HOW TO DEVELOP QUALITY ASSURANCE PROGRAM IN HEALTH CARE INSTITUTION

Ahmad Fuady

Background

Health care institutions have to provide their best quality of care

Quality assurance (QA) program is critical to improve and maintain quality of care

QA means “all the arrangements and �activities that are meant to safeguard, maintain, and promote the quality of care.” – Donabedian, 1980

Dimensions of quality

Perception of quality Patient, client Health care provider Health care

manager

WHO, Quality Assurance of Health Care In Developing Countries

Your goals

Understanding QA activities Being able to do QA activities Recognizing ways to establish and

maintain QA as an integral, sustainable part of health care institution

Core activities

Silimperi et al, 2002

Defining quality

Developing expectation or standard of quality, and designing system for quality

What standard of quality should be developed?

standard for input, processes, output (outcome), or clinical and administrative

Measuring quality

Quantifying the level of performance or compliance with expected standard

Patient or client satisfaction? How to measure?

Defining indicators Development/adaptation of information

system Analysis Interpretation of results

Improving quality

The application of quality improvement methods and tools to close the gap between current and expected level of quality

Understanding and addressing system deficiencies

How to improve? Individual problem solving Re-design of system/processes Re-structure organization Re-engineering

Simple, but....

Problems in QA

Failed to define quality Choosing inappropriate interventions Not addressing existing resources Minimum involvement of healthcare

staffs Extremely short and unsustainable

program Students often find QA merely as a

burden, not as a learning process

Finish?

Are you sure that your QA program would provide any improvements?

Institutionalizing QA

Silimperi et al, 2002

In this clerkship, you will not be ordered to solve these four elements, but...

you have to recognize these four elements in your analysis and interventions.

Considering these four elements would aid you to develop the most appropriate intervention and to predict the result.

Policy

Does the policy environment explicitly recognize the importance of quality for reaching organizational or system goals?

Does the policy environment provide support, guidance, and reinforcement for QA implementation?

Leadership

Does the clinic manager have vision and provide strategies to future achievement of the clinic?

How the clinic manager lead his/her staffs and programs?

Core values

Does the clinic have its core values? Are the core values clearly understood

by their staffs? Does all staff provide their best

contributions and desire to be part of the efforts?

Resources

Number of staffs? Staffs’ time? Staffs’ capacity and its capacity building

programs? Money required?

Where is your clinics?Silimperi et al, 2002

What should you do?

1. Defining quality The first week Observation and discussion with clinic manager

and staffs Choose the quality item and its problem

The most emerged problem set the priority Problem submitted by clinic manager Consider prior QA activities Similar problems to prior group(s)? Allowed, if

the problem is truly important different approach Confirm to clinic manager and your group

adviser

2. Measuring quality The first week Defining indicators Developing tools to measure Discuss with your group adviser and clinic

manager for the appropriateness and feasibility

Analysis Interpretation of results

3. Improving quality The second week Develop interventions

Considering policy, leadership, core values and resources

Precise target Individual or group interventions What outcomes you expect

Short-term evaluation (in the third/fourth week)

Tips

Share the task to all group member Discuss with clinic manager and your

adviser precisely prepare yourselves prior to discussion

Explore literatures Do not copy and paste from previous

reports Understand what you write Imagine; you are the clinic manager!

How to engage clinic manager and staffs in your QA activities?

Senior staffs tend to be more motivated than frontline employees different approach Discuss with senior staffs and explore what they

expect formal interviews as an organization Offer benefits to frontline employees if your QA

project has been run relaxed, informal manner

Time schedule and well prepared

Greenfield, 2011

Ahmad Fuady, MD, MSc-HEPL

Department of Community Medicine, Faculty of Medicine, Universitas Indonesia

Email : ahmad.fuady01@ui.ac.id

Thank you