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Standard Treatment Protocols Managing Quality & Cost. Dr. Farouk Abdallah Pediatrician, Q.M. Consultant Esqua Founder & Board Member 1995 Nasser Institute Quality Unit Founder & Consultant 2001. بسم الله الرحمن الرحيم. Current Health Environment: Avoid Overutilization.

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standard treatment protocols managing quality cost

Standard Treatment ProtocolsManaging Quality & Cost

Dr. Farouk Abdallah

Pediatrician, Q.M. Consultant

Esqua Founder & Board Member 1995

Nasser Institute Quality Unit Founder & Consultant 2001

slide2
بسم الله الرحمن الرحيم
  • Current Health Environment:
    • Avoid Overutilization.
    • Minimize Health Insurance Benefit Package.
    • Spending Caps on national basis.
    • Review Care Provided in order to reach high quality and law cost.
using standard treatment protocol to manage quality and cost in health care
Using standard treatment protocol to manageQuality and cost in health care:
  • New standardized set of clinical Guide lines that reduce unnecessary Variation in care.
  • Elimination of redundant intervention.
  • Establish clear Line of Communication for all care givers.
  • Simultaneously reduce L.O.S in Hospitals, and bad Practice in O.P as Well.
approach to quality and cost control new thinking
Approach to Quality and Cost Control New Thinking:
  • Cost Reduction and Quality Improvement are Related Issues – no more Unrelated.
  • Quality by Inspection theory of bad apples (Donald Berwick) Harvard. To reach and eliminate bad Employee and practices.
methodology
Methodology:
  • Standardization: are best way to provide service & control cost.
  • Demonstrate effectiveness as a prerequisite for adopting the new processes.
  • Shared Responsibility by each person in health care for each process agreed upon.
coals of s t p s
Coals of S.T.P.s:
  • Raising Quality and Lowering cost by defining and standardizing best care for a typical patient in a diagnostic category.
  • To redesign care for patients within selected diagnoses in a Health care facility Meeting Minimum structure standards.
  • Eliminating Unnecessary tests procedures, intervention, Drugs, Standardize Quality and limit cost.
  • Integrating Management of Quality and cost to reach (charge / cost) models.
  • To establish a bench Mark that can be used to calculate actual cost – so contracting can be no more guess work – for a certain care given.
s t p s development selection of target procedures and diagnoses criteria
S.T.P.s DevelopmentSelection of Target Procedures and Diagnoses Criteria:
  • Volume.
  • High cost procedure.
  • High Risk procedure.
  • Multiple Specialties involved.
  • Multiple Nursing units work.
  • Niche program.
  • Political consideration.
structure involved
Structure Involved:
  • Oversight committee.
  • Sub committees Concerned for specialties involved in those diagnoses.

Participants:

  • Avoid resistant group (cook – Book vision).
  • Select Best Physicians who understand and adopt the current environment, besides Lab., Radiology, and Nursing groups.
  • Financial expertise: is critical and essential.
monitoring
Monitoring:
  • Using Clinical Indicators which measures Both the desirable and undesirable occurrences.
  • Review clinical paths and essential steps in diagnoses and treatment of a condition or procedure Via appropriate Medical Record screening.
summary
Summary

Standard Treatment Protocols Managing Quality Cost

  • to familiarize all care givers with new best practices in order to adapt and tailor best care for a given Facility.
  • To Structure Committees for Concerned specialties, besides the over sight Committee.
  • To Identify and select Target procedures and interventions and Diagnoses for S.T.P.s.
summary11
Summary

Standard Treatment Protocols Managing Quality Cost

  • To standardize S.T.P.s by the proper Committee, approved by the oversight committee within available Facilities structure and selected Drug Formulary.
  • Documentation of all steps for a given care for a certain category of patient Diagnoses, Using the approved and valid medical record.
  • To monitor the process by screening the desirable and the undesirable occurrences and indicators for continuous Evaluation using proper screening form (available).
summary12
Summary

Standard Treatment Protocols Managing Quality Cost

  • Billing, for all components of care given for a certain Category of diagnoses or procedure using suitable form (available) Regularly for 6 months to reach standards and identify deviations in cost by Expertise Financial analyst.
  • Consequently contracting for a given care is no more a guess work but rather a valid value.