Operation Eyesight’s Policy on Quality of Eye Care Services

Operation Eyesight believes in the delivery of quality treatment and understands quality health care from six attributes:

  1. Safety: patients should not be harmed by the care that is intended to help them;
  2. Patient-centered: care should be based on individual needs;
  3. Timely: delays in care should be reduced;
  4. Effective: care should be evidenced-based; and
  5. Efficient: best use of resources and reduced waste
  6. Equitable: care should be equal for all people, irrespective of their gender, economic status or religion.

Operation Eyesight has developed a quality policy with the main objective to lay down certain guidelines, protocols, standards and best practices that should help deliver quality eye care to all. This policy is specific to Operation Eyesight’s partner hospitals that are engaged in delivery of eye care services.

Operation Eyesight’s policy is built on the WHO’s health system framework of service delivery, eye health workforce, medicine, technology, infrastructure, health information, health financing, leadership and governance.

In an effort to integrate the Operation Eyesight policy into the Kenya program, a workshop was held on 6thFebruary 2014 to launch the policy. All partner hospitals benefiting from SiB Phase V funding were represented at the workshop.

The Ministry of Health, Ophthalmic Service Unit outlined the government perspective on quality assurance. In an attempt to contextualize Operation Eyesight policy, the partners participated in a situation analysis based on spectrum of quality standards, using the following checklist:

  • The hospital partner performs comprehensive eye examinations on all new patients;
  • The hospital partner has and uses a pre-operative checklist to reduce risk;
  • The hospital partner has and uses an infection control policy;
  • The hospital partner has a policy on safety and protection;
  • The hospital partner has a clearly defined care pathway, from the point of checking in to point of checking out;
  • The hospital partner has and uses standards, protocols and guidelines for surgeries; and
  • The hospital partner has and takes into account a system for assessing patients’ satisfaction.

The results of the analysis showed that some aspects of quality were already in place. However, there were areas that needed strengthening and others needed to be put in place all together.

While some things seemed obvious to the eye care workers, they discovered others were not happening. For instance, the eye care workers reported marking eyes for surgery but failing to get confirmation from the patients about the marked eyes.

In other instances, detailed protocols for scrubbing and gowning were present in some eye units but the protocols were not displayed in strategic places for reference by the clinicians.

None of the eye units had care pathway flow charts at all service points, and none had systems for assessing patient satisfaction. Counseling was being done by clinicians, even though the need to build the capacity of nurses to provide comprehensive counseling was cited.

All the hospitals had infection control policies, but the clinicians recognized the need to sensitize all staff working at the eye units regarding the policy. At the same time, the need was emphasized to frequently remind health workers about the protocols and procedures for disposal of items (e.g. needles) potentially contaminated with infections such as HIV.

Regarding quality aspects related to surgery, areas identified for improvement included: the use of biometry for all patients; the use of IOLs of the correct power; not performing bilateral surgery at the same sitting except under exceptional circumstances; routine monitoring of post-operative visual acuities, as per WHO guidelines; and only allowing one surgery to be performed on one table in one theatre at a given time.

A major challenge was noted in follow-up. A numbers of patients returning for follow-up reduces significantly after the second week. For program planning, the eye workers agreed to report follow up at second week. However, there is still a challenge to follow-up with patients seen during outreaches, since many patients disappear once they heal.

Some gaps could be worked on immediately while others are long term requiring more resources. It was very encouraging the enthusiasm the partners showed towards improving the quality.  Operation Eyesight will work closely with the partners to ensure the quality policy is implemented and support systems are in place by end of 2018.

Alice Mwangi
Country Manager – Kenya
Operation Eyesight Universal
mwangia@operationeyesight.com