http://barha.tripod.com

Barha Health Center is among many of the Kingdom's health centers participating in an innovative plan to improve quality of health services.

For this purpose a Quality Assurance (QA) Team was established consisting of:

Team Leader:

1. Dr. Yahya Khader - GP

Team Members:

2. Dr. Fadwa Hijazi - Dentist

3. Ghassan Miqdad - Asst. pharmacist

4. Ibrahim Sharif - Clerk

5. Abeer Bataineh - Asst. nurse

6. Wajid Talafhah - Midwife

Team Coordinator:

Dr. Mazen Marji

Director of Irbid Health Directorate: Dr. Abdulrahman Tbaishaat (center)  Quality Assurance Team Leader: Dr. Yahya Khader (right)  Quality Assurance Team Member: Abeer Bataineh (left)

Dr. Fadwa Hijazee	Ibraheem Sharif	Ghassan Miqdad

During the QA five-day workshop a performance improvement review (pir) process was used to collect Data on the six elements of QA: Environment and safety, Client satisfaction, Client care, Community involvement, Management and Technical competence.

The Data was collected from clients and center staff using observation, interviews and record reviews.  The Data was analysed and the following problems were unveiled:

1. Absence of client privacy.

2. Infection prevention non-compliance.

3. Non-availability of clinical protocols.

4. Ineffective health education plan.

5. Screening for disease is not done.

As soon as the QA worksop was over, the QA team held its first meeting in which a number of recommendations were made:

Setting every Thursday morning as the time of the QA team weakly meeting.

Immediate implementation of client privacy in all divisions within the limitations of the available means.

Putting notices in various areas of the health center requesting clients to respect other clients' privacy.

Working with the coordinator to make available the necessary clinical protocols, train the Doctors and urge them to start following them without delay.

Obtain the Infection prevention protocol and place it in suitable places where staff can see and follow closely.  All concerned were urged to comply with the hand-washing and infection prevention protocol.

Screening for diseases should commence immediately for blood pressure of the age group 30 years and above and another for breast examination five subjects per weak.

The following obstacles were encountered:

• The midwife is one of the team members but not of the center's staff.  She works in theBarha MCH center which is completely independent administratively which makes it extremely difficult to implement decisions taken and follow them up.

• The heavy work overload, lack of basic needed tools such as an accurate BP apparatus, a weighing & height taking instruments, untrained and unmotivated staff, and the difficulty in getting the necessary stationary and displaying boards hinder the full iplementation of the quality assurance plans.

• The physical environment of the center is difficult to alter, therefore improvement can only be minimally observable no matter how hard one tries.

• An interruption of the teams weakly meetings took place due to the abscence of the majority of the teams members including the team leader either in a long training course or a long leave.

In spite of all the above mentioned, the team members endeavored to make the QA attempt a success, so they continued to implement whatever was recommended in the previous meetings within the available resources.

We thought of some alterations in the physical environment of the center to make room for full client privacy and to provide space for staff training.

We analysed the data of BP screening in the first two-month period: from 4/2 - 4/4/2002 and the results were as follows:

The problem:

During the performance improvement review it was found that no screening for diseases of any sort was carried out in the center.

Aim:

Putting a strategy of doing screening for diseases on a regular basis, and putting a mechanism of follow up and evaluation.

Determining the disease to which screening is to be done.  BP screening was chosen.

Determining the targeted group to who BP sceening is to be carried out.  It was decided that all clients of the age group 30 years and above should be the targeted group.

Training the assistant nurses on taking the BP correctly using the BP taking prtocol as a guide and using the teaching method of role play to ensure accurate results.

Making available a new BP apparatus and a register to record the readings.

Determining the  starting point and it was on 4/2/2002 and to be continued on a regular basis.

Obstacles:

Heavy work load.

Inability to keep client privacy 100%.

Results:

Data was analysed of the first two-month period of BP screening, i.e.from 4/2 to 4/4/2002 and it was as follows:

The number of clients examined were as indicated in the following table and the corresponding graph:

Grand Total	514	Percentage
Number of males	162	31.52%
Number of females	352	68.48%

The following table shows the number of BP cases old and new according to age-group and sex:

Regular screening procedures for diseases contribute to the early dicovery of diseases, and therefore early treatment and help in minimizing complications and sometimes full recovery.

• Continuing the BP screening and the analyses of data at regular intervals to arrive at conclusions and institute the necessary interventions.

• Expanding the screening program to include other areas like the Testicular swellings and the Breast tumors.

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