quality management in healthcare

1. Quality management in
Healthcare services
Dr Imran Naeem
Senior Instructor
Community Health Sciences
Aga Khan University

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A measure of excellence or a state of being free from defects,
deficiencies and significant variations.
Quality is "the totality of features and characteristics of a product or
service that bears its ability to satisfy stated or implied needs.“
Definition of ‘Quality’

3. Dimensions of Quality of service
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Quality Management
Quality management is the act of management functions to
maintain a desired level of excellence. It is management activities
and functions involved in determination of quality policy and its
implementation.
It has four main components:
• Quality planning
• Quality assurance
• Quality control
• Quality improvement

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- Quality planning:
Quality planning is determining the activities required for
"developing the products, systems, and processes needed to meet or
exceed customer expectations.“
- Quality Assurance:
Quality assurance is means of providing enough confidence that the
goals as outlined in quality planning for a product and/or service will
be fulfilled.

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- Quality Control:
A system of maintaining standards in services by testing a sample
of the output against the specification. Quality of good or service
produced are measured using tools such as auditing and inspection.
- Quality Improvement:
"The combined efforts of everyone to make the changes that
will lead to better patient outcomes (health), better system
performance (care) and better professional development
(learning)".

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Quality assurance is a way of preventing mistakes and defects in
services to customers
e.g. JCIA accreditation of AKUH
Quality Assurance

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Purpose of QA
• To meet the rising expectations of consumers of quality of
services
• Help patients by improving quality of care.
• Assess competence of medical staff, serve as an impetus to keep
up to date and prevent future mistakes.
• Bring to notice of hospital administration, about the deficiencies
and in correcting the causative factors.
• Help exercise a regulatory function.
• Restricting undesirable procedures.
• Eliminating medical errors, Adverse Drug Events, and HAI.

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Principles of Quality Assurance
• QA is a never ending process of continuous improvement, and
continuous updating with rapid advances in technology
and medical knowledge.
• The emphasis is on establishing professional excellence and
patients’ satisfaction at reasonable cost.
• Quality is not proportionate to the use of sophisticated
technology or to be expensive.
• Technical imperative should not insist on prolonging life at any
cost, with no consideration to quality of life.
• Decisions must be based on data.

11. Dr Edward Deming’s 14 principles
of Quality management
1. Constancy of purpose: “Create constancy of purpose for continual
improvement of service to society.“
e.g. Innovate, Allocate resources for long-term planning
2. Adopt Philosophy of change: People resist change not only
because they love the status quo, but also because they fear the
uncertainty of what lies ahead
3. Cease dependence on inspection to achieve quality:
Quality does not come from inspection, but from improvement of
the process

12. 4. Stop awarding business on Money alone: In healthcare this means
awarding tenders for equipment, supplies, goods and drugs on the
basis of cheapest price, for example
Instead, move toward a single supplier for any one item, on a long-
term relationship of loyalty and trust
5. Improve every process: Continuous process improvement
6. Institute training on the job: Training must be done on the job,
learning by doing; striving for perfection

13. 7. Institute leadership of people:
Don't simply supervise – provide support and resources so that each
staff member can do his or her best
Be a coach instead of a policeman
8. Drive out fear:
-Allow people to perform at their best by ensuring that they're not
afraid to express ideas or concerns.
-Make workers feel valued, and encourage them to look for better
ways to do things.
- Ensure that your leaders are approachable.

14. 9. Break down barriers:
Break down barriers between departments.
- Focus on collaboration and consensus.
10. Eliminate Warnings:
Eliminate slogans, warnings and targets for the work force asking for
zero defects
Recognize that majority of low quality and low productivity is
basically caused by faulty system
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11. Eliminate arbitrary numerical targets:
No more focus on achieving certain margins; that impedes
professionals from performing their work well and taking the
necessary time for it
Managers should therefore focus on quality rather than
quantity.
12. Permit pride of workmanship:
We need people to have pride in their work. Barriers to pride among
other things, results in low morale and absenteeism

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13. Encourage education:
Improve the current skills of workers.
Encourage people to learn new skills to prepare for future changes
and challenges.
Build skills to make your workforce more adaptable to change.
14. Make "transformation" everyone's job.
Improve your overall organization by having each person take a step
toward quality.

17. Donabedian's model to analyse quality
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includes three factors: structure,
process, and outcome. Structure refers to prerequisites, such as hospital
buildings, staff and equipment. Process describes how structure is put into
practice, such as specific therapies. Outcome refers to results of processes, for
instance, results of therapy.

18. PDCA (Plan–Do–Check–Act or Plan–Do–Check–Adjust) is an iterative
four-step management method for the control and continual
improvement of processes and products.
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Approaches of Quality Assurance Program
It involves a large governing or official bodies’ evaluation of a
2. Specific Approach.
person or agency to meet established criteria or standards at a
given time.
- Credentialing
- Licensure
- Accreditation
- Certification

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Credentialing:
Credentialing is the process of obtaining, verifying, and assessing the
qualifications of a practitioner to provide care or services in or for a
health care organization. Credentials are documented evidence of
licensure, education, training, experience, or other qualifications.
Examples of credentials include academic diplomas, academic
degrees, certifications, security clearance etc.
Licensure:
Licensing is an obligatory process by which an agency of government
regulates a profession. A process by which a governmental agency
grants time-limited permission to an individual to engage in a given
occupation after verifying that he or she has met predetermined and
standardized criteria (Usually education, experience, and
examination). E.g. PMDC

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Accreditation:
Accreditation is the process of formally obtaining credibility from an
authorized body, such as the International Organization for
Standardization (ISO), Joint Commission International (USA),
Accreditation Canada International etc.
Certification:
Formal procedure by which an accredited or authorized person or
agency assesses and verifies the attributes, characteristics, quality,
qualification, or status of individuals or organizations, in accordance
with established requirements or standards and attests in writing by
issuing a certificate. eg, ISO certification of labs

22. Specific Approaches
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23. Factors Affecting QA in Healthcare
Absence of mechanism
of reporting Medical Errors
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Absence of system
of accountability

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25. Total Quality Management (TQM)
Total quality (TQ)/Total Quality management (TQM) is “a philosophy
or an approach to management that can be characterized by its
principles, practices, and techniques.
Three principles:
1. Customer focus
2. Continuous improvement
3. Teamwork

26. A process for building a strategy
for quality: choosing interventions

27. QI Tools
• Shewhart Cycle (PDSA)
• Process Flow chart
• Workflow diagram
• Root-cause analysis: Fish bone diagram
• Pareto chart

28. Process Flow chart
A process flowchart is a picture of the sequence of steps in a process.
Different steps are represented by different-shaped symbols. An oval
indicates the start and end of the process, a rectangle indicates a
process action step, and a diamond indicates a decision that must be
made in the process.

30. Workflow diagram
A workflow diagram is a tool used to document how people or things
actually move through the physical workspace.

32. Pareto chart
A Pareto chart is a simple graph that displays data in descending
order using a bar graph and displays cumulative totals using a line
graph when reading from left to right.

33. Thank you