Quality Degree of adherence to pre-established criteria or standards. Not an easy subject to get quality healthcare services. Quality management Doing the right thing, at the right time, for the right person, and having the best quality result. 4 main components: Quality planning Quality control Quality assurance Quality improvement Focused on product/service quality & means to achieve it

1. HEALTH QUALITY & MANAGEMENT
Dr. Dalia El-Shafei
Assist.Prof., Community Medicine Department, Zagazig University

2. LEARNING OBJECTIVES
At the end of this unit the student should be able to:
1) Define quality assurance, quality control and total
quality management.
2) Identify the criteria for quality in health care.
3) Describe quality improvement steps and cycle.

3. • Degree of adherence to pre-established criteria or standards.
• Not an easy subject to get quality healthcare services.
Quality
• Doing the right thing, at the right time, for the right person, and
having the best quality result.
• 4 main components:
• Quality planning
• Quality control
• Quality assurance
• Quality improvement
• Focused on product/service quality & means to achieve it
Quality management

5. THE EVOLUTION OF QUALITY

6. 1. QUALITY PLANNING
Art of quality management focused on setting quality objectives
and specifying necessary operational processes and related
resources to fulfill quality objectives.

8. 2- QUALITY CONTROL (QC)
The operational techniques & activities aimed both at monitoring a
process & eliminating causes of unsatisfactory performance or
relevant stages of the quality loop (quality spiral) in order to result
in economic effectiveness.

9. 3- QUALITY ASSURANCE (QA)
 Contains all the planned & systematic actions required to provide
adequate confidence that a product or service will satisfy given
requirements for quality.
 Part of quality management focused on providing confidence that
quality requirements will be fulfilled.
 Broad concept that focuses on the entire quality system including
suppliers and ultimate consumers of the product or service.

10. QC VS QA
Both are a set of activities for ensuring quality of the process (QA) &
the product after being produced (QC).
Quality Control
• Set of activities for ensuring
quality in products. The activities
focus on identifying defects in the
actual products produced.
• Reactive process aims to identify
(& correct) defects in the finished
product.
• Goal: identify defects after a
product is developed & before it's
released
Quality Assurance
• Set of activities for ensuring
quality in the processes by which
products or services are developed.
• Proactive process aiming to
prevent defects.
• Goal: improve development & test
processes so that defects do not
arise when the product is being
developed.

12. 4. QUALITY IMPROVEMENT (QI)
 Part of quality management focused on ↑ ability to fulfill quality
requirements.
 Any action taken to ↑ value to the customer or other stakeholder
by improving effectiveness & efficiency of processes and
activities throughout the organization.
QI is a management process and set of tools & techniques that are
coordinated to ensure that departments consistently meet the health
needs of their communities.

14. STEPS FOR QI:
Develop a plan with
SMART objectives.
Set standards
• Practice guidelines.
• Administrative procedure
• Responsibilities
• Performance standards
Communicate
standards for the
people concerned to
conform to.
Monitoring of
implementation;
Auditing.
• Identify problems & put
priorities (Pareto
technique)
Define the problems
Choosing a team to
solve the problem.
Analyze problem to
identify root causes
(data collection,
analysis &
presentation, Fish-
bone diagram).
Develop solutions &
actions for QI.
Implement & evaluate
QI efforts.
Repeat the cycle after
success in another
area.

17. 5. TOTAL QUALITY MANAGEMENT (TQM)
 Approach which promised to both ↑ quality & ↓ costs
 Patients are expecting more from health care and are increasingly
to be dissatisfied. However, improving patient satisfaction and
reducing costs are perhaps the least important reasons for using
TQM in healthcare.

20. • Comprehensive management of service processes aiming to:
• Maintain a desired level of excellence.
• Ensure complete customer satisfaction at every stage, internally and
externally, the 1st time and every time.
• Includes implementing of: QA & QC & QI.
• Focuses on preventive measures, not detection of problems i.e.
proactive rather than reactive actions.
• Ensures quality standards from the beginning and in every step
(planning, implementation, supervision and output).

21. HEALTHCARE QUALITY

22. The USA, Institute of Medicine (IOM) defines healthcare quality
“as the extent to which health services provided to individuals and
patient populations improve desired health outcomes”.
The care should be based on the strongest evidence and provided in
a technically and culturally competent manner with good
communication and shared decision making.

23. WHY QI IN HEALTH CARE?
↑ Patient safety ↓ Medical
errors
↓ Waste ↓Inefficiency Ensure that
scare resources
for healthcare
are used to
derive their full
impact

24. DIMENSIONS OF QUALITY IN HEALTH CARE:
A
Accessibility
Acceptability
Appropriateness
C
Continuity
Patient
Centered
Competency or
capability
E
Effectiveness
Efficiency
Equity
S
Support
Safety
T
Timeliness

25. Accessibility: Ease with
which health services are
reached in terms of:
location, money, time,
and ease of approach.
Access can be physical,
financial or
psychological.
Acceptability: Health
care should be
acceptable and attractive
to its users.
Appropriateness:
Effective care that meets
the health needs of the
entire population.

26. Effectiveness: % of
success & the extent to
which care achieved the
desired objectives in
correct manner. In health
programs measured by
indicators.
Efficiency: system’s
optimal use of available
resources to yield
maximum benefits or
results to avoid wasting
time and other resources
Equity: Fairness &
consistent care regardless
of patient characteristics
and demographics.

27. Continuity: Customers
should be provided with
comprehensive,
integrated care, without
interruption.
Patient centered: Care
that is respectful and
responsive to individuals.
Competency or
capability: Skills &
actual performance of
HCPs

28. Support: Economic &
social support to HCPs at
all levels to motivate
good work.
Safety: Avoiding
preventable injuries &
reducing medical errors
Timeliness: degree to
which patients are able to
obtain care promptly.
It includes both timely
access to care &
coordination of care

29. HEALTH ECONOMICS

30. LEARNING OBJECTIVES
At the end of this unit the student should be able to:
1) Define health economics
2) Understand cost-effectiveness analysis.
3) Enumerate the criteria of evaluation of the financing system.
4) Demonstrate how to reduce cost of health care system.

31. • Study of how people and society choose to employ resources,
usually scarce / limited resources.
• Economics analyze the costs and benefits.
• Economists seek to answer important questions about how people,
industries, and countries can maximize their productivity, create
wealth, and maintain financial stability.
Economics
• Branch of economics concerned with issues related to efficiency,
effectiveness, value and behavior in the production and
consumption of health and health care.
• Health economics is an important component of health
management.
Health economics

32. THE 4 MAJOR METHODS FOR FINANCING HEALTH CARE
Governmental
financing
National
(production, taxes,
oil)
User fees
users out of pocket
charges
Health insurance
The insurer
The health care
provider (paid by
the insurer).
The patient pays a
premium and co-
payment for each
service received.
Non-governmental
organization
(NGO's)
And donations

33. CRITERIA OF EVALUATION OF THE FINANCING SYSTEM:
• Extent that health intervention is successful to reach the desired objectives; or, simply
the percent of success.
Effectiveness
• Process that reaches the desired objectives with minimal resources (uses the lowest
amount of inputs to create the greatest amount of outputs).
Efficiency
• Degree of adherence to preset criteria or standards.
Quality
• Sufficient resources are always available despite changes in the outside environment.
Sustainability
• People should be able to utilize health care when they need it.
• Equity in finance: According to ability to pay (poor pays minimum fees and rich
pays larger fees).
• Equity in delivery of health care: Health care distributed according to need, rather
than ability to pay
Equity

36. Healthcostclassification
Fixed cost Covers salaries & wages.
Direct cost
Covers operational cost “drugs,
supplies, rents, petrol for
vehicles, maintenance, water,
electricity”
Capital cost
Covers durable assets with a life
>1 year. It includes buildings
(owned not rented) &
equipment.

37. COST-EFFECTIVENESS ANALYSIS (CEA)
It is a type of economic analysis where both the cost and the outcome
(result, benefit, health gain …) of an intervention are evaluated.
The evaluation expressed in the form of a cost-effectiveness ratio.
Numerator: cost of the intervention associated with one unit of
“outcome”.
Denominator: unit of outcome.

39. IMPORTANT INDICATORS TO MEASURE COST-EFFECTIVENESS
OF AN INTERVENTION
Morbidity reduction
No. of day’s disability
prevented
Mortality reduction
DALYs
• ↓ Incidence or prevalence of
disease
• If the ttt can ↓ or prevent No. of
days lived with disability
• No. of averted deaths; can be
adjusted to measure the potential
years of life gained
• Sum of years of life lost (YLL) due
to premature death & years of life
lost due to disability (YLD)

40. SUCCESS STORIES OF HIGHLY COST-EFFECTIVE
PUBLIC HEALTH ACTIVITIES
Immunization in
1st year of life:
Highest cost
effective of all
health measures
all over the world
Health
education:
family planning,
nutrition & HIV
prevention.
School based
health services,
screening &
immunization
Programs: Anti-
smoking & anti-
alcohol
consumption
PHC is cost
effective than
building 5 stars
hospitals
Head helmets
using to prevent
complications of
accidents

41. 10 important causes of rise of health care spending
• Aging of the population & ↑ life expectancy.
• ↑ Public needs & demands.
• A changing pattern of disease towards chronic illness.
• Advances in medical technology & highly sophisticated equipment.
• Higher wages & salaries.
• Higher cost for drugs & supplies
• Lack of preventive medicine & health promotion programs.
• Lack of cost conscious behavior by providers.
• Over-utilization by some insurance companies, doctors, and
patients.
• Inadequate health management system: lack of good planning, bad
implementation, lack of supervision & evaluation

42. 10 important measures to reduce health cost
• Effective management and 'managerial capacity' at all level.
• Manpower support (hiring, qualification, salaries training,
CME…etc.)
• Expanding & strengthen PHC system.
• Active implementation of public health & preventive medicine.
• Health insurance system reform.
• Using health management information system.
• Using evidence-based new technologies (not necessarily costly one).
• Rationalized investigations, expensive technology and medications.
• Economy-wise behaviors of doctors, patient and all population.
• National Modern pharmaceutical industries (cheaper drugs &
machines).

43. Prevention is better & more cost-effective than cure