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Implementation of Quality Assurance & Kayakalp Programme in Rajasthan

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RK Hospital

RK Hospital Rajsamand team members

‘Kayakalp’ scheme, an initiative taken under the Centre Government’s flagship programme Swachh Bharat Abhiyan, aims to improve cleanliness, hygiene and waste management practices at public health facilities, writes Elets News Network (ENN).

Rajasthan is second largest State in India having 10 high priority districts & six tribal districts (Three under HPD). At the same time it also falls under the category of high priority State. the governmental setup is the main stay of healthcare in the State particularly for the poor and those living in rural areas who can’t afford private facilities.

RK Hospital

PMO, RK Hospital Rajsamand Felicitated at National Level

Therefore, it becomes utmost important for the State to ensure quality services at its various public health facilities. Off late the Government run facilities have come under constant pressure due to increased awareness among common consumers. As a result, the need for quality improvement activities in public health facilities has gained importance in the State. Upsurge of demand for quality health services and lack of standardisation of care processes serve as key drivers for the implementation of quality programme.

Quality improvement programmes:

Kayakalp’ scheme, an initiative taken under the Centre Government’s flagship programme Swachh Bharat Abhiyan, aims to improve cleanliness, hygiene and waste management practices at public health facilities. Facilities go through internal and external assessment process against predetermined criteria. The best facilities are given cash award as well as felicitation at the State and National level.

National Quality Assurance Standards (NQAS) have been developed by the Government of India keeping in mind the specific requirements for public health facilities as well as global best practices. NQAS is currently available for District Hospitals, Community Health Centres (CHCs), Primary Health centres (PHCs) and Urban PHCs. Programme aims to recognise the good performing facilities and to improve credibility of public hospitals. Certification is provided against NQAS on meeting pre-determined criteria for three years. Certified facilities are also provided financial incentives as the recognition of their good work.

Challenges Vacant sanctioned position and funds issues are among common challenges during implementation of the programme. However, continuous motivation and nonconfrontational attitude of the leading roles helped the staff to adapt new concept. Inadequate number of cadre was also an important issue. However, optimum use of the available human resource helped us in overcoming this problem.

How we began

Quality was a new concept for public health facilities which were struggling with infrastructure, funds and human resources issues. Ensuring standard practices, improving infection control practices, especially changing the behavior and attitude of staff was not an easy task. About 120 trainings were conducted both at the State and the district level in last three years by the State quality cell. During the trainings, emphasis was laid on improving the infection control & BMW (Bio-medical waste) management practices, adherence to technical protocols, importance of key performance indicators and use of quality tools.

We created and shared sustainable the faulty machines & damaged practices related to improved cleanliness in public health facilities linked to positive health outcomes.

Besides training, due importance was also given to rigorous monitoring and continuous encouragement of the proactive facilities. Most importantly, it was the ownership of the staff working at the facility for implementation and sustainability of quality efforts that gave us the desired results.

Strategies Adopted Kayakalp

• On-site study to analyse the prevalent status and practices to identify gaps (Infrastructure, equipment, documentation, processes and practices) were executed.

• Process mapping of critical activities

• Development, review and implementation of standard operating procedure (SOP) for all departments.

• Defining, monitoring and evaluating the key performance indicators

• Development of Quality Management System (e.g. Patient / employee satisfaction, clinical record indicators and quality indicators etc )

• Upgradation of facility as per requirement e.g. infrastructure, human resource, equipments and training. • Calibration and testing of medical equipments.

• Required civil construction work / structural re-allocation of departments was done

• Hospital compliance to the license, statutory acts and regulatory norms of the State.

• Intensive and continuous trainings

• Regular process monitoring

• Regular mentoring and monitoring visit by the State team and continuous review at state level.

Kayakalp RESULTS

In 2015-16 we started implementing ‘Kayakalp programme’ in all District Hospitals and NQAS in only High Priority District. Now the programme has been taken up to the PHC level. Within one year, number of Kayakalp award winning facilities has increased from 46 in 2016-2017 to 131 in 2017-2018.

For NQAS programme, we started mentoring the District Hospital, Rajsamand, winner of Kayakalp award in 2015-16. The foundation was laid by enhancing the hospital environment through Kayakalp programme. Further emphasis was laid on improving the clinical practices, documenting the policies, implementation of workplace management method, fixing of the faulty machines & damaged parts of the building, patient safety practices and patient satisfaction etc. Also, garbage dumping areas were transformed to waiting areas for the patients, car parks, and flower beds in order to make the surrounding more appealing. Staffs were motivated with success of Kayakalp programme and were further mentored for NQAS certification.

In the year 2017-18, facility was assessed against 5000 checkpoints of NQAS by a team of three empanelled external assessors for three days and became the first District Hospital of Rajasthan to be NQAS certified with 82%.

State adopted the strategy of handholding of Kayakakp award winning facilities and till now eight facilities (3 District Hospitals, 2 Community Health Centres, 3 Primary Health Centres) have been State certified and application for their national assessment has been sent to the Government of India. Community Health Centre Bissau, district Jhunjhunu has already been assessed and has been NQAS certified with 95 percent score while the assessment of other institute will be completed by the Government of India by year end.

The programmes have resulted in improvement in infection control and biomedical waste management practices and have resulted in creating a healthy completion among the health facilities. Recognition provided at various levels is encouraging other facilities to implement the program & improve subsequently. The award money given to health facilities further motivated the staff to implement the programme.

Most importantly the State has been able to create a zeal for quality improvement among public health facilities. “Quality is not an act it is a habit” and to inculcate this habit in public health facilities will undeniably take some time but definitely a start has been made and “Q” word which earlier looked like a distant dream now seems achievable and has become reality for public health facilities also.

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