ACCORDING to the World Health Organisation, there are about 5.7 to 8.4 million deaths annually in low and middle income countries due to poor quality of healthcare. Some of these countries have attributed the loss of their human capital as high as 15 per cent of the overall death toll to compromised care. Can we afford not to provide quality care to our patients? This translated to about $1.6 trillion losses in productivity.

Global assessments done prior to Covid-19 show that one in eight healthcare facilities had no water, one in five had no sanitation services, and one in six had no hand hygiene facilities. It was estimated that 24 per cent of the world’s population or 1.8 billion were in a fragile state and had challenges to access essential healthcare services.

Hence, the 2019 United Nation Political Declaration on Universal Health Care, agreed upon by the world leaders and aimed to provide an additional one billion persons with essential health services by 2023 and by 2030 to cover the world’s population. Global partnerships and sharing in lessons learnt are key in providing universal healthcare. The Sustainable Development Goal (SDG) number three states that everyone should be able to access quality, affordable health services.

Healthcare is effective when providing evidenced based services to the correlated patient group so as to achieve a desirable health outcome. People-centered service is tailoring the treatment to the patient needs, values and personal preferences so that patient adherence is achieved, ultimately benefitting the patient. Patient safety is the motto throughout the process.

Making essential healthcare services more accessible is different from sustaining quality in the system which requires the integration of ethics, resilience and commitment.
Quality healthcare is the provision of safe and effective treatments that are most-importantly people-centered. These services should be timely, equitable and standardised in a non-discriminatory and efficient manner.

Efficiency is enhanced using lean synchronisation principles such as just-in-time deliveries and optimal utilisation of scare resources, induced by the pandemic and war crises, so that maximum benefits and minimum wastages are realised. Continuous improvements in quality are recommended for the maintenance of high standards.

Continuous Quality Improvement (CQI) simply evaluates the current operations and seeks to raise the benchmark and to establish the CQI Framework Model for excellence. Strategies are developed to optimise the healthcare practice with the collaboration from all partners, the healthcare providers, health IT professionals, health administrators and the consumer. Tools such as the electronic health record systems to enhance the efficiency of the system, minimise wastage due to expiration of overstocked supplies, duplication of medical services provided inclusive of tests and medications dispensed and to maximise the use of limited human resources for effective clinical outcomes. For CQI to work there must be a cultural shift in the expectations on all sides of the spectrum, the patient, the practitioner and the general public where the watchwords are accountability, continuous assessments and feedback.

Quality of care is measureable and ranges from promotion, prevention, treatment, rehabilitation and palliation. Critical success factors are accurate data collection for measurement of key performance indicators (KPI), adverse event reporting (ADR) and learning systems. Many developing countries are weak in these areas due to scarcity of trained human resources, monitoring agencies and sustainability since migration of people prevent transfer of institutional knowledge.

There are some outstanding healthcare workers who have worked for years beyond the call of duty and made invaluable contributions. They should be recognised and rewarded during the structured performance appraisals system, a necessary step to drive quality care. Key performance indicators (KPI) for standardised healthcare must be precise and measurable, which the immediate supervisor uses to evaluate the care giver.

Apart from the individual performance metric, the following KPI for quality care are:
* Staff to patient ratio
* Patient follow up rate
* Overall patient satisfaction
The KPI for the Emergency Department are:
* Time between symptom onset and hospitalisation
* Patient mortality rate
* Emergency Room waiting time
The KPI for the operations are:
* Average hospital stay
* Bed or room turn over
* Medical equipment utilisation
* Average waiting time for patient
* Patient drug cost consumption
* Average treatment charge
* Average cost per discharge
The KPI for internal operations are:
* Error rate
* Training by department
* Appointment cancellation rate
* Readmission rates
* Patient safety
Public Health metrics include childhood immunisation rate and the number of educational programs.

All levels of healthcare providers must display professional work ethics, attend to patients’ need as a priority, and deliver timely and effective treatment. The system must de designed to make the patient a priority, providing the best care for patients irrespective of your rank, social class, ethnicity, geographical location or gender.

Current assessments such as a SWOT analysis will identify strengths, weaknesses, opportunities and threats in the system and a gap analysis will highlight where we are currently and what are the next steps required to achieve our goals.

William Foster noted that quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.
For further pharmacological guidance, contact the pharmacist of Medicine Express PHARMACY located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic kindly forward them to medicine.express@gmail.com or send them to 223 Camp Street, N/burg. Tel #225-5142.