Group B: –  Visit OPD of Pediatrics
12.00 – 13.00	Lunch
13.15 – 14.00	Visit Siriraj Piyamaharajkarun Hospital (SiPH) Outpatients Clinics (2nd Floor) Cancer Center (1st Floor) Heart Center (4th Floor) Ward (12th Floor)
14.00 – 15.30	Visit Siriraj Bhimukstan Museum
15.30	Leave from the Hospital
18.00 – 20.00	Thank you party – dinner hosted by CAP UHC and HA

Hari 5

Time	Activities	Responsible person
09.00 – 09.10	Recap of Day 4	Participant
09.10 – 10.30	Wrap up Short summary and highlight of HA and HAI Q&A, discuss and clarification	Anuwat Supachutikul MD. Piyawan Limpanyalert MD
10.30 – 10.45	Coffee break
10.45 – 11.30	Key Lessons learned and moving forward together	Anuwat Supachutikul MD. Kittinan Anakamanee MD. Piyawan Limpanyalert MD.
11.30 – 12.00	Closing remarks	Dr Suwit, Dr Winai, Dr Phusit, Dr Viroj, Dr Anuwat, Dr Piyawan and Dr Kittinan
12.00 – 13.00	Lunch

Exchange and Study Program on “Universal Health Coverage and
Hospital Accreditation Program Realization”

PKMK, Bangkok – Program Exchange and Study Program on “Universal Health Coverage and Hospital Accreditation Program Realization” telah dilaksanakan pada tanggal 25 – 29 November 2013. Program yang dilaksanakan di Bangkok, Thailand ini terdiri dari seminar dan study tour. Seminar dilaksanakan di Narai Hotel. Sedangkan saat study tour, peserta diajak berkunjung ke National Health Security Office (NHSO) dan Faculty of Medicine Siriraj Hospital.

Ada dua tema besar yang diangkat pada program kali ini, Universal Health Coverage (UHC) dan Hospital Accreditation (HA). Tujuan panitia mengangkat tema UHC adalah: (a) untuk berbagi formulasi kebijakan, implementasi, outcome dan tantangan-tantangan pelaksanaan UHC dalam skema Universal Coverage di Thailand, (b) untuk bertukar informasi dari negara lain mengenai program-program yang mereka lakukan dalam menghadapi UHC, (c) untuk membangun jejaring diantara partisipan. Sedangkan tema HA diangkat dengan tujuan: (a) untuk mendapat pemahaman mendalam mengenai konsep mutu dan proses akreditasi untuk mengembangkan akreditasi dan rencana implementasi, (b) untuk mengidentifikasi dan berbagi inovasi sukses dalam proses akreditasi di masing-masing negara peserta (termasuk penyusunan standar, tahap-tahap penilaian dan roadmap bagi surveyor), (c) untuk mengikat partisipan untuk mendukung HA sebagai upaya peningkatan kualitas layanan dalam skema UHC.

Jadwal kegiatan program dapat dilihat dalam tabel berikut:

Hari 1
Jam	Kegiatan	Penanggung Jawab	Reportase & Materi
09.00 – 09.15	Welcome Address Self introduction Introduction of the Program	Dr Suwit, Dr Winai, Dr Viroj, Dr Anuwat and Dr Piyawan
09.15 – 10.30	Overview of UHC UHC movement at the global, regional and national levels Thai Experience on UHC and its outcomes Q&A and interactive discussion on UHC movement of participants’ countries	Presentation by Dr Suwit Wilbulpolprasert, the senior advisor to Thai MOPH
10.30 – 10.45	Coffee break
10.45 – 12.00	UC Scheme Management of UC Scheme by National Health Security Office (NHSO) focusing on governance structure, provider payment mechanisms, information system and auditing system An independent assessment of the first 10 years (2001-2010) UC Scheme Q&A	Dr Viroj Tangcharoensathien, Senior Advisor of International Health Policy Program (IHPP)
12.00 – 12.45	Lunch
12.45 – 13.30	Move from the hotel to NHSO
13.30 – 15.30	Study tour at NHSO – the organization which operates the UC Scheme for 47 million population or 75% of total Thai population Short presentation of NHSO organization and its functions on UC Scheme Study tour at NHSO 3 groups:- call center, data center and HA Summary of the study tour of 3 groups, clarification, Q&A and discussion	Ms Wilailuk Wisasa, and NHSO staff
15.30 – 15.45	Coffee break
15.45 – 17.00	NHSO and application of HA How to apply HA for UC Scheme	NHSO
Hari 2
Jam	Kegiatan	Penanggung Jawab	Reportase dan Materi Presentasi
09.00 – 09.15	Recap of Day 1	A representative of participants
09.15 – 09.30	Introduction and welcome on HA An overview of where we are now, and where we are going in the next three days	Anuwat Supachutikul, MD. Piyawan Limpanyalert, MD.
09.30 – 10.00	Concept of quality & accreditation	Anuwat Supachutikul, MD.
10.00 – 12.00	How to: Standard setting From basic to advance	Anuwat Supachutikul, MD.
12.00 – 13.00	Lunch
13.00 – 13.30	Café-style storyboard session Learning standard across the Group	Piyawan Limpanyalert MD.
13.30 – 14.30	Scoring guideline: Step by step for assessment	Anuwat Supachutikul MD.
14.30 – 14.45	Break
14.45 – 15.45	Group discussion: Applying lessons to your context	Anuwat Supachutikul MD. Kittinan Anakamanee MD. Piyawan Limpanyalert MD.
15.45 – 16.30	Talk about surveyor: Competency & Training	Anuwat Supachutikul MD. Kittinan Anakamanee MD.Piyawan Limpanyalert MD. Phongpan Tana
16.30 – 17.00	Group discussion: Where we are now, and how to walk together	Anuwat Supachutikul MD.
Day 3
Jam	Kegiatan	Penanggung Jawab	Reportase dan Materi Presentasi
09.00 – 09.15	Recap of Day 2	Anuwat Supachutikul, MD. Piyawan Limpanyalert, MD.
09.15 – 10.30	Survey Process: Concept, system thinking, tracer, report, decision	Anuwat Supachutikul, MD.
10.30 – 10.45	Break
10.45 – 11.30	Panel Session: Sharing of surveyor experience	Anuwat Supachutikul, MD. Somjit Cheejareon, MD. Phongpan Tana
11.30 – 12.00	Group discussion: Where we are now, and how to walk together
12.00 – 13.00	Lunch
13.00 – 14.00	Café-Style Storyboard Session Models and Innovations of quality tools across the Group
14.00 – 15.00	Quality Improvement support	Anuwat Supachutikul, MD. Duangsamorn Bunpadung
15.00 – 15.15	Break
15.15 – 16.15	Organization management: Leadership, strategy, human resource, information and technology	Anuwat Supachutikul, MD. Piyawan Limpanyalert, MD.
16.15 – 16.45	Group discussion: Applying lessons to your context Action-Planning at the Country-Level	Anuwat Supachutikul MD. Kittinan Anakamanee MD. Piyawan Limpanyalert MD.
16.45 – 17.00	Briefing on Day 4 Study visit to Siriraj Medical School Hospital
Hari 4
Jam	Kegiatan	Penanggung Jawab	Reportase dan Materi Presentasi
09.00 – 09.15	Group photo in front of Prince of Mahidol Statue
09.20 – 09.30	VCD presentation of Faculty of Medicine Siriraj Hospital
09.30 – 09.35	Welcome by Dean
09.35 – 10.00	Lecture on “Universal Health Coverage at Siriraj Hospital”
10.00 – 10.30	Lecture on “Hospital Accreditation Program Realization at Siriraj Hospital”
10.30 – 11.00	Sharing and Discussion
11.00 – 11.30	Group A: Visit OPD of Pediatrics Group B: Visit Siriraj Primary Care Division (PCU)
11.30 – 12.00	Group A: Visit Siriraj Primary Care Division (PCU) Group B: Visit OPD of Pediatrics
12.00 – 13.00	Lunch
13.15 – 14.00	Visit Siriraj Piyamaharajkarun Hospital (SiPH) Outpatients Clinics (2nd Floor) Cancer Center (1st Floor) Heart Center (4th Floor) Ward (12th Floor)
14.00 – 15.30	Visit Siriraj Bhimukstan Museum
15.30	Leave from the Hospital
18.00 – 20.00	Thank you party – dinner hosted by CAP UHC and HA
Hari 5
Jam	Kegiatan	Penanggung Jawab	Reportase dan Materi Presentasi
09.00 – 09.10	Recap of Day 4	Participant
09.10 – 10.30	Wrap up Short summary and highlight of HA and HAI Q&A, discuss and clarification	Anuwat Supachutikul MD. Piyawan Limpanyalert MD
10.30 – 10.45	Coffee break
10.45 – 11.30	Key Lessons learned and moving forward together	Anuwat Supachutikul MD. Kittinan Anakamanee MD. Piyawan Limpanyalert MD.
11.30 – 12.00	Closing remarks	Dr Suwit, Dr Winai, Dr Phusit, Dr Viroj, Dr Anuwat, Dr Piyawan and Dr Kittinan
12.00 – 13.00	Lunch

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Oleh : dr. Hermanto urya, MM (Direktur Eka Hospital BSD) Dipresentasikan pada Forum Mutu Pelayanan Kesehatan IHQN (Jakarta 19-20 November 2013)

Konsep awal standar QPS dalam JCI adalah bagaimana rumah sakit menerapkan prisip mutu dan melakukan peningkatan mutu secara berkelanjutan untuk mencapai keselamatan pasien. Mutu pelayanan dan keselamatan pasien bertumpu pada penerapan/ implementasi kegiatan harian tenaga profesi kesehatan baik dokter, perawat, maupun tenaga profesi kesehatan lainnya. Namun penerapan yang konsisten mengutamakan keselamatan pasien tersebut tidak dapat terjadi begitu saja tanpa upaya. Diperlukan komitmen , kapasitas dan kapabilitas dari setiap petugas dan juga dari manajemen, bahkan sampai kepada tingkat pemilik rumah sakit.

Untuk membangun kapasitas dan kapabilitas dalam meningkatkan mutu pelayanan membutuhkan peranan pimpinan dalam mengupayakan dan membangun budaya kerja yang mengutamakan keselamatan. Pimpinan yang memiliki komitmen akan pelayanan yang aman bagi pasien akan mendorong pelayanan yang baik bagi keselamatan pasien dan akan membentuk budaya pelayanan yang mengutamakan keselamatan pasien.

Peran pimpinan diawali dengan menetapkan arah atau tujuan dari pelayanan berdasarkan area-area prioritas sesuai dengan Goals yang ingin dicapai oleh rumah sakit. Kemudian dibuat indikator untuk pemantauan mutu pelayanan sesuai dengan area prioritas tersebut. Indikator tersebut mencakup indikator aspek klinis, aspek manajerial, indikator sasaran keselamatan pasien dan indicator dari library of measures JCI. Indikator –indikator tersebut dipantau setiap bulan untuk kemudian dianalisa kecenderungan / trend dari hasil pemantauan tersebut dan dibandingkan dengan target yang ingin dicapai.

Untuk membangun budaya keselamatan pasien, pimpinan juga harus memberikan arahan , terbuka untuk perubahan, dan menerapkan budaya pelaporan. Setiap laporan dianalisa dan ditindak lanjuti untuk perubahan yang lebih baik dan bukan untuk mencari kesalahan dan pemberian hukuman. Laporan tersebut juga memberikan gambaran akan kapabilitas tenaga kesehatan kita di lapangan sehingga dapat menjadi masukan untuk kebutuhan pelatihan dan ketrampilan bagi tenaga kesehatan di lapangan.

Perbaikan dan peningkatan mutu tidak hanya dilakukan secara reaktif tetapi juga dilakukan secara proaktif. Setiap tahunnya diidentifikasi minimal 1 proses yang dilakukan perbaikan secara proaktif melalui metode Failure Mode Effect and Analysis sampai terbentuk suatu alur atau desain baru yang lebih baik. Demikian proses perbaikan dan peningkatan mutu dilakukan secara terus menerus dan berkelanjutan.

Konsep untuk menjaga dan memantau mutu pelayanan yang mengutamakan keselamatan pasien akan menghasilkan pelayanan yang efektif dan efisien , biaya kesehatan yang lebih terjangkau dan kepuasan pasien yang meningkat.

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Oleh : Thomas Behrenbeck, MD (Cardiologist, Mayo Clinic, USA) Dipresentasikan pada Forum Mutu Pelayanan Kesehatan IHQN (Jakarta 19-20 November 2013)

“Our [medical] systems are too complex to expect merely extraordinary people to perform perfectly
100% of the time. It is our responsibility to put in place systems to support safe practice.”
Modified from James Conway, COO Dana-Farber Cancer Center

Quality and safety are inextricably linked in the delivery of health care when it aspires to provide the best care for the patient. A large part of this conference is dedicated to the improvement of health care in the new era of Universal Health Care coverage, this presentation will focus on the safety aspect as it pertains to quality.

The landmark report “To err is human” in 1999 by Kohn et al, pointed out that about 44,000 Americans by conservative estimate, and 98,000 by other studies die every year as a result of medical error. Despite these significant numbers, there is still reluctance in medical systems to openly discuss medical errors. Partly, this is due to the approach that an institution takes towards errors, especially when they cause irreparable harm: ‘Who made the error’, whereas the correct question should have been: ‘What happened’. This approach will open the door to the most rewarding discussion: ‘How can we learn from this experience?’, ‘How can we prevent a similar incidence like this in the future’. The key to success is to avoid seeking to place blame, since nobody conscientiously wants to cause harm, but to ensure that we understand the processes leading to the adverse event better and to create a support system which abolishes such problems.

It is now understood that about 80% of medical errors are system based. To take a more detached view, a stochastic approach might be most beneficial. Medical care is a sequence of complicated, interconnected steps, each of them carrying an inherent chance for error. In a simplified model, where each step carries a failure rate of 1 in 1000 times this step is performed, the chances that a multistep process is executed without error can easily be calculated. In a procedure including 25 steps, the probability of success is 78%, when 50 steps are necessary, it drops to 61%, and in a complicated sequence requiring 100 steps, the chance for success drops to less than half, 37%!
From this, some of the most important tenets for maximizing patient safety become apparent: Procedures should be analyzed in accordance to their complexity. It may be safer to break a procedure down into fewer steps, and have checkpoints along the way; ensure that every checkpoint is met before proceeding to the next level. System changes will increase the likelihood of success at every step, removal of unnecessary steps is critical to ensure increased patient safety.

Adverse events can take many forms. It can be due to delayed diagnoses, missed diagnoses, mistakes during treatment, medication errors, delayed reporting of results, miscommunication at any level, particularly though during transfers or transitions of care, inadequate postoperative care, and mistaken identity, not only to person, but also to site of surgery, confusion regarding left vs. right, etc.

The intersection of safety with quality is at the heart of the concept of reliability. Reliability is defined as patients getting the intended tests, medications, patient information, and procedures at the appropriate time and in accordance with patients’ values and preferences (IHI 2004). Since medicine is at its heart an all-or-nothing phenomenon, it is helpful to compare systems in other high risk industries, i.e., commercial flight, nuclear power industry, and even Formula 1 racing.

Safety as a priority in patient care requires cultural change, which is one of the most difficult to successfully achieve in any system. It is imperative that leadership in any medical institution wholeheartedly embrace the culture of safety, to foster an environment in which errors are looked upon as an opportunity to improve without the stigma of personal blame. Every participant in the health care process is a stakeholder in this critical process. Systems and procedures need to be analyzed on a cyclical basis to identify where best practice patterns need to be updated and simplified processes can be implemented to achieve optimal patient outcomes.

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