Standard Treatment ProtocolsStandard Treatment ProtocolsManaging Quality & CostManaging Quality & Cost

Dr. Farouk AbdallahDr. Farouk AbdallahPediatrician, Q.M. ConsultantPediatrician, Q.M. Consultant

Esqua Founder & Board Member 1995Esqua Founder & Board Member 1995Nasser Institute Quality Unit Founder & Nasser Institute Quality Unit Founder &

Consultant 2001Consultant 2001

الرحيم الرحمن الله الرحيم بسم الرحمن الله بسم

Current Health Environment:Current Health Environment:– Avoid Overutilization.Avoid Overutilization.– Minimize Health Insurance Benefit Minimize Health Insurance Benefit

Package.Package.– Spending Caps on national basis.Spending Caps on national basis.– Review Care Provided in order to Review Care Provided in order to

reach high quality and law cost.reach high quality and law cost.

Using standard treatment protocol to manageUsing standard treatment protocol to manageQuality and cost in health care:Quality and cost in health care:

New standardized set of clinical Guide New standardized set of clinical Guide lines that reduce unnecessary Variation lines that reduce unnecessary Variation in care.in care.

Elimination of redundant intervention.Elimination of redundant intervention.

Establish clear Line of Communication for Establish clear Line of Communication for all care givers.all care givers.

Simultaneously reduce L.O.S in Simultaneously reduce L.O.S in Hospitals, and bad Practice in O.P as Hospitals, and bad Practice in O.P as Well.Well.

Approach to Quality and Cost Approach to Quality and Cost Control New Thinking:Control New Thinking:

Cost Reduction and Quality Cost Reduction and Quality Improvement are Related Issues – Improvement are Related Issues – no more Unrelated.no more Unrelated.

Quality by Inspection theory of bad Quality by Inspection theory of bad apples (Donald Berwick) Harvard. apples (Donald Berwick) Harvard. To reach and eliminate bad To reach and eliminate bad Employee and practices.Employee and practices.

Methodology:Methodology:

Standardization: are best way to Standardization: are best way to provide service & control cost.provide service & control cost.

Demonstrate effectiveness as a Demonstrate effectiveness as a prerequisite for adopting the new prerequisite for adopting the new processes.processes.

Shared Responsibility by each Shared Responsibility by each person in health care for each person in health care for each process agreed upon.process agreed upon.

Coals of Coals of S.T.P.sS.T.P.s::Raising Quality and Lowering cost by defining and Raising Quality and Lowering cost by defining and standardizing best care for a typical patient in a standardizing best care for a typical patient in a diagnostic category.diagnostic category.

To redesign care for patients within selected diagnoses To redesign care for patients within selected diagnoses in a Health care facility Meeting Minimum structure in a Health care facility Meeting Minimum structure standards.standards.

Eliminating Unnecessary tests procedures, Eliminating Unnecessary tests procedures, intervention, Drugs, Standardize Quality and limit cost.intervention, Drugs, Standardize Quality and limit cost.

Integrating Management of Quality and cost to reach Integrating Management of Quality and cost to reach (charge / cost) models.(charge / cost) models.

To establish a bench Mark that can be used to calculate To establish a bench Mark that can be used to calculate actual cost – so contracting can be no more guess work actual cost – so contracting can be no more guess work – for a certain care given.– for a certain care given.

S.T.P.sS.T.P.s Development DevelopmentSelection of Target Procedures and Selection of Target Procedures and Diagnoses Criteria:Diagnoses Criteria:

Volume.Volume.

High cost procedure.High cost procedure.

High Risk procedure.High Risk procedure.

Multiple Specialties involved.Multiple Specialties involved.

Multiple Nursing units work.Multiple Nursing units work.

Niche program.Niche program.

Political consideration.Political consideration.

Structure Involved:Structure Involved:

Oversight committee.Oversight committee.

Sub committees Concerned for specialties Sub committees Concerned for specialties involved in those diagnoses.involved in those diagnoses.

Participants:Participants:

Avoid resistant group (cook – Book vision).Avoid resistant group (cook – Book vision).

Select Best Physicians who understand and adopt Select Best Physicians who understand and adopt the current environment, besides Lab., the current environment, besides Lab., Radiology, and Nursing groups.Radiology, and Nursing groups.

Financial expertise: is critical and essential.Financial expertise: is critical and essential.

Monitoring:Monitoring:

Using Clinical Indicators which measures Both the desirable and Using Clinical Indicators which measures Both the desirable and undesirable occurrences.undesirable occurrences.

Review clinical paths and essential steps in diagnoses and Review clinical paths and essential steps in diagnoses and treatment of a condition or procedure Via appropriate Medical treatment of a condition or procedure Via appropriate Medical Record screening.Record screening.

SummarySummary

to familiarize all care givers with new best practices in order to adapt and tailor best to familiarize all care givers with new best practices in order to adapt and tailor best care for a given Facility.care for a given Facility.

To Structure Committees for Concerned specialties, besides the over sight To Structure Committees for Concerned specialties, besides the over sight Committee.Committee.

To Identify and select Target procedures and interventions and Diagnoses for To Identify and select Target procedures and interventions and Diagnoses for S.T.P.s.S.T.P.s.

Standard Treatment Protocols Managing Quality CostStandard Treatment Protocols Managing Quality Cost

SummarySummary To standardize S.T.P.s by the proper Committee, approved by the oversight committee To standardize S.T.P.s by the proper Committee, approved by the oversight committee within available Facilities structure and selected Drug Formulary.within available Facilities structure and selected Drug Formulary.

Documentation of all steps for a given care for a certain category of patient Documentation of all steps for a given care for a certain category of patient Diagnoses, Using the approved and valid medical record.Diagnoses, Using the approved and valid medical record.

To monitor the process by screening the desirable and the undesirable occurrences To monitor the process by screening the desirable and the undesirable occurrences and indicators for continuous Evaluation using proper screening form (available).and indicators for continuous Evaluation using proper screening form (available).

Standard Treatment Protocols Managing Quality CostStandard Treatment Protocols Managing Quality Cost

SummarySummary

Billing, for all components of care given for a certain Category of diagnoses 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 or procedure using suitable form (available) Regularly for 6 months to reach standards and identify deviations in cost by Expertise Financial analyst.standards and identify deviations in cost by Expertise Financial analyst.

Consequently contracting for a given care is no more a guess work but rather Consequently contracting for a given care is no more a guess work but rather a valid value.a valid value.

Standard Treatment Protocols Managing Quality CostStandard Treatment Protocols Managing Quality Cost