The Road to Improvement

It is important to note that the problems faced by our healthcare system are not new


The GB Pant tragedy, SMHS doctors strikes, rampant Hospital Acquired Infections (HAI), medical negligence cases – the list of healthcare problems in the valley goes on.  It is impossible not to read, hear or experience firsthand the many issues ailing our healthcare system.  But the purpose of this article is not to belabor facts already presented in various articles in the past.  This article offers food for thought: evidence-based measures aimed at initiating systemic improvement to create a stronger, efficient and effective healthcare system in Kashmir for generations to come.  It is important to note that the problems faced by our healthcare system are not new.  These issues plague many developing countries around the world currently, and have been faced by developed countries in the past.  Therefore, instead of reinventing the wheel, analyzing the success and strategies of countries that have overcome similar problems can serve as a guide on the road to improvement. 
The Science of Improvement
“You can’t improve what you can’t measure.”, Edward Deming, founder of Total Quality Management has aptly underlined.
The Institute for Healthcare Improvement (IHI), based in Massachusetts, USA is a non-profit organization that aims at improving the lives of patients, the health of communities, and of the healthcare workforce.   The IHI focuses on identifying and testing new models of care in partnership with both patients and health care professionals to ensure the broadest possible adoption of best practices and effective innovations. When it comes to structural healthcare improvement, the IHI recommends a four-step model as a framework:
1. Formulating a Team:  Effective teams include individuals from different but relevant backgrounds with a range of knowledge, expertise and the power to create change.  In order to effectively drive improvement, physicians, allied healthcare professionals, public health officials, social workers should collaborate with the administration, quality & risk management teams, and - most importantly - patient/patient advocates.  Patients must be elevated from traditional, passive roles and provided a platform to voice their concerns and be a part of the committee that drives improvement.  Also, it is critical that individuals on committees be chosen based on their work ethic, knowledge, expertise, and vision instead of how much weight their position holds in the organization and/or the state. 
2. Setting Aims: Improvement requires setting time-specific and measureable goals.  For example, with respect to Hospital Acquired Infections (HAIs) like surgical site infections, bloodstream infections, ventilator associated pneumonia and catheter associated urinary tract infections, the team must first establish a distinct goal of decreasing the rate of HAIs in the hospital (or a specific department - ICU) by a certain attainable amount (for example, 20% in the next three years).  Once the vision is established, evidence-based tactics to achieve improvement need to be defined.  Following the World Health Organization (WHO) guidelines for preventing HAIs can be a starting point – these guidelines include establishing an infection control committee to set IC policies; setting methods for HAI prevention and surveillance; delegating technical aspects of hospital hygiene to appropriate staff, such as nursing, housekeeping, maintenance, clinical microbiology laboratory; periodically reviewing the status of nosocomial infections and effectiveness of interventions to contain them; training all staff on IC practices and policies; assuring availability of sufficient and appropriate supplies necessary for adherence to Standard Precautions (e.g., hand hygiene products, personal protective equipment, injection equipment)2.  You cannot ‘cut corners’ when it comes to human lives.  Standard healthcare precautions must be taken every time without exceptions.  Proper hand hygiene must be followed by all members of the clinical staff and actively monitored by administration.
3. Defining Measures: As Robert Downey Jr. said in the movie Sherlock Holmes, “Never theorize before you have data, Watson.  Invariably, you end up twisting facts to suit theories, instead of theories to suit facts.”  Measurement is a critical part of testing and implementing changes because it reveals whether the tactics actually lead to improvement.  Establishing a team focused on collecting data on, for example, the frequency and causes of HAI during the 3-year pilot will allow the committee to evaluate whether the tactics put in place are leading to the necessary changes. 
4. Implementation of Successful Tactics: “The ability to develop, test, and implement changes is essential for any individual, group, or organization that wants to continuously improve.”1 Not every change introduced will lead to improvement.  But it is important to identify tactics that have led to statistically significant improvements and to extend those findings to the entire organization. 
Change is a slow process.  Organizational and systemic changes are even more so.  But history is testament that with a clear vision, strong leadership and a dedicated team, even the most challenging of tasks is possible.  It may take a generation, but at least we will know that the seeds we have planted will create a stronger system and a better future for Kashmir.

 The author has a Masters in Healthcare Administration from the University of North Florida, Florida.  Reach her at

Lastupdate on : Wed, 7 Nov 2012 21:30:00 Makkah time
Lastupdate on : Wed, 7 Nov 2012 18:30:00 GMT
Lastupdate on : Thu, 8 Nov 2012 00:00:00 IST

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