Quality Healthcare

Question 1

Healthcare

Answer 1

The maintenance or improvement of health via the diagnosis, treatment & prevention of disease, illness, injury & other physical & mental impairments in human beings

Question 2

Quality of care

Answer 2

The degree to which health services increase the likelihood of desired health outcomes

Question 3

6 dimensions of good quality healthcare

Answer 3

1. Safety
2. Effective
3. Patient-centred
4. Accessible
5. Efficiency
6. Equitable

Question 4

Safety

Answer 4

• minimise risk & avoid injuries to service users from the care that is intended to help them

Question 5

Effective (3)

Answer 5

• evidence based therapy
• improve health outcomes
• based on the needs of the patient

Question 6

Patient-centred (2)

Answer 6

• patient preferences, needs & values

- shared decision making

Question 7

Accessible

Answer 7

• timeliness

Question 8

Efficiency

Answer 8

• maximise / optimise resource use

- avoid waste

Question 9

Equitable

Answer 9

• provide care that does not vary in quality
• regardless of personal characteristics
  eg gender, ethnicity

Question 10

Is the provision of quality healthcare easy?

Answer 10

No.

But the public/patients hold the government/provider accountable for the quality of healthcare

Question 11

Barriers to quality healthcare (4)

Answer 11

1. Rapid changes in medical science & technology
2. Growing complexity of healthcare
   - more to know
   - more to do
3. Change in public health needs
   - aging population
   - increase chronic diseases
4. Disorganised healthcare delivery
   - complex & uncoordinated
   - esp during transition of care & institutions working in silo

Question 12

Singapore Healthcare Landscape & Delivery (5)

- aka types of healthcare services

Answer 12

1. Health Promotion
   - individual & community responsiblity
   - supported by HPB
2. Primary Care
   eg GP, family medicine clinics & polyclinics
3. Acute Care
   - private hospitals
   - restructured hospitals & national centres
4. Intermediate Care
   - community hospitals
5. Long term Care
   - nursing homes
   - vanguard health (nursing homes owned by the government)

government owned facilities are mainly acute care (restructured hospitals & national centres)

Question 13

Singapore Healthcare Philosophy (3)

Answer 13

1. Achieve better health for all
   - well people
   - promote healthy living
   - promote preventive health programmes
2. Ensure quality & affordable basic medical services
   - for all
   - at public hospitals or clincis
3. Anchored on individual responsibility
   - copayments
   - pay more for a higher level of service

Question 14

In Singapore,

• core issues (2)
• pain points (3)

Answer 14

Core issues (2)

• quickly aging society
• more people with chronic diseases

Pain points (3)

• increase out-of-pocket cost
• increase bed occupancy
• decrease ILTC capacity (Intermediate Long Term Care)

Question 15

Healthcare 2020 to Beyond Healthcare 2020

Answer 15

Healthcare 2020

• accessibility
• quality
• affordability

Beyond Healthcare 2020

1. Move beyond hospitals to community
2. Move beyond quality to value
   - 3 main clusters (NHG, NUHS & Singhealth)
3. Move beyond healthcare to health
   - promote healthier lives

Question 16

Healthcare clusters in Singapore

Answer 16

• reorganised from 6 to 3 in 2017
• optimise resources & capabilities
• provide more comprehensive, integrated & patient-centred care

Question 17

Number of

• general hospitals
• community hospitals
• primary care

Answer 17

General hospitals : 8
Community hospitals : 6
Primary care : 23 (polyclinics)

Question 18

Singapore Healthcare Financing Approach (2)

What are the various tiers of protection to ensure no Singaporeans are denied access to basic healthcare due to affordability issues (1)

Answer 18

• individual responsibility
• affordable healthcare
• S + 3M

Subsidies
Medisave (personal savings)
Medishield (basic health insurance)
Medifund (safety net)

Question 19

Subsidised drug list & schemes (3)

Answer 19

Subsidised drug list

1. Standard Drug List (SDL)
2. Medication Assistance Fund (MAF)

Scheme
1. CHAS

Question 20

Frameworks for quality healthcare in Singapore (2)

Answer 20

1. Legislative framework

2. Non-legislative framework

Question 21

Legislative framework (3)

Answer 21

1. Private Hospitals & Medical Clinic Acts
   - ensures quality of healthcare service providers
   - ensures compliance to the act
2. Professional registration & conduct
   - licensed HCP
   - upholding professional standards
   - continue professional education for license renewal (practicing cert)
3. Medical products, procedures & diseases
   - Health Product Act
   - what medical profession can & cannot do
   - follow recommended guidelines

Question 22

Non-legislative framework (4)

Answer 22

1. Evidence-based clinical practice guidelines & practice standards
   - ACE on cost effective patient care
2. Monitoring patient satisfaction
   - national survey
3. Market-based mechanisms to promote competition & transparency
   - fee benchmarks & bill amount information
4. Voluntary accreditation for quality & safety standards
   eg Joint Commission International

Question 23

The National Pharmacy Strategy (NPS)

Answer 23

A transformation programme to make pharmacy services

• accessible & timely
• affordable
• quality focused
• giving patient safer & more integrated care

Question 24

5 key thrusts of NPS

Answer 24

1. Pharmaceutical Care Excellence
2. Confident Pharmacy Workforce
3. Re-design Supply Chain
4. Information Enablement
5. Technology Enablement

Question 25

Pharmaceutical Care Excellence (5)

Answer 25

- establish the role of pharmacy in the community care setting - improve drug stewardship in non-acute care setting - establish collaborative models of care for medication reconciliation - implement a clinical governance framework for medication management - promote pharmacists as part of the mutli-disciplinary healthcare team

Question 26

Confident Pharmacy Workforce (6)

Answer 26

- implement advanced practice framework for pharmacists - establish pharmacy residency programmes - enhance pre-reg training - develop & train pharm technicians - build up manpower capabilities for community care setting - build capability in collaborative prescribing

Question 27

Re-design Supply Chain

Answer 27

- centralise procurement, packaging, compounding & distribution - deliver medications when patient need it (timely & accessibility)

Question 28

Information Enablement (3)

Answer 28

- common platform to stimulate & share clinical-based research & innovation - increase consumer & patient access to contextualised health information & education - establish a National Drug Formulary (NDF)

Question 29

Technology Enablement (3)

Answer 29

- standardise drug terminology & code structures (seamless & accurate transfer of information) - common pharmacy system for harmonised medication dispensing - enhance telepharmacy services

Question 30

Why should we care about quality improvement?

Answer 30

- its about improving health & disease conditions of our patients - an attitude we have & want our patients to have - to make healthcare better

Question 31

Quality Improvement Mindset (3)

Answer 31

1. Will - must have the will to improve 2. Ideas - ideas alternatives to the status quo 3. Execution

Question 32

Model for Quality Improvement Steps (5)

Answer 32

1. Set an aim 2. Establish process & outcome measures 3. Identify changes 4. Test changes using PDSA cycle - pilot tests 5. Implement changes

Question 33

PDSA cycle

Answer 33

1. Plan 2. Do 3. Study - get feedback - study current plan 4. Act

Question 34

Phenomenon in Singapore's population (5)

Answer 34

1. Declining population 2. Low birth rates 3. Smaller ratio of old age support 4. Higher life expectancy 5. Higher healthcare expenditure