Quality in healthcare Organization
FARIDAY 11-03-2022 1
Quality ???
Dec 2021 2
Definition
Quality is a set of attributes of a service
3
Definition
- that satisfies the given need of the customer
- and proper performance of services that are
safe.
4
Quality of Care
Why Quality?
5
Why Quality
• Patients/Community Satisfaction
• Patient Safety
• Reduce variations - Uniformity in Input, Process and Outcomes - Standards and Norms
• Reduce waste
• Reduce Cost
• Accreditation
• Technical Innovations
• Increased motivation (Providers perspective)
QUALITY IN HEALTHCARE
REASONS:
• Rising expectations of people for better effective healthcare.
• Bringing uniformity in the process of healthcare through the
establishment of standards and practice guidelines.
• Ensuring safety and minimizing risk
• Reducing out of pocket expenses through advancements in
diagnostic therapeutic technology.
• Safeguarding against Consumer Protection Act and other
litigation
QUALITY IN HEALTHCARE
• Everyone is in favor of it
• Most recognize it when they see it
• Defining quality is difficult
• More so in the case of health care
Dimensions of Quality
• Quality in healthcare has
various dimension
• Play an important role in
assuring that the care needed
• by people is delivered to
them in a competent, caring ,
cost effective, timely and
safe manner.
Transforming Comprehensive Healthcare in India
Quality Improvement Approaches
• Quality Control (QC)
• Quality Assurance (QA)
• Continuous Quality Improvement (CQI)
• Total Quality Management (TQM)
Quality Control (QC)
Quality Control
• They do what ???
• They do an inspection
• Focused on END PRODUCTS
• Separating BAD APPLES
• Responsibility of QUALITY DEPARTMENT
• They do inspection ( now is supervision not inspection). inspection is
outdated
12
Quality Assurance (QA)
Quality Assurance
Refers to the Internal and External methods of assessing
the incidence and levels of quality problems and attempts
to assure that quality problems are reduced and not
repeated, thus improved quality
Continuous Quality Improvement
Continuous Quality Improvement
Similar to Quality Assurance but differs in approach. It is more
participatory (Employers and Employees) and based on broader
perspective of cultural change in the organization.
Total Quality Management
It is a structured, systematic process of creating organization-
wide participation in planning and implementing continuous
improvements in quality with focus on clients/users of services
Concept of Quality in healthcare
Do The Right Things Right the First time
and Better the Next Time
18
Who Decides Quality ?
Users
20
Different perspectives on the quality of care
Dec 2021 21
Quiz 1
Q: Which of the following is not the dimension of
quality?
a)Continuity
b)Accessibility
c)Registration
d)Safety
Dec 2021 22
Quiz 1
Q: Which of the following is not the dimension of quality?
a)Continuity
b)Accessibility
c)Registration
d) Safety
Dec 2021 23
MODELS
24
Models
DONABEDIAN 1966
Defined Quality in Patient Care
Method of Assessment of Quality
Systems Approach - structure/process/outcomes
Dec 2021 25
• Donabedian Model: to analyze quality includes three factors:
Structure, Process, and outcome. Structure refers to prerequisites,
such as hospital buildings, staff, and equipment. Process describes
how the structure is put into practice, such as specific therapies.
Outcome refers to results of processes, for instance, results of
therapy.
Dec 2021 26
Systems Framework
Structure--->Process--->Outcome
27
Structure/Inputs
Physical infrastructure: Building, space, furniture, Water supply,
Sanitation, Electricity
Human Resources: Number, types, qualifications, skills etc
Equipment and other material supplies Funds
Process
• Set of activities performed to achieve the outcomes or the objectives
• Process is a key for actual services deliver.
• It is not just one activity you have to perform set of activities
• e.g: management of diabetes/ cardiac arrest
• we make flow chart of this
Outcomes
In terms of changes in health status measured by
Morbidity
Mortality
Complications
Client Satisfaction
30
P-D-C-A Cycle
• P-D-C-A Cycle is a four-step method
Plan for the control and continual
improvement of processes and
product/ services
– PLAN- Plan for quality
– DO- Provide the Quality
– CHECK- Check that works (see
Act Do the problems &Gaps)
– ACT- Act accordingly
Check 31
QA Committee
• Medical Administrator
• Two Senior Clinicians
• Pathologist
• Radiologist
• Matron (Senior Nurse)
• Medical Record Officer ( Secretary)
• Additional Personal : eg: consultant /Super specialists
Dec 2021 32
WHAT IS ACCREDITATION
Accreditation
Public recognition of the achievement of accreditation standards
by a healthcare organization demonstrated through an
independent external assessment of that organization’s level of
performance in relation to the standard.
International Society for Quality in Health Care (ISQua)
34
Accreditation is an external review of quality with four major
components:
1. It is based on written and published standards
2. Reviews are conducted by professional peers
3. The accreditation process is administered by an
independent body
4. The aim of accreditation is to encourage
organizational development.
Assessment Method
OBSERVATION STAFF INTERVIEW
(OB) (SI)
RECORD REVIEW PATIENT INTERVIEW
(RR) (PI)
