QUALITY OF CARE
Sharon Gondodiputro, dr., MARS., MH
Department of Public Health Faculty of Medicine
Unpad
References:
1. A.F. Al-Assaf, Mutu Pelayanan Kesehatan, Perspektif
Internasional (Health Care Quality: An International
Perspective), alih bahasa: Munaya Fauziah & Andri
Lukman, Penerbit Buku Kedokteran-EGC, Jakarta, 2003,
Bab 1 dan 2
2. Rakish,Longest & Kurt Darr, Managing Health Services
Organizations, Health Professions Press, Inc. USA,1992,
hlm.407-422
What is Quality?
some definitions of quality
PHILIP CROSBY , ’78 :
Mutu adalah pencapaian kepada suatu keinginan atau
spesifikasi tertentu (quality is conformance to requirements or
specification)
AL ASSAF, ’93 :
Mutu adalah melakukan sesuatu dengan baik mulai dari
pertama kali dan melakukan berikutnya lebih baik lagi (quality
is doing the right thing the first time and doing it better the next)
AMERICAN MEDICAL ASSOCIATION,’91 :
Mutu adalah pelayanan kesehatan mencapai tingkatan
probabilitas dampak yang optimal bagi pasien (Quality is the
degree to which care services influence the probability of optimal
patient outcomes)
IBM ’92 :
Mutu adalah tercapainya keinginan dari pelanggan, baik
internal maupun eksternal untuk suatu produk yang sempurna
(quality is meeting the requirements of the customer , both
internally and externally , for defect free products and services)
Key words :
Requirements or specification
Doing the right thing the first time
Defect free products and services
Optimal patient outcomes : meeting the requirements of the
customer , both internally and externally >> customer satisfaction
Who are the customers?
Who are the customers?
Health workers
Patients and their families
INTERNAL
CUSTOMERS
Owners or third payers
INTERMEDIATE
CUSTOMERS
EXTERNAL
CUSTOMERS
Principles of Quality
 DONABEDIAN
 DEMING
 JURAN
 CROSBY
 ISHIKAWA
DONABEDIAN, BALANCE BENEFIT AND RISKS
Components of
quality
Technical care
Definition
involves using medical knowledge and
technology to maximize the benefits of care
for the patient while minimizing the risks
involved;
Interpersonal
involves paying attention to the psychosocial
aspects of care, including the patient provider
relationship, the larger social context in
which care is provided and the social
circumstances with which the patient must
cope;
Management/organ
izational
determines its accessibility, timeliness, the
amenities provided and efficiency.
Dr. Deming's philosophy
 Quality = Results of Work efforts
Cost
 quality tends to increase and costs fall over time.
 However, when people and organizations focus
primarily on costs, costs tend to rise and quality declines
over time.
DEMING’S WHEEL
1. PLAN: Design or revise business process components to improve results
2. DO: Implement the plan and measure its performance
3. CHECK/STUDY: Assess the measurements and report the results to decision
makers
4. ACT: Decide on changes needed to improve the process
JURAN
1.
Determine who the customers
are
2.
Determine the needs of the
customers
3.
Develop product features that
respond to the customer’s need
4.
Develop the process that are
able to produce those product
features
5.
Transfer the resulting plans to
the operating forces
1.
Evalaute “actual Quality performance”
2.
Compare actual performanceto quality goals
3.
Act on the differences
1.
Establish the infrastructure needed to secure anually quality
improvement
2.
Identify spesific needs for improvement
PHILIP B. CROSBY
: 4 absoluts of quality (zero defect concept )
1.
Quality is conformance to requirements  customer’s real need
2. PREVENTION  Should have a system of detecting potential
problem areas and identifying methods for preventing the
occurrence of these problems  cost savings
3. the performance standard is zero defect
4. the measurement of quality is the price of non conformance 
cost savings , because non quality causes problems and problems
cost money
ISHIKAWA CAUSE AND EFFECT DIAGRAM
 Quality Assurance is to demonstrate that a service or
product fulfills or meets a set of requirements or criteria.
Actual processes and/or outcomes are compared to predefined criteria or pre-selected requirements.
 Quality Control refers to the systematic use of methods to
ensure that a service or product conforms to a desired
standard. Primary emphasis is placed on monitoring
processes and/or outcomes.
 Quality Improvement refers to the betterment or
enhancement of a product or service. When enhancements
are ongoing or occur repeatedly over time, the process is
known as continuous quality improvement.