Performance Management & Quality of Care of Mater Dei's

Diabetes Clinic

By: Jennie Bauer, Thomas Maselli, Samantha Read, and Jeffrey Wagoner

James Madison University

Background of Diabetes in Malta. Around 10% of the Maltese population suffers from Diabetes, 30,000- 40,000 people. The percent of those suffering is expected to double in the next few years. Expected high number of those with Diabetes and are not aware of their condition

http://www.diabetesmalta.org/Profile.html

Background of Mater Dei’s Diabetes and Endocrine Clinic

Mission Statement:We strive to offer be a centre of excellence in:

.Providing the best clinical service to patients suffering from diabetes & other endocrine disorders in a friendly environment, making best use of

the resources available to us.Performing research which furthers knowledge of diabetes and endocrine

disorders, in collaboration with the University of Malta Medical School .Promoting awareness of and knowledge about diabetes and endocrine

disorders as well as healthy life-styles amongst the general public, in collaboration with the Health Promotion Department and the Maltese

Diabetes Association .Postgraduate training of doctors in the specialty of Diabetes and

Endocrinology

https://ehealth.gov.mt/HealthPortal/health_institutions/hospital_services/mater_dei_hospital/diabetes/diabetes_endocrine_clinic_mdh.aspx

Background of Mater Dei’s Diabetes and Endocrine Clinic

Services offered at the clinic:. Nursing staff for basic diabetic care . Podiatrist. Optometrist (retinopathy care). Dietitian . Diabetes education and health promotion

Background of Mater Dei’s Diabetes and Endocrine Clinic

Diabetes Education and Health Promotion:. Have a class room in the clinic. Hold diabetes education classes for all patients . Appeal to children diabetes education with Lenny the Lion

http://www.medtronicdiabetes.com/lenny-carb-app/

Background of Mater Dei’s Diabetes and Endocrine Clinic

By the numbers… Total No. of New Patients:

1,250 - as of March 25th 2010 (a total of 6,140 New Patients in 2010)

994 - as of February 4th 2011

Avg. wait time from date when appt was done to actual appt date

231.2 Days - as of March 25th 2010

203.2 Days - as of February 4th 2011

*Number’s gathered from Clinic Records

Background of Mater Dei’s Diabetes and Endocrine Clinic

By the numbers continued…..

*Number’s gathered from Clinic Records

Logical Framework Analysis (LFA)

• LFA is an integrated quality management model and adopts brainstorming sessions among the hospital managers, practicing doctors, nurses and support staff in workshop environment.

Develop Performance Parameters - The process parameters are both objective and

subjective in nature. Identifying those factors and developing a framework to analyze them are to be carried out to derive process performance.

. Used qualitative observations

. Conducted interviews with staff and patients

. Used and analyze data from the clinicDey, P. K., & Hariharan, S. (2006). Integrated Approach to Healthcare Quality Management: A Case Study. The TQM Magazine , 583-605.

Measure Current Performance-Extensive data collection and analysis in line with the performance measurement framework with the active involvement of the process owners are to be carried out in order to measure performance of each process.

. Qualitative Measures

. Use of prior knowledge of quality care

. Qualitative assesment of interviews Dey, P. K., & Hariharan, S. (2006). Integrated Approach to Healthcare Quality Management: A Case Study. The TQM Magazine , 583-605.

Accessibility to Diabetes Information

Lack of Diabetes Literature

• Brochures not readily accessible

• Posters displayed are not relevant to diabetes

• Pamphlets need to be patient friendly - available in both Maltese and English - clear of excessive medical jargon

Solutions • Provide diagrams ex. Illustrating proper injection sites• Instructional/procedural Posters ex. Administration of insulin• Health posters ex. Posters on nutrition, vision etc…

Patient Confidentiality

Organization of Files

• Files need to be organized in a manner which is easily understood and not disorganized– More space– Shelving to accommodate the number of records

• The location of the filing room is easily accessible to anyone in the clinic– New location– Properly secure access

• Abbreviated files– Files were bulky and potentially cause clutter and confusion

File Misplacement

• Files were liberally scattered throughout the clinic and in few cases were even on the floor– Have a system where files are not in the open

• Fully integrate a digital filing system– Paper files used as a backup rather than primary

source– Use of laptops or tablet PCs by doctors

Vocalization

• Patient names should be called out using only their daily number

• Medical conditions should only be talked about behind closed doors

Patient Discrimination?

• Does the breach in patient confidentiality cause employer discrimination?

• Could be a problem if not closely monitored

Patient Wait Times

• New system of patient progression

• Create clearly labelled patient waiting areas

• New Scheduling System– Extend appointment scheduling times– Train Receptionists

Final Remarks

Special Thank You to:

Moira Grixti Antonella Grima

Dr. Sandra Buttigieg

Questions?