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RVD Introduction To Quality

This document provides an introduction to quality and quality improvement in healthcare. It defines quality using several frameworks that center around providing effective, safe, patient-centered care. It discusses challenges to quality like gaps between best practices and actual care. Quality management involves quality planning, control/assurance, and continuous quality improvement. Quality is measured using Donabedian's structure, process and outcome framework. Overall, the document establishes that improving healthcare quality is important for health outcomes, system performance, and building public trust.

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mihret gashaye
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75 views

RVD Introduction To Quality

This document provides an introduction to quality and quality improvement in healthcare. It defines quality using several frameworks that center around providing effective, safe, patient-centered care. It discusses challenges to quality like gaps between best practices and actual care. Quality management involves quality planning, control/assurance, and continuous quality improvement. Quality is measured using Donabedian's structure, process and outcome framework. Overall, the document establishes that improving healthcare quality is important for health outcomes, system performance, and building public trust.

Uploaded by

mihret gashaye
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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INTRODUCTION TO QUALITY AND

QUALITY IMPROVEMENT

Federal Ministry of Health, Ethiopia


Session Outline
• Introduction
• Conceptualizing and defining quality
• Quality Management
• Quality planning, quality improvement and quality assurance
• Measuring quality
Quality Challenges: Brainstorming (1)

What are some examples of poor quality health


services that you have seen or experienced?
Quality Challenges: Brainstorming (2)

 What is quality?
 Do all stakeholders agree on what constitutes good or
poor quality health care?
 What causes poor quality?
 Why quality now?
CROSSING THE QUALITY CHASM
“Between the health care we
have and the health care we can
have lies not only a gap but a
chasm…”
- IOM
2001
THE “KNOW – DO GAP”
The gap
between what
we can do and
what we
actually do
What Causes the Quality Chasm?
Why are we not able to consistently deliver health interventions that we
know to be effective?
• Scarce resources?
• Lack of knowledge/skills?
• Lack of accountability?
• Health system complexity
DEFINING QUALITY (AHCRQ)
• Doing the right thing
• At the right time
• In the right way
• To achieve the best possible
results
- US Agency for Health Care Research and Quality
DEFINING QUALITY (IOM)

Quality is the extent to which health services:


• Improve desired health outcomes
• Are based on clinical evidence
• Are provided in a technically and culturally
competent manner, with good communication and
shared decision making
- US Institute of Medicine
DEFINING QUALITY (IOM,
2001)
Six domains of health care quality:
1. Safe
2. Effective
3. Patient-centered
4. Timely
5. Efficient
6. Equitable
DEFINING QUALITY (PATIENTS/CLIENTS)
• Patients/clients may not always define quality
in the same way as clinicians and policy makers
• Priorities often include:
– Technical competence
– Respectful treatment
– Availability of medications
Is quality also an end in itself?

• The health system is a core social institution


• An important means by which individuals interact with their
government
• Should be an institution where inequities are redressed
• Health system performance is positively correlated with trust in
government
(Rockers et al., 2012)
Quality is a Means to an End (Six building blocks of a Health
System)
Service Delivery
Access
Improved Health Coverage Health Workforce
Equity
Responsiveness Information

Risk Protection Products, vaccines, technology


Quality
Financing
Safety

Efficiency Leadership/Governance
Quality Management: “The Juran
Triad”

Quality Improvement
Quality Management

Quality Planning:
• Establishes strategic and tactical goals needed to attain results
• Sets specifications (“standards”) for processes and outcomes

Quality Control:
• Measures actual performance through reporting and inspection (compared to standards), and takes action
to correct.
• Goal is stability and consistency with standards

Quality Improvement:
• Activities to foster change to achieve new levels of performance
• Focuses on effective design, management, organization and delivery of health services
Quality Assurance Vs Quality
Improvement
Quality Assurance:
• Measures performance vs. standards at a point in time
• “Snapshot” or retroactive, focuses on individuals, Ex. SS, Acc., audits, inspections
• Standards and measures developed for quality assurance, however, can inform the
quality improvement process
Quality Improvement:
• Scientific methods to continuously improve processes to meet or exceed standards
• Measures change over time
• Proactive approach to improve processes and systems
COMPARE AND CONTRAST
Criteria Quality Assurance Quality
Improvement
Source of Ideas experts, best practice concepts from experts, best
practice, ideas from front-line
staff, patient/client
Type of Measurement input, process process, outcome
Process of Measurement periodic, usually external continuous, internal

Ownership leadership/management Mgt, front-line staff


Sustainability external checks (accreditation) self-regulation through high-
level continuous measurement

Future state static evolving


QUALITY PLANNING, QUALITY CONTROL AND CONTINUOUS QUALITY IMPROVEMENT

Policy, resources, coordination, accountability,


Quality Planning execution design

Quality Control (QA) CQI


Standards/ 1. Aims: what are the “gaps”
Guidelines/ in performance and outcomes
protocols 2. Measures: tools to measure
Professional and feedback processes and
oversight IMPROVED outcomes
Accreditation
OUTCOMES 3. Changes: QI change
activities for leadership, admin
Performance
and frontline to close the “gap”
review
MEASURING QUALITY
Donabedian’s Framework:
• Structure: The context in which care is delivered,
including infrastructure, staffing, financing and equipment
• Process: Transactions between patients and
providers (what is done and how it is done)
• Outcome: Effects of health care on the health status of
patients and populations
LINKING DEFINITIONS AND INDICATORS
Category Sub-Category Description and Indicators
Structural Infrastructure Availability and condition of facilities,
equipment, drugs and supplies
Supply chains
Delivery Responsiveness Wait time, privacy, friendliness,
communication, dignity
Effort Length of consultation time, # of
explanations given, physical examination
Patient satisfaction Patients’ satisfaction with last consultation
Technical Competence Professional knowledge and skills
Clinical practice Presence/absence of critical elements of care,
following standards & guidelines, correct
prescribing behavior
Berendes, PLoS Medicine
2011
THE ROLE(S) OF QUALITY IN HEALTH

Utilization ✗ Qualit = Health


y

Margaret Kruk
2013
In Summary

• Health systems deliver suboptimal quality in rich and poor countries alike
• Evidence from LMIC shows particularly poor performance in patient safety,
effectiveness and patient-centeredness
• Quality management comprises quality planning, quality control/assurance
and quality improvement.
THANK YOU!!

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