Introduction to Self-regulatory Quality Improvement System (SQIS)
Public and private health sector groups came together to develop a Self-Regulatory Quality Improvement System (SQIS) for the Uganda health context. This system is complementary to the current regulatory and supervision system and builds on available institutions with a view to make it more efficient and effective.
The SQIS allows private providers to easily assess quality of their facility and services offered and to develop action plans to address the gaps identified. The SQIS standards are not meant as a tool for fault finding but as a mirror that will help identify gaps in service provision. One assumes that improved quality, on the supply side, will increase efficiency and effectiveness of care. On the demand side, quality services lead to greater client satisfaction, increased use of services, and better adherence to recommended treatment. The SQIS has the following attributes:
Private providers and facilities were consulted extensively to ensure the SQIS is easy-to-use and understandable by this target group. The SQIS is flexible enough to be applied to a wide spectrum of service delivery areas and in different facility settings. When applied correctly and persistently, the SQIS is designed to help private providers address gaps and improve quality of care. The SQIS answers, amongst others, the following questions:
- What standards and guidelines are available?
- How frequently are they applied?
- How is their use monitored and documented?
- What avenues are available for providing feedback?
- What bottlenecks affect their applications?
Perception of quality varies from person to person or whether it is from the provider’s or the client’s perspective. The SQIS defines the provision of quality care as “doing the right thing, right, at the right time all the time”. Or simply put, performance according to standards. One has to address all aspects of quality to bring about quality improvement in a facility.
Ten Dimensions of Quality
- Client- centered care – ensuring that the client has access care at all times. The question to ask frequently is “How does this benefit the client?”
- Access – when needed, the services are available and reachable as determined by location, time and health care providers
- Continuity – having initiated a program of care this shall be followed un-interrupted through to completion
- Safety – the services that are delivered is done in a manner that minimizes risk and harm to the client, relatives and service providers.
- Competence – the persons providing care should have the required knowledge, skills and competence to do so. Non-adherence to this will lead to poor work done and present a risk to the users of services provided
- Effectiveness – the service provided, while adhering to the recommended guidelines, will achieve the required outcomes
- Efficiency – the service delivered will maximize the use of available resources while minimizing waste
- Equity – delivering care which does not vary in quality because of sex, age, status, or geographical location
- Interpersonal relationship – this defines how the health care provider interacts with patients, relatives, community and fellow workers
- Choice – this is to ensure that the client can exercise choice as to what services to take and who will provide that service, unhindered by external influences
Organization of the SQIS
The SQIS sets the basic quality standards that each facility has to meet whatever the size and type of services provided. Please note that not all the standards may apply to one’s facility and depends on the size and complexity of services offered. Although generic in nature, the SQIS is deliberately detailed to allow the user an in-depth check of the prevailing standards of care. The tool is organized in sixteen (16) service areas as listed below. These areas were identified from the reports generated during supervisory visits, because they have the greatest bearing on provision of quality services.
- Facility Governance, Leadership and Management
- Human Resource Management and Development
- Occupational Health and Safety
- Infrastructure and Amenities
- Health Promotion and Education
- Essential Care
- Maternity services
- Infection Prevention and Control
- Client-Provider Interactions
- Laboratory Services
- Medicines and health supplies
- Imaging and Radiology (IR) Unit
The SQIS is designed for an individual to make a self- assessment of his/her performance and work environment. Only take the assessment for the number of areas that are relevant to one’s scope of practice and facility level. One does not have to complete the self-assessment in one sitting, it can be completed over several days. Based on the findings during the pilot, it takes approximately 3 hours to complete all 16 service areas.
To take full advantage of the SQIS tool, it is recommended that one conducts self- assessment on a regular basis. At a minimum, conduct the exercise twice a year, but preferably it should be done four times a year.
Set a specific timetable with a clear schedule to carry out the exercise.