QUALITY IN HEALTH CARE DELIVERY
VIKRAM ANAND
HOSMAC INDIA PVT.LTD
Contents :Quality in Health Care Delivery





Quality in Health Care Sector-Key Principles
Infrastructure for Quality Assurance in Health
Care
Decision Making in Health Care Improvement
Audit –Key Tool in Q.A
Conclusion
Quality in Health Care Sector :
Key Principles
HEALTH CARE



The system that a Nation has built up and continuously
maintains in order to combat (unnecessary)
Death,Disease,Disability,Dissatisfaction and (social)
Disruption
A collection of curative,preventive,rehabilitative and
promotive services
Health care is a social and economical endeavor
encompassing activities by
providers,consumers,financiers and government within
their respective value systems
What’s wrong in today’s Health Care?







Avoidable errors
Underutilization of services
Overuse of services
Variation in services
Communication problems
Lack of Evidence
Dissatisfied clients
What can we do about it?





Do nothing
Better education and training
Policing,Inspection,Punishment
Change,Improve,Reward
Comprehensive Approach:Quality Assurance
Definition of Quality
Why define quality of care?
 Reach consensus among employees
 Avoid confusion and in-house fighting
 Allow for sound evaluation
 Allow consumers to make a choice
From the beginning there was







chaos
quality assessment
quality assurance
quality improvement
continuous quality improvement
Information technology
values
Quality :Terminology



Quality Assurance: the overall philosophy on
Quality and its Assurance
Total Quality Management:one of the newest
organizational and managerial approaches to
Quality Assurance in the (not) for profit industry
Continuous Quality Improvement:an
important organizational and managerial
mechanism for quality assurance in the health
sector
Continuous Quality Improvement
Important elements:
 External and internal customer satisfaction
 Management leadership
 Involves all personnel
 Uses statistical methods
 Focuses on improvements
Definition of healthcare quality



Quality is working according to specifications
Quality is providing effective services with a
minimum of unnecessary use of resources
Quality is to satisfy customers
The Core Principles
The essentials are:
 Assuring(I.e assessing and improving) quality
is the responsibility of the provider
 Quality assurance is an evaluation and
improvement process
 Of all the necessary
attributes(knowledge,skills,attitudes,values)
values and attitudes are the most important
TOTAL QUALITY
The end point of a development in phases:
 Focus on professional quality
 Focus on client satisfaction
 Focus on system effectiveness
 Focus on interconnections
 Organizational and societal unification
Why improve my quality




Because I know it is needed
because I am told to do so
because I must survive
Because I need to follow the rules
Today’s choice:SURVIVAL
Mission Statement
Rationale:programme SURVIVAL
My programme is dedicated to
 Provide high-quality service to the members of
the community
 Employ well-trained professionals
 Maintain a high safety record
 Provide a customer –friendly environment
Plan high –quality services




Identify priorities,goals and customers
Set up working groups
Describe service according to:
-consumer and client needs
- structure,process,outcome
Make plans for evaluation
Quality Planning







Establish Quality project: goals and team
Identify customers
Determine client needs
Design services to be provided
Design delivery process
Determine information need
Use and evaluate
Train professionals






Select key professionals
Design appropriate training
Organize continuous training sessions
Evaluate results of training including
satisfaction
Reward participants
Repeat training regularly
Evaluation







Includes assessment and improvement
Orientation:what are the possibilities?
Selection:What is most appropriate?
Implement: who is doing what?
Collect and discuss the results
Disseminate the results inside and outside
Prepare for the next round
Improvement of care




Focus:Structure,Process and Outcome
Structure:better equipment
Process:doing the right things better!
Outcome:obtain better results in
- effective services
-costs
- client and employee satisfaction
Improvement of structure



Includes building,equipment,personnel,manuals,
information systems,rules and regulations
Includes new provisions,and updating and
refurbishing of old provisions
Need to include recording of inputs and costs
Improvement of Process
Principle:Doing the right things better!
 Doing the right things more effective!
 Doing the right things more efficient!
Includes:
 Appropriate use of technology
 Appropriate use of personnel
 Client/provider relationship
Improvement of outcome
Focus:
 Programme effectiveness
 Programme efficiency
 Consumer and employee satisfaction
 Consumer and employee education
 Building and technology safety
 Community relations
 Information and communication needs
Tools for Improvement







Motivation
Insight
Evaluation methods
Communication tools
Dedicated personnel
Dedicated Management
Money
That implies:

Quality improvement is essential for survival

Customer satisfaction is important for survival

Monetary support will come only after wellexecuted quality assurance studies
Infrastructure for Quality
Assurance in Health Care
Quality Assurance Universe – Big
including small
Small
 Concepts
 Methods
 Application
 Effectiveness
 Efficiency
 Criteria for good care
 Improvement
activities
Big
•Patients
•Providers
•Organization
•Technology
•Information
•Costs
•Risks
•Innovation
Infrastructural Needs
Assessment of actual situation:
 Structural analysis
 Rapid need assessment
 SWOT analysis
 Programme evaluation
 Part of certification
Essentials

A Policy Document for Quality Assurance

A Blue Print for Quality Assurance
Quality Assurance Policy Document

Directed to Quality Assurance,not to quality

Based on National Needs for Improvement of
health services

Items:definitions,principles,locus,focus,actors,
costs,strategies
Contd…..






Size:less than 32 pages
Production Time: less than 9 months
Easy to understand ,no jargon
Support by main parties(participants)
Distributed widely
Updated once in five years
Listing the Infrastructure






The Body
The Engine
The Petrol
Assembly line and Maintenance
The Route Map
The Driver
And then ……On the road!
The Engine







Policies
Planning Mechanisms
Implementation strategies
Organization
Resources
Knowledge,skills,attitudes
Value systems
The Body



The system for quality assurance
Information systems
Conformity between healthcare system and QA
system
The Driver







Roles and Functions
Education and Training
License
Rewards
Remuneration
Accountability
Value Systems
The Petrol






Epidemiology of Health and disease
Epidemiology of quality(ABNA)
Willingness to evaluate/be evaluated
Willingness to Change and Improve
Legislation
Value Systems
Epidemiology of Quality





Rumours and Hearsay
Surveys:Opinions,Dissatisfaction
Registration of Facts:Incidents
Registration of Facts: Trends
ABNA:Achievable Benefit Not Achieved
Maintenance




Support mechanisms
Research and Development
Internal Quality Assurance System
Value Systems
Assembling Quality Assurance




A Laboratory (be in control)
Real Life situations(hope the best)
Value Systems
Whatever you do , you still need a Manual and
a Road Map!
Decision Making in Healthcare
Improvement
Key Concerns:


To find the decision makers:
Who decides about quality?
Who decides about quality improvement?
To identify the client in health care quality
improvement
Roles and Functions in Decision making in
Quality Improvement

The Consumers

The Professionals

The Managers

The Government,Policy Makers
The Seven Roles of the Consumer







Definers of Quality
Evaluators of Quality
Informants of Care
Co-producers of care
Targets of Quality Assurance
Controllers of Practitioner Behavior
Reformers of Health Services
The Seven Roles of the Provider







To be accountable
To provide quality care(plan,implement)
To safeguard the quality of care services
To be evaluated by colleagues
To evaluate his colleagues
To continue learning
To collaborate with colleagues and
management
Seven Roles and Functions of
Management







Do their job(Quality Management)
Exert leadership
Participate in Quality Management
Communicate on Quality matters
Be accountable re: quality
Evaluation of Quality Management
Provide resources
Role of Government
Still open:
 Active role with responsibilities
 Support role with limited responsibilities
 No role at all
AUDIT
Key Tool for QA Implementation
History of Audit
Global Development:
 Until 1980s : the only mechanism available
 since 1985: superseded by CQI
 Since 1995: rebirth of audit as tool for professionals in
CQI programmes
Historical definition: audit is retrospective review of
medical care as laid down in the medical record
Audit: a modern definition


Is a criterion –referenced review of health care
delivery to establish quality followed by, if
necessary, specific activities to improve care
delivery
The method is used by professionals to assess
and, if needed, improve the quality of their
work
Audit :Applied with little more discipline
Practical Solutions:
 Focusing on relevant health care delivery
 Focusing on multidisciplinary professional work
 Retrospective and concurrent in orientation
 Focus on assessment and improvement
 Based on reliable and valid data
 Not more time consuming than others
Audits’ Building Stones






A well selected topic
A limited number of relevant criteria
Well selected reliable and valid data
A functioning judgment procedure
A will to change when needed
Relevant changes leading to improvements
What are benefits in health care?
Improvement in health status
 Increase in satisfaction
 Elimination of impairment
 Elimination of disability
 Elimination of risks
 Elimination of malfunctioning
all due to present health care

What is ABNA?
ABNA
Maximum conceivable benefit
Achievable benefit
Benefit not achievable
Achievable benefit achieved Achievable benefit not achieved
Errors of commission
Errors of omission
Well –chosen priorities
Priorities for Quality Improvement:
 Are formulated in a clear <problem> mode
 Identify targets with high ABNA
 Identify all players in the field including patients
 Provide insight into attainable improvements
 Put the responsibility for quality improvement
where it should be
Conclusion
We should:
 Focus on generalities,later on specifics!

Focus on gaps and weaknesses!
Each country gets the quality assurance
system it deserves!
Thank You