HARAMAYA GENERAL HOSPITAL

QUALITY IMPROVEMENT PROJECT on

reducing cancellation ration by increasing OR
productivity

January, 2023
Maya
Background of Haramaya General Hospital
Haramaya Hospital is found in East Hararghe; Oromia
National Regional state; 507Km from Finfinne and 18 km
from Harar town
◦ It is established in 2005 Ethiopia calendar.
◦ It was upgraded from health centre
Then in 2009 it was expanded to a zonal hospital by the
Regional Health Bureau.

haramaya general Hospital cluster 1st Q report prp by HA

Cont…
◦ Now the Hospital have more than 172 beds and giving
health service for two towns and four districts for more
than 1.4 million people and also there is 27 Health centers
in the catchment and two lead health centre
◦ It has 340 employees; 186 health Professionals and the
rest supportive staff

haramaya general Hospital cluster 1st Q report prp by HA

Cont…
◦ On averages Daily 320-460 patients visit OPD
◦ It has specialty in psychiatry, eye, ART clinic, Youth
friendly service ,ophthalmic clinic, and TBL among other
services and also four referral clinic
◦ To promote quality service effectively the hospital has fully
utilized all health reform core processes, namely
BPR,BSC, HCF, HMIS/DHIS2/HPMI, EHSTG, SaLTS,
CaTCH-IT, HSTQ, IPD initiatives and EHAQ/EBC
haramaya general Hospital cluster 1st Q report prp by HA
 Organization’s Mission, Vision, Scope
of Service
◦ Mission
Haramaya General Hospital plays a basic role to reduce morbidity, mortality and disability and improve the health
status of Haramaya hospital catchment population through providing and regulating a comprehensive package of
preventive, promotive, rehabilitative and basic curative health services via a decentralized and democratized health
system.
◦ Vision
To see healthy, productive, and prosperous Haramaya Hospital catchment population
 Reducing cancellation rate of elective
surgery in Haramaya General Hospital
 Background
◦ Cancellation of elective surgical operation is defined
elective operation which is not performed on scheduled
date.
◦ cancellation causes increased cost of treatment, loses of
daily wage and mental trauma it also causes under
utilization of hospital resources
 Problem statement
• In the past 6 months of 2023 EC. at haramaya G/Hospital,
2% elective surgical cases are cancelled.
• Cancellation of elective surgical cases are major causes
emotional trauma to the patient as well as to their
families.
 Aim statement
◦ To reduce cancellation rate of elective surgical
cases from 2% to 0% cases in surgical wards of
Haramaya General Hospital. From Feb 1-2023 to
dec, 30-2023
 methods
◦ Study setting
the quality improvement project was conducted at surgical wards of Haramaya General Hospital
Team selection
◦ A multi dispillenery team was established from inpatient case team. surgery department anesthesia
department lasion office healthy care quality improvement .
◦ the team consists of two surgeon 4 anesthetist one quality officers OR head three scrub nurses
Study design and method
◦ Institutional based interventional quality improvement study design was employed.
◦ this study was conducted with continues detailed meeting and discussion to prepare processes map to
identify root causes and generate intervention ideas for reducing cancellation rates’
◦ following this the PDSA model for improvement was applied to test intervention ideas and followed
for improvement in the processor out come in the project with specific measures
 Root Cause Analysis

• the QI team had conducted a root cause analysis

using fishbone diagram to identify root causes of
problems related to surgical cancellation.
 work process

Patient change their mind about

management after admission
-incomplete inv before admission
Patient discontinue
medication eg thyroid -Late intioatin of first incision

Late service seeking behavior Late posting of or schedule

Prolonged NPO stay

Low Low socio economic status of

partner Reducing
Poor communication
Increasin Bed shortage among mngteam cancellation rate
gcancella to o%
Unavailability of anesthesia
tion
Medication
rate2%)
Shortage of or material ppe

provider factors
 Measures
 Out come measures: Percentage(%) of cancellation rate reduced

 Process Measures

 % of elective cases Sean at pre operative clinics among admitted

patients .
 % elective cases evaluated by preanesthesia check list evaluated before
operation days.
 Cont.
 Balancing measures

• Frequent alert meeting and exter work to multi dispillenery

team on different activity and innervation of quality
improvement project led to increases work load
 Drivers diagram
Secondary drivers Intervention
Primary drivers
PROVIDE
Patientchangetheir mindabout EDUCTION
managenent afteadmmisin
Patient discountine PATIENT about
Shortage of or materialf ppeBed
client medication eg thyroid
shortage planned
Late service seeking behevior
Low socio econimic statusof management
Unavalability of anesthesia
Medication

Shortage of or materialf ppi

GIVE AWERANESS ON QI
supply PROJECT
REDUCE incomplete I Aveil all anesthesia drugs
Aveil adquate amount of
elective surgical PPE
cancellation ADD aditional or table
SURGIGENERA
L HOSPITAL [ncomplete inv before
FROM2% admssion Complet investigetion
Late intionatin of first before admission
0%FROM Work processr Ealry inition of first incission
incission
Ealy posting of OR scheduale
late posting of or schedule
Prlolonged npo

Communicate well on
Provider factors Poor communication daily OR schedual
among mngteam
 PROBLEM; INCREASED elective surgical cases cancellation rate

Change Reduce
elective
Measure
Awered surgical staff surgical
COM[PLETED Percentage of
cancellation
INVESTIGATION Implementation elective surgical
rate to 0%
BEFORE cancellation
ADMISSION reduced
ADQUATE OR GIVE AWERANESS ON QI PROJECT
TABLE Avail all anesthesia drugs
Data collection Avail adequate amount of PPE
Sufficient PPE Analysis ADD additional or able
SUFFICENTANETH Interpretation Complete investigation before admission
ESIA DRUGS Early initiation of first
incision
Early posting of OR
schedule

Prediction reduced elective surgical cancellation

Aim-
Serial no Change ideas measures Implementation Responsible
time frame person
1 PROVIDE EDUCTION Process indicators Feb 30 To dec 30 Surgical staff
PATIENT about planned Outcome indicators
management

2 GIVE AWERANESS ON QI Process indicators Feb 30 To dec 30 OR head

PROJECT
Avail all anesthesia drugs
Avail adequate amount of PPE
ADD additional or table

3 Complete investigation before Process measure & out Feb 30 To dec 30 clinicians
admission come measure
Early initiation of first incision
Early posting of OR schedule

4 Communicate well on daily OR Process indicators Feb 30 To dec 30 Surgical staff

schedule
THANK YOU!