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Healthcare quality assurance

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Healthcare quality assurance

  1. 1. Healthcare Quality Assurance Prof. Amal Khalifa
  2. 2. By the end of this lecture attendants will be able to: •Define Quality •Differentiate between the three aspects of Quality •Identify key dimensions of Quality •Know the difference between limited and total Quality
  3. 3. The application of medical science and technology in a way that maximizes its benefits to health without correspondingly increasing its risks. The degree of quality is, therefore, the extent to which the care provided is expected to achieve the most favorable balance of risks and benefits. Avedis Donabedian, M.D., 1980 What is Quality?
  4. 4. What is Quality? Proper performance (according to standards) of interventions that are known to be safe, that are affordable to the society in question, and that have the ability to produce an impact on mortality, morbidity, disability, and malnutrition. WHO, 1988
  5. 5. What is Quality? Doing the right thing right , the first time and every time to ensure: •The best possible outcome for patients. • Satisfaction for all our customers. • Retention of talented staff. • Sound financial performance.
  6. 6. To do what is right you need to know what is right
  7. 7. Today’s Challenge in Healthcare  Improve care quality  Decrease cost  Improve outcomes  Increase Patient satisfaction And to do it all at the same time!!!
  8. 8. Why Quality in Healthcare? Increasing costs of healthcare in presence of rising demands and limited resources Variation in quality of medical performance and outcomes in similar health organizations
  9. 9. Is Quality Costly? Poor quality is costly
  10. 10. Cost of Quality Quality is free What costs is Non-Quality production • Non-conformance----- Cost to fix it • Conformance ----- Cost to evaluate and improve
  11. 11. Cost of Good Quality  The cost of planning (PREVENTIVE COST)  The cost of doing QC (APPRAISAL COST) •Both are associated with finding errors BEFORE customers are affected by them
  12. 12. Cost of Bad Quality  Internal failure cost: cost of our efforts to prevent, detect and react to quality problems. The customer does not see the associated deficiency directly but customer service may be impaired.  External failure cost: Those that directly affect the customer and most expensive to correct.
  13. 13. $1 $10 $100 Prevention Appraisal Failure Comparative Cost of Quality Defect prevention Efforts/ CQI. Cost of correcting at once Inspection & testing to catch and correct Defects. Cost of Correcting errors while patient is still at healthcare facility. Customer finds d or is dissatisfied with the service. Cost of getting patient to come back from home
  14. 14. Standards Customers Vs Providers (recipients) Services Vs Products
  15. 15. Customer Requirements 1- Satisfaction 2- Understand his requirements 3- Do it right first time and every time 4- Continually improve
  16. 16. Definition of a Quality Standards QS are a set of specific, concise statements that:  Make a statement of expectation defining the capacity to deliver value to perform as expected  Act as markers of high-quality, cost-effective patient care across a pathway or clinical area  Are derived from the best available evidence  Are produced collaboratively with the health services and social care, along with their partners and service users
  17. 17. Fitness for use Free from deficiencies Meeting customer needsJoseph M. Juran: 1904 – 2008 Juran’s perception of quality
  18. 18. The 3 Aspects of Quality  Measurable Quality  Appreciative Quality  Perceptive Quality
  19. 19. The 3 Aspects of Quality  Measurable Quality is the ……  Appreciative Quality is the ……..  Perceptive Quality is the ……… Provider’s Aspect of Care Peer Review Bodies Aspect of Care Recipient's Aspect of Care
  20. 20. 20 Quality System Goals  Develop, implement, maintain & continually improve healthcare quality management system  Enhance patient safety & error prevention  Increase effectiveness and efficiency  Conform to established health care industry requirements and standards  Reduce variation and waste  Increase patient satisfaction
  21. 21. Dimensions of Quality Technical Competence Access to Service Effectiveness Interpersonal Relations Efficiency Continuity Safety Amenities Affordable
  22. 22. o QA is oriented toward meeting the needs and expectations of the patient and the community. o QA focuses on systems and processes. o QA uses data to analyze service delivery processes. o QA encourages a team approach to problem solving and quality improvement. The Four Tenets of Quality Assurance
  23. 23. ProcessStructure Outcome Donabedian Paradigm GIGO theory
  24. 24. 1. Planning for quality assurance 2. Developing guidelines and setting standards 3. Communicating standards and specifications 4. Monitoring quality 5. Identifying problems and selecting opportunities for improvement 6. Defining the problem operationally 7. Choosing a team 8. Analyzing and studying the problem to identify its root causes 9. Developing solutions and actions for improvement 10. Implementing and evaluating quality improvement efforts Quality Assurance Process (QAP’s)
  25. 25. Quality Assurance Cycle Assess Monitor Improve Assess Monitor Improve
  26. 26. % of women above 50yrs who had a mammogram in screening program
  27. 27. Breast cancer death rate per 100,000 women, all ages
  28. 28. Quality Assurance QA Vs CQI Continuous Quality Improvement Focus Problems Responsibility Prevention System All Involved Inspection People Department
  29. 29. Quality Planning Quality Measurement Quality Improvement Quality Trilogy
  30. 30. Quality Planning Enables organizations to create a service or process that will be able to meet established goals and to do so under operating conditions
  31. 31. Quality Planning Roadmap Establish Project Identify Customers Discover customers needs Develop product/process Develop Process controls/ Transfer to operations M E A S U R E S
  32. 32. Quality Control Depends on a feedback loop. Always asks: What happened to cause the results to become worse? Measure actual performance Compare to Standards Regulate Process Established Standards OK Not OK
  33. 33. Quality Improvement Quality Improvement Includes:  Analyzing causes of process failure, dysfunction, and/or inefficiency  Systematically developing optimal solutions to chronic problems Focuses on the reasons for chronic, continuing problems
  34. 34. Strategy for Quality Improvement Six Sigma Strategy  Define  Measure  Analyze  Improve  Control  Replicate
  35. 35. Thank You Any Questions??