Lcif and sf dr pararajasegram

LCIF SIGHTFIRST
SightFirst

History

HISTORY AND BACKGROUND
AIMS AND OBJECTIVES
ACHIEVEMENTS
FUTURE TRENDS AND DIRECTIONS
Meeting the Challenges at Lion Eye Hospital Level

10/30/13

LIONS SF Conclave.Kolkata Oct.
2013

1

WHAT WAS THE IMPETUS FOR
LIONS
BECOMING INVOLVED IN SIGHTRELATED WORK?

10/30/13

2013

2

Helen Keller’s speech
Occasion:
1925 Lions International Convention
Venue:
Cedar Point, Ohio, USA.
Date:
June 30, 1925
10/30/13

2013

3

10/30/13

2013

4

What Helen Keller said:
• “Will you not help me hasten the day when
there will be no preventable blindness; no
little deaf, blind child untaught; no blind
man or woman unaided?
• It is the caring that we want more than the
money. The gift without the sympathy and
interest of the giver is empty.

10/30/13

2013

5

Helen Keller’s appeal to the
Lions.
“I appeal to you Lions , you who have
your sight, your hearing, you who are
strong and kind,
Will you not constitute yourselves
KNIGHTS of the BLIND,
in this crusade against darkness?
10/30/13

2013

6

Throughout its History
• Lions have had an enduring interest in prevention
of blindness and its alleviation.
• Projects include Cataract Surgical Camps,
Cataract Free zones, Distribution of used
spectacles, Eye Banks, Training projects, Low
Vision care, Lions Eye Clinics and Hospitals,
Academic Chairs in Ophthalmology, Eye health
education, Rehabilitation, etc.
10/30/13

2013

7

The importance of our EYES
Perhaps the most important of our five
senses.
Sight
Loss of Sight is the most
feared event.
Hearing
Touch
Smell
Taste
10/30/13
8
2013

The role of Sight
 Development and growth
 Education and Learning
 Mobility
 Doing Tasks
 Employment
 Recreation
 Quality of Life
10/30/13

2013

9

BUT we take our sight for
granted
 No one appreciates Sight more than
one who has had good sight and lost it.
 No one cherishes Sight more than one
who has lost it and regained it

10/30/13

2013

10

Lions “Seminar for Sight” in Singapore
1988
International President: Lion Austin Jennings
The Seminar made the delegates aware of the
- magnitude of the problem of global
blindness,
- the feasibility and cost effectiveness of
intervention
- the great potential for Lions everywhere to
participate and help those who were blind
or in imminent danger of going blind.
10/30/13

2013

11

LCIF decided to launch SightFirst
"Lions Conquering Blindness”
• The first step was to mobilize resources
through a SightFirst Campaign.
• Chair: Past International President
Judge Brian Stevenson.
• Lions worldwide responded with their
hearts and their purses.
• Over US$140 million was raised
10/30/13

2013

12

Setting up of a Structure
• Global Level
 SightFirst Advisory (Review) Committee
 WHO as Technical advisors to SF
 SightFirst Department in Oakbrook
• Country level
 Lionistic SightFirst Committees
 Technical Advisors for different regions
10/30/13

2013

13

Projects launched under SightFirst
•
•
•
•
•
•

Cataract Surgeries- camps, cataract free zone
Training Institutions and training
New Eye Hospitals and upgradations
Eye Health Education - Diabetes, Glaucoma
Onchocerciasis and Trachoma Control
Childhood Blindness

• EVALUATIONS CARRIED OUT
• Findings resulted in the need for re-thinking
priorities and new needs.
10/30/13

2013

14

SightFirst Mission Statement
• “The Lions Clubs International Foundation
SightFirst program, funds the efforts of Lions, Non
Governmental Organizations, government
agencies, and others to fight the major causes of
preventable and reversible blindness through the
support of eye health care delivery systems,
training and infrastructure development.”
• Wherever possible the local LIONS should be
involved. It is in their Benefit to do so.
• Visibility that this was a LIONS project was
important
10/30/13

2013

15

"From LIONS Conquering blindness"
Partnerships and Collaborations
were encouraged and developed
 Enhanced Partnerships for improving
impact of SF.
 Reinforce existing and forge new
partnerships as stated in mission
statement.
 Seek joint project development where it is
not inimical to Lions SF
10/30/13

2013

16

New developments
"Top-Down Projects"
 Projects targeted for Action by the
International leadership based on an
identified need which go beyond even
multiple districts.
 A small technical committee should pursue
the identification and development of such
project(s) eg. Childhood Blindness
10/30/13

2013

17

Child friendly Eye Care Centers
10/30/13

2013

18

NEED FOR COMMITMENT OF LIONS
LEADERSHIP AT ALL LEVELS
 Lions Leadership to become very familiar with SF
goals, criteria, projects and outcomes
 Formal training of new International Directors on
SF
 Include SF information Seminar in Regional
Forum and have staff on hand
 Training of MD SF Chairmen
 Include SF information in DG-Elect Training
10/30/13

2013

19

PUBLIC RELATIONS regarding
SIGHTFIRST
 Highlight SF achievements in LCI PR
 in-house to Lions and externally to general
public
 Use opportunity of World Sight Day to
emphasize activities and achievements of
Lions SF.
 Keep Lions Web site updated on SightFirst
10/30/13

2013

20

• Some new principles and criteria
• The general moratorium on Capital
Construction projects to be maintained
• Upgradation of facilities be entertained based on
established criteria
• Management
• Prior MOU/ Letter of intent, with partners be
established before proposal submission
• Management training for Project staff including
Lions
• Standardized Management (Technical) monitoring
system be introduced
10/30/13

2013

21

MONITORING, REPORTING AND
EVALUATION
 SHOULD BE AN INTEGRAL PART OF THE
PROPOSAL
 OPERATIONAL RESEARCH AND
POPULATION BASED SURVEYS TO BE
CONSIDERED WHERE NECESSARY.

10/30/13

2013

22

PRIORITY AREAS FOR
SIGHTFIRST
Disease perspective
 Blinding Cataract – an unfinished agenda (phasing
out)
 Blinding Trachoma (S A F and E ). “
 Diabetic Retinopathy, Glaucoma, URE LV care in
areas where adequate infrastructure exists.
 The Lions Eye Health Program (LEHP)
 Areas not included could be supported by other
LCIFLIONS SF Conclave.Kolkata Oct. clubs
grants or local
10/30/13
23
2013

TRAINING
 Technical training/skills development
 Management skills
 Community Eye Care
 Establishing partnerships with existing
centres of excellence
 Comprehensive Eye Care
10/30/13

2013

24

•
•
•
•
•

DEVELOP ALTERNATIVE PROJECTS
Comprehensive eye care
Sustainable projects
Develop model projects in poor areas
• TRAINING IN MANAGEMENT AND CEH
Identify Centres for training
Develop capability in Region

10/30/13

2013

25

TECHNICAL COOPERATION BETWEEN “LIONISTIC”
AND “NON LIONISTIC” COUNTRIES

• The Committee accepted this in principle and
would like to promote this idea especially between
geographically proximal countries, with active
local participation in needs assessment, planning
and implementation, monitoring and evaluation,
with special emphasis on training and local
capacity building.
10/30/13

2013

26

PAST AND PRESENT
• The SightFirst Programme has been a
DYNAMIC one with periodic evaluation,
reviews and long range planning. These
Long range plans have served as dynamic
guidelines to assist Lions and TA’s, out in
the field, and SF staff and the SAC.
• They have been flexible enough to deal
with unforeseen or emerging situations.
MUCH HAS BEEN ACHIEVED
MUCH MORE REMAINS Oct. BE DONE 27
TO
10/30/13
LIONS SF Conclave.Kolkata
2013

Future directions for the Lions
SightFirst Programme.
• The second Lions Seminar for Sight, in
Seoul, S Korea,held in 2004, 16 years
since the first one, brought in the
promise of new dimensions, with a
galaxy of experts in fields, representing
a broad spectrum of Vision related
eye care and activities including
research
10/30/13

2013

28

DETERMINING THE BEST INVESTMENT

How can the Lions, individually and
collectively, through their
philanthropy and volunteerism, do
the greatest good, to the largest
number, in greatest need, in the
shortest possible time, at the
lowest cost?
10/30/13

2013

29

Sight Preservation, Restoration
and Enhancement
Helping to apply the knowledge and
skills that we already possess, to
prevent and treat blindness and
visual impairment and enhance
functional vision, is perhaps the
first priority.
10/30/13

2013

30

ENHANCING VISION AND IMPROVING
Function

Uncorrected Refractive errors
Low Vision care
Orientation and Mobility Training
10/30/13

2013

31

Vision loss
from Diabetes Mellitus
( A Chronic Multi- System Disease)

Diabetic Retinopathy
Control of systemic disorder
important
10/30/13

2013

32

• Preventing Blindness from
GLAUCOMA
Aging related
Chronic Disease – Long follow up.
Care expensive and labour intensive
Adherence to treatment poor
Best case detection through
Comprehensive eye examination
10/30/13

2013

33

Measuring the Results of our
labours
To measure is to know.
If we do not measure (EVALUATE)
we will never know whether we
achieved what we set out to achieve.
Publish and truthfully share our
results.
It will help reaping rich dividends
10/30/13

2013

34

HOSPITAL LEADERSHIP/
MANAGEMENT
• PATIENT CENTRED COMPREHENSIVE EYE
CARE
• EFFECTIVENESS AND EFFICIENCY
• HUMAN RESOURCES
• QUALITY OF CARE
• SUSTAINABILITY
• SELF RELIANCE
10/30/13

2013

35

• “See the Person in the
Patient”
• PATIENT CENTRED CARE
that is COMPREHENSIVE
10/30/13

2013

36

EFFECTIVENESS
and
EFFICIENCY

10/30/13

2013

37

HUMAN RESOURCES

10/30/13

2013

38

SUSTAINABILITY

10/30/13

2013

39

• QUALITY OF CARE

10/30/13

2013

40

Quality Assurance in
Eye Care

10/30/13

2013

41

The Role of Lions Eye Hospitals in
the context of implementing
SightFirst Projects

10/30/13

2013

42

• HOSPITAL
• LEADERSHIP and MANAGEMENT

• SUSTAINABILITY
• and
• SELF RELIANCE

10/30/13

2013

43

The SightFirst Programme
• The SightFirst Programme was conceived
as a Sight preserving and sight restoration
project
• Of the LIONS
• By the LIONS
• For the PEOPLE – the poorest of the Poor.
• The rewards for the LIONS would come
from the gratitude of the PEOPLE who are
helped
10/30/13

2013

44

The provision of health, including Eye
Health is already a “service business”.
Patients (customers) must come first.
They should not be treated with
needless technology for diagnosis or
treatment.
They must be the recipients of a
product (VISION) that is good, is
affordable and is delivered with
compassion and in a timely manner.
10/30/13

2013

45

The key to Quality in Health Care
Service Delivery is patient
satisfaction
Patient satisfaction means fulfilling
the expectations of patients.
10/30/13

2013

46

The Deming Philosophy
Three basic precepts
• Customer orientation
• Continuous sustained improvement
• Recognising that Quality is determined
by the system
10/30/13

2013

47

.If you or your parents went as a
patient
what factors would make you feel
confident and satisfied with the
doctor you are consulting?
10/30/13

2013

48

Behaviours and service quality perceptions of
customers
• Reliability
• Responsiveness
• Competence
• Access
Inspiring confidence
• Courtesy
• Communication
• Credibility
• Security
• Understanding
• Empathy
10/30/13

2013

49

QUALITY ASSURANCE
The Concept of Quality
assurance comes from the
Manufacturing Industry
It has not been used in Health
Care Delivery till recently
10/30/13

2013

50

In What way has this happened?

10/30/13

2013

51

ADAPTING QUALITY PRINCIPLES
• Adapting quality principles used in manufacturing
to health care services is a means to achieve both
productivity improvement (quantity) and along
with it, product improvement (quality).
• However quality improvement is not something
that you do once and then sit back to enjoy the
results.
• QUALITY is associated with an attribute of a
product at a discrete time.
• RELIABILITY relates to performance over a period
• of time - consistent quality.
10/30/13

2013

52

ENSURING QUALITY
• With a product, the manufacturer
(provider) ensures that the product is
of acceptable standards through
various forms of quality control
• The Customer (user) is the final judge.

10/30/13

2013

53

IN EYE HEALTH CARE
THIS IS SADLY LACKING
• There is generally hardly any
mechanism for ensuring quality control
in the production of the product, which
is FUNCTIONAL VISION.
• The PATIENT (customer) is seldom
consulted on, or an opinion sought on
the quality of the product (outcome).
10/30/13

2013

54

Lessons from Manufacturing
Industry

• Much of our quality practice
comes from the
manufacturing industry but
fundamental differences exist
10/30/13

2013

55

MANUFACTURE OF A
PRODUCT
> STRUCTURE
> PROCESS
> PRODUCT
10/30/13

(OUTPUT and OUTCOME)
2013

56

STRUCTURE
(In manufacturing)
•
•
•
•
•

Factory building
Machinery
Trained Personnel
Components
Stores etc.
10/30/13

2013

57

PROCESS
(In manufacturing)
COMPONENTS
PRODUCT
INPUTS
OUTPUTS
• Checking parts and product
• Discarding faulty items
• Assembling
• Checking final product for quality
10/30/13

2013

58

OUTPUT
(In manufacturing)
The Product
In productivity terms this refers to
quantity
• the Number of a products
manufactured
10/30/13

2013

59

OUTCOME
(in manufacturing)
• Finished Product of assured Quality
• Determined by the consumer in terms
of the “value” and enjoyment of the
use of the product (customer
satisfaction).
10/30/13

2013

60

EYE HEALTH CARE
STRUCTURE
•
•
•
•
•
•

Outpatient Department
Wards
Operating Theatre
PERSONNEL
Equipment
General facilities – lobby, waiting rooms,
toilets
• Dining rooms
10/30/13

2013

61

PROCESS
(In Health Care)
NON CLINICAL ACTIVITIES
• Appointment system
• Registration
• Counseling
• Billing
• CLINICAL ACTIVITIES
• Patient care – Doctor/patient relationship
• Pre Op/ Operative/Post Op care
10/30/13

2013

62

PRODUCT
(In health care)
OUTPUT- Number of surgeries
OUTCOME - quality of surgery
•
•
•
•
•

VISION - VA
Return of Functional activity
Activities of Daily Living (ADL)
Quality of Life
Patient Satisfaction
10/30/13

2013

63

Measures of OUTCOME
• ORGAN LEVEL

Function of eye

» Visual acuity
» Field of vision
» Contrast sensitivity
» Colour vision

• PERSON LEVEL

Function of person

» ADL - QOL

• SOCIETAL LEVEL
»
Patient
satisfaction
10/30/13
2013

64

Methods of Measurement
• ORGAN LEVEL - Clinical audit
• PERSON LEVEL - extended clinical audit
- community based study
RACSS
• PATIENT SATISFACTION
- part of clinical audit
- follow-up study
10/30/13

2013

65

“CLINICAL AUDIT”
SELF ASSESSMENT
•
•
•
•

Measure outcome - VA
Analyse outcomes - good and poor results
Identify reasons for suboptimal outcome, if any.
Retrain as necessary - individual or team
THIS SHOULD BE A RECURRING PROCESS.
CONTINUOUS SELF ASSESSMENT and SELF
IMPROVEMENT IS THE KEY TO SUCCESS

10/30/13

2013

66

Learning and Progress
“To measure is to know”
Learning and Progress accrue only when
there is something to learn from, and
the something, is any completed
action.
DO NOT FALL INTO THE TRAP OF THE
“SYNDROME OF ASSUMED MERIT “SAM”
10/30/13

2013

67

There is a major difference
between the
manufacturing industry
and health care

10/30/13

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68

A MAJOR DIFFERENCE IN
MANUFACTURING AND HEALTH
CARE
• The interface between the producer
( health care provider ) and the
customer ( patient )
10/30/13

2013

69

INTERFACE
• Customers never interact with
workers in manufacturing
organizations, whereas in service
organizations, interactions
between provider and patient
(consumer) is high.
• INTERACTIONS AFFECT PERCEPTIONS OF QUALITY
• STAFF BEHAVIOUR HAS A CRITICAL IMPACT UPON
PERCEPTIONS OF QUALITY
10/30/13

2013

70

PRODUCER/CUSTOMER
INTERFACE IN
MANUFACTURING
F
A
C
T
O
R
Y
10/30/13

STORE

2013

R
E
T
A
I
L
E
R

Customer

71

HEALTH FACILITY/ PATIENT
INTERFACE
STRUCTURE

PROCESS

O
P
D

10/30/13

W
A
R
D

O
T

OUTCOME

W
A
R
D

2013

72

HEALTH FACILITY/ PATIENT
INTERFACE
STRUCTURE

PROCESS

OUTCOME
Satisfaction

O
P
D
10/30/13

W
A
R
D

O
T

W
A
R
D

2013

73

Service Organizations
• Must recognize that QUALITY is a product of
the SYSTEM, and in service organizations,
particularly, PEOPLE are the system.
• Sustained excellence has to be developed in a
systematic and well directed fashion.
• Pre-experience training
Skills
Training
• “On the job” guidance
Re10/30/13
74
training
2013

Team Work
A number of personnel with different job
descriptions and training are involved in these
three phases.
 However the Team Leader has to ensure the
highest quality of performance in each one of the
personnel. Being a good role model is critical.
 This cannot be enforced. The value of quality must
be a shared culture.
 Motivation is a key factor in developing a quality
culture. Job satisfaction is a key element.
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75

Training needs
• Training is necessary in order to enable
personnel to acquire the skills, knowledge
and attitude necessary to perform the task
to an acceptable standard.
• Training is essentially a learning process ,
and in order that progress can be
successfully monitored there should be a
system of constructive performance
assessment.
10/30/13
76
2013

Details of Training
• The training needs of both the individual
and the organization must be identified and
analyzed.
• Targets and standards must be set for the
trainee which are within their capabilities.
• There must be active involvement on the
part of the learner, not just passive
acceptance of information.
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77

Training
• A variety of methods and techniques should
be used to provide stimulus variation and
maintain interest.
• The pace of the training programme should
reflect the trainee’s ability to maintain
progress.
• The trainee should have regular feedback of
results. Any problem areas should be
highlighted/ discussed/resolved as soon as
possible.
10/30/13

2013

78

Shared value of Quality
• Quality control should not be construed as
an extra burden incorporated in, or added
to, a process.
• It should be the concern of all personnel,
since the production of high quality
services enhances the reputation of the
institution.
• Thus all employees should be encouraged
to contribute ideas for increasing efficiency
of the processes and the quality of the
10/30/13
79
product.
2013

QUALITY ASSURANCE
(In health care )

ENSURE QUALITY OF
• STRUCTURE
• PROCESS
• PRODUCT/ (OUTCOME)
IF PATIENT SATISFACTION IS DESIRED

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80

ENSURING QUALITY
• Mission for Quality in top
management
• Shared Vision of Quality
• Development of a Quality Culture
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81

Ensuring Quality (Contd)
Adopting Norms/Preferred Practice
Guidelines
Continuous Measurement &
Monitoring
Self assessment
Continuing Professional Development
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82

Quality Aspects of Cataract
Surgery

Each year cataract surgery enables millions
of people to improve their vision - it is one
of the most frequently performed and
successful surgical operations in the world.
Although it has been performed from
ancient times, the last half century has seen
remarkable refinements of the procedure
We need to ensure that the benefits are
passed on to all patients
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2013

83

Use of Quality (Visual
Outcome)
The primary purpose is for the surgeon
to assess his or her own results of
Surgery.
Analysis of these results would indicate
how well or badly they are helping the
patient.
It is a clue to improving the outcome.
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84

Stages in Cataract Surgery
• Preoperative Assessment
• Surgical procedure
• Post Operative care
• A POOR result may be due to one or
more of these stages
10/30/13

2013

85

Elimination of Avoidable Blindness
• We now say 38 million people are blind and 3
times that number have "low vision".

• ."
• We need to address the issue of blindness on an
individual basis, whether it is cataract surgery, or
prescription and supply of glasses, or glaucoma
etc.

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86

Extreme sub-specialization
 With increasing sub-specialisation professionals
begin to focus on the tissue rather than on the
person and beyond.
 Some overlook that the cornea is part of the eye,
leave alone part of a person, a family, a
community.
 Adopt a holistic view of eye care, not a narrow
tissue oriented focus.
10/30/13

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87

Benefits of Quality Assurance
(In health care)
• Patients perspective
• Surgical team’s perspective
• Institutions perspective
10/30/13

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88

Patients’ perspective
• Patients expectations achieved - Patient
satisfaction
• Better functioning
• Better productivity
• Better Quality of life
• Removes barrier to service utilization by
patients
10/30/13
89
2013

Surgical Teams Perspective
•
•
•
•
•
•

Self esteem and professionalism
Identification of weaknesses
Needs assessment for training
Improvement in teamwork and practice
Sense of achievement
Gratitude of patient
10/30/13

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90

INSTITUTIONAL PERSPECTIVE
•
•
•
•
•
•

Gaining in Popularity
Increased patient load and income
Sustainability
Sense of achievement
Sense of gratitude of community
Recognition as a centre of excellence
10/30/13

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91

REWARDS OF QUALITY
• PERSONAL LEVEL

• Self Esteem working in a
Quality Facility
• Seeing happy, Satisfied Patients
• Professional satisfaction
• Enhanced practice and incomes
10/30/13

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92

> willingness
to pay
Quality
reputation
Patient
satisfaction
Provider
satisfaction
QA
QUALITY
REPUTATION

Cost effective
10/30/13
Standards

Loyalty to
Facility

> REVENUE

> CUSTOMER BASE
SUSTAINABILITY

QUALITY

> NET REVENUES

Reduced
Attrition

Doing it

Right the first time
2013

93
< COSTS

Quality Assurance in
Eye Care Delivery
• Take Home Messages
 A WORTHWHILE INVESTMENT
 IT REMOVES AN IMPORTANT BARRIER TO UPTAKE OF
SERVICES
 IT ENHANCES PATIENT COMPLIANCE and
 LOYALTY
 IT ENSURES SUCCESS IN ACHIEVING VISION 2020 GOALS

10/30/13

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94

Take Home Messages (contd)
 CLEAR VISION AND GOALS ABOUT QUALITY MUST BE
COMMUNICATED TO ALL
 TOTAL TEAM MEMBER EMPOWERMENT AND INVOLVEMENT IS
NECESSARY
 CUSTOMERS( patients ) AS THE KEY DRIVERS FOR CHANGE
 FOCUS ON PROCESS: THE HOW OF DOING WORK:PEOPLE THE KEY
ELEMENT
 MEASURES FOR CONTINUING PERFORMANCE ASSESSMENT and
IMPROVEMENT

10/30/13

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95

Thank you

10/30/13

2013

96

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