2. What Is Quality?
• To the ordinary person, quality is how good something is. This
may be a service e.g. canteen service or a product e.g. wrist
watch.
• A person's judgment about a service or product depends on
what he expects of it or from it. Some of the words used to
describe quality are:
- Beautiful or attractive
- Durable
- Meeting standards
- Healthy
- Value for money
3. Definitions
• Quality is defined as the extent to which a product
or service satisfies a person or a group i.e. how
much satisfaction the person gets from the service.
(Healthcare Quality Assurance Manual 2004)
• Quality means conformation to requirements or
specifications, (Philip Crosby 1978).
• Quality is the conformity between the actual care
and preset criteria,(Donnabedian 1997).
4. • Quality is a systematic process for closing the
gap between the actual performance and
desirable outcome, (Dr. Rules and Frank).
• Quality is doing the thing right the first time,
and doing it better the next time, (al Assaf).
5. What is Quality of Care?
• Quality of Care, means healthcare activities (in the
medical, nursing, laboratory fields etc.) perform daily to
benefit our patients without causing harm to them.
• Quality of Care demands that we pay attention to the
needs of patients and clients. We also have to use
methods that have been tested to be safe, affordable and
can reduce deaths, illness and disability.
• Furthermore, we are expected to practice according to set
standards as laid down by clinical guidelines and
protocols.
6. • With Quality of Care we do the right things at the right time.
e.g. see to patients promptly, make the right diagnosis and
give the right treatment.
• With quality of care we keep on improving on our standard of
services till excellence is attained.
7. Operational definition given in Policy on Quality Assurance in
Health Care Services by GoN, Ministry of Health and
Population (2007), Quality of Health Care is “Health care
services that produce desired health outcomes and fulfill
consumer’s needs, with optimum use of available resources,
provided by trained and competent providers as per the
national norms and standards with minimizing risk for service
providers as well as consumers.”
8. Concept and Definition of Quality
Assurance in health care
• The concept of quality in health care- its assessment and
assurance- originated mainly in the world of clinical
medicine. Quality assessment and assurance are
inseparable
• Ultimate purpose of quality assessment of health care or
any other kind of public service is to improve the
outcome or effectiveness of public services.
• Widely recognized interest in quality assurance of health
care programs. Almost every organization now acquires
and develops quality assurance techniques
9. • The quality of technical care consists in 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)
• ...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, 1983)
10. • Quality Assurance is a set of activities that are planned for,
carried out systematically or in an orderly manner and
continuously to improve quality of care. It involves:
- The setting of standards;
- Monitoring to see if there is a gap between what is being
done now and what is expected; and addressing the gap on a
regular basis (quality improvement).
( Health care quality assurance manual 2004)
11. • ‘All the arrangements and activities that are meant to
safeguard, maintain, and promote the quality of care’.
(Donabedian, Avedis 1980)
• “a process of measuring quality, analyzing the
deficiencies discovered, and taking action to improve
performance followed by measuring quality again to
determine whether improvement has been achieved. It
is a systematic, cyclic activity using standards of
measurement. (Palmer, Heather, 1983 )
“Systematic process for closing the gap between actual
performance and the desirable outcomes. . . .” (Ruelas,
Enrique and Frenk, Julio 1989 ),
12. • “a systematic managerial transformation designed to
address the needs and opportunities of all organizations
as they try to cope with increasing change, complexity
and tension within their environments”. (Berwick, Donald,
1991 )
• Quality Assurance: “Quality Assurance is a continuous process
which includes series of activities for improving and
maintaining optimum level of quality of health care services
that includes mainly; setting standards and protocols,
communicating standards, developing indicators, monitoring
compliance with standard and solving problems by team
approach.” (GoN, Ministry of Health and Population 2007)
13. Components or Dimension of Quality Health
Services
A health system should seek to make improvements in six
areas or dimensions of quality. These dimensions require
that health care be
• Effective- delivering health care that is adherent to an
evidence base and results in improved health outcomes
for individuals and communities, based on need;
• Efficient- delivering health care in a manner which
maximizes resource use and avoids waste;
• Accessible- delivering health care that is timely,
geographically reasonable, and provided in a setting
where skills and resources are appropriate to medical
need;
14. • Acceptable/patient-centred- delivering health care which
takes into account the preferences and aspirations of
individual service users and the cultures of their communities
• Equitable- delivering health care which does not vary in
quality because of personal characteristics such as gender,
race, ethnicity, geographical location, or socioeconomic status
• Safe- delivering health care which minimizes risks and harm
to service users.
15. Dimension of Quality
• QA activities may address one or more dimensions,
such as technical competence, access to services,
effectiveness, interpersonal relations, efficiency,
continuity, safety, and amenities.
• These dimensions of quality are a useful framework
that helps health teams to define and analyze their
problems and to measure the extent to which they
are meeting program standards.
(Brown L D, Franco M L, Rafeh N, Hatzell T, Quality
Assurance of Health Care In Developing Countries)
16. Need and Importance of Quality
• Increased demand for effective and appropriate care.
• Need for standardization and variance control.
• Necessity for cost saving measures
• Benchmarking
• Accreditation, certification and regulation
• Report cards on provider performance.
• Requirements to define and meet patient needs and
expectations
• Pressure of competition, and to enhance marketing
• Need for improvements in care and services.
• Desire for recognition and to strive for excellence
• Ethical considerations
17. Principles of Quality Assurance
• Quality Assurance is oriented toward meeting the needs and
expectations of the patient and the community.
• Quality assurance focuses on systems and processes.
• Quality assurance uses data to analyze service delivery
processes.
• Quality assurance encourages a team approach to problem
solving and quality improvement.
• Quality Assurance uses effective communication to
improve service delivery
18. Benefits of Quality assurance
1.Benefits to the Clients- Good health outcomes, Client
satisfaction, Value for money, Less frustration.
2. Benefits to Health Providers- Health staff become more
satisfied with their work, understand patients better,
Information flow among staff is improved, Health staff
who perform well are rewarded.
3. Benefits to the Health Institution- Patients become more
satisfied with the services, More patients may use our
services, The environment will become clean and
beautiful., The facility will have a good reputation.
19. Cost for Poor Quality
Costs of poor quality that are obvious to us include:
• Wrong diagnosis, Wrong treatment, Repeated visits to the
OPD, Prolonged illness, Death.
Costs that are hidden include:
• Wasted time to both patient and health worker;
• Unnecessary treatment, wasted drugs;
• Patients not complying to treatment;
• Unnecessary laboratory tests, wasted reagents;
• Frustrated patients;
• Low staff morale.
20. Types of Quality
• Product based quality: product’s attributes e.g.
sweet mangoes, soft silk etc.
• User based quality: the ability of the product to
meet the user’s needs and expectations.
• Value based quality: cost benefit relationship. It is
the ratio of what the customer gets and gives.
• Manufacturing based quality: Conformance to
established standards.
• Transcendent based quality: It is inherent value
apparent to the customer. “Beauty lies in the
beholder’s eyes”
21. Three Levels of Quality
1. Organizational level: ask the customer --customer driven
• performance standards should be used as bases for goal
setting,
• problem solving, performance appraisal, compensation, non-
financial
• rewards, and resource allocation
• Which products and services meet your expectations and
which do not?
• What products or services do you need that you are no
receiving?
• Are you receiving products or services that you do not need?
22. 2. Process level: managers should try to work towards cross-
functional integration, and not solely try to optimize the
activity under their control
• What products or services are most important to the external
customer?
• What processes produce those products and services?
• What are the key inputs to the process?
• Who are my internal customers and what are their needs?
• Which processes have the most significant effect on the
organization’s customer driven performance standards?
23. 3. Performer/job level: standards for output (cost, accuracy,
timeliness) must be based on quality and customer-service
requirements that originate at the organizational & process
levels.
• What is required by the internal and external customer?
• How can the requirements be measured?
• What is the specific standard for each measure?
24. 3. Performer/job level: standards for output (cost, accuracy,
timeliness) must be based on quality and customer-service
requirements that originate at the organizational & process
levels.
• What is required by the internal and external customer?
• How can the requirements be measured?
• What is the specific standard for each measure?
26. Communities or service users wants
services that:
• are delivered on time by friendly and respectful staff;
• are safe, produce positive result and that they can afford;
• provide them with adequate information about their
condition and treatment;
• provide them with all the drugs they need;
• give privacy.
• are within their reach (distance) and given in a language they
can understand.
27. • Communities and service users are the co-producers of
health.
• They have critical roles and responsibilities in identifying their
own needs and preferences, and in managing their own
health with appropriate support from health-service
providers.
28. The Health Staff Provider
The health provider can provide quality care if he/she has:
• adequate knowledge and skills.
• enough resources- staff, drugs, supplies, equipment and
transport etc
• safe and clean workplace.
• opportunity to regularly improve himself/herself.
• is well paid and rewarded for good work.
29. • The core responsibilities of health-service providers for
quality improvement are different.
• Providers may be seen as whole organizations, teams, or
individual health workers.
• In each case, they will ideally be committed to the broad aims
of quality policy for the whole system, but their main concern
will be to ensure that the services they provide are of the
highest possible standard and meet the needs of individual
service users, their families, and communities.
30. The Health Care Manager
The health care manager sees quality care as:
• managing efficiently the resources of the health facility.
• health staff achieving set targets.
• health staff being regularly supported and supervised.
• having adequate and competent staff to provide care.
• staff being disciplined.
• providing enough resources for work.
31. • The main concerns of decision-makers at these levels will be
to keep the performance of the whole system under review,
and to develop strategies for improving quality outcomes
which apply across the whole system.
