INTRODUCTION TO THE INSURANCE OF QUALITY

OBJECTIVES OF THE FORMATION

• 1 - to bring the participants to master the concepts of basis of the quality approach insurance;

2 To be able to explain the importance of the processes and systems in the concept of quality insurance;

3. To allow the participants to seize the importance of the different types of customers and their place in the insurance of quality;

4.To bring the participants to follow the activities that they lead while using the techniques of monitoring;

5. To develop the knowledge, the attitudes and faculties of the participants in the domain of the team work;

6. To be capable to apply the tools of resolution of problems to improve the quality;

• 7 - to be able to apply the stages of fast resolution of problem in team.

What is it the quality? And the quality insurance ?

ELEMENTS OF APPRECIATION OF THE WATCHES

• APPEARANCE • RESISTANCE • ORIGIN • BEAUTY • SATISFACTION

Historic of the QA

• 1800 years before J.C: the code of Hammourabi (to punish the physician who harmed the patient).

• 400 before J.C., Hippocrate recommended to the physicians not to make the wrong to the patient"

• 1845 Florence Nightingale during the war of Crimea: enters the first norms the cares male nurses.

• Second world war: improvement of the quality in American l`industrie (pomegranate and rifle that didn't explode or exploded in the hands of the soldiers.

• The years 80 in USA and Europe: AQ in the SSP.

• WHO: Norms on the hold in charge of the diarrheas and sharp respiratory infections

• Africa: program for the struggle against the transferable illnesses of the childhood.

• URC: PAQ = Project of insurance Quality •

Justification of the introduction of the QA in the SSP

• Declaration of Alta Alma where all countries began facing the primary cares of health for all.

• Efforts of span, but the quality was not valued as well as the impact on the good to be populations.

• The proofs of the mediocrity abound and the limited resources.

• She/it has his/her/its advantages and his/her/its limits with which it is necessary to count.

Advantages of the QA

• Makes of the customer a partner who is consulted regularly.

• To improve the communication for the users of health and makes understand the needs and the waitings of the community.

• Give to the agent the possibility to demonstrate excellent performances and reinforce the professional satisfaction thus.

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• Develop the maturity of the staff and his/her/its intellectual capacities through the resolution of the problems in team.

• Permits the improvement of the system of support and management.

• The insurance of Quality creates the incentive and develop the creativeness.

• Guaranteed a better use of the services of santé ; to give the possibility to optimize the investments made in the cares of health

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• Returns the lasting results when the different actors of the health system use the methods and the tools of AQ in their actions of every day.

ELEMENTS (measurementsdimensins) OF QUALITY

• Professional expertise • • Technical performance • • Efficiency • • Efficiency • • Innocuité • • Accessibility • • Interpersonnelles relations • • Continuity • • Couverture/utilisation • • Choice of the services • Environment

Competence / Performance• Competence = knowledge, techniques, features, abilities, • Performance = resulting behavior of expertise. Thus, a

beneficiary of cares can know the theory, to know how to execute the necessary diagnostic gestures, very well and nevertheless not to follow the correct clinical gait. The situations or the beneficiary "knows and knows how to make, but fait is not numerous.

• Expertise is necessary, but not sufficient, for a good performance

•

Norms of performance

• In AQ one suggests that the performance, no expertise, must be the focus d 'une norm

• The rate of blood sugar is measured 4 times per day: performance

• The beneficiary of cares says the frequency correctly to measure the blood sugar: Performence

Professional competence knowledge and capacities of the beneficiaries of the cares Technical performance stains executed by a staff or don't structure any health in the conditions habiuelles of work

Efficiency qualities of services produced by the . costs

efficacity degree to reach the wanted results

level to reduce the risks of innocuity blessures,infection,ou effects secondary ominous or other dangers

ctdAccessibility degree of reduction of the barrier

géographiques,économiques,sociales,culturelles,organisations, or linguistic and services of health cares

Interpersonnel relationship level of confidence, respect,confidentialité,courtoisie,empathie,et capacity of écoute,de answer and communication,

Continuity of carebenefit of services of cares for the same staff every time and reference and suitable communication between the staff of health

Couverture/utilisation degree with which the population targets receives the wanted service

Choice of the services existance of development in answers to a problem of health

Environment physical appearance of the structure suitable confort,caractères deprived of the places and everything that is important to the eyes of the customers

EXEMPLES

• known procedures of sterilization of the surgery staff.

• Performance technique : respect of the hold norms in charge of a traumatized cranial.

• Efficacité : reduction of the specific mortality. • Efficience : of the optimal cares rather than maxima,

efficiency requires that the agents of health abstain from providing useless or maladjusted cares. A Caesarean practiced according to the norms.

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• procedures of control of the blood bank. • Accessibility: welcome of the patients by a

talking staff that the Kinyarwanda. • Relations interpersonnelles : explanations

given to the patient on his/her/its illness. • Continuity of the soins : procedure of transfer

of a patient between 2 services.

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• treatment of the cancer of the breast. • Other Caractéristiques s: orientation of the

patient toward the different services of the hospital

Perspectives on the quality

• Client• Prestataires• Administration gestion• community

Definition of the Quality

• It is the correct execution (in conformity with the norms) of interventions that one knows sure and that are affordable for the society in question and that have the power also to have an impact on mortality, the morbidity, the invalidity and according to the customer's needs.

Definition of the quality

• To provide cares of quality consists in applying

the medical science in order to maximize the results that one pulls of it without for it to increase the risks."

• Avedis Donabedian, MD,

To really make the good thing, the first time".

• ODI Consulting

Common characters to the definitions

• The quality refers to norms • One can define some norms for each of the

measurements • Importance to know the perspectives of

his/her/its customers to satisfy their waitings • To try to make explicit most possible the

perspectives of the customers •

Maladie prolongée Décès

Traitement erronéUtilisation erronée de médicaments

Malades insatisfaitsPerte de temps

Personnel frustré

Perte de productivité Communauté Méfiante

Gaspillage de matériel

Administrateurs/Directeurs insatisfaits

Contagion prolongéee Servicessuperflus

Coût de la mauvaise qualité

Relations between the quality and the cost

1. To reduce the cost of the bad quality 2. to improve the efficiency

3. to analyze the costs and the profits of the improvements

The cost of the correction of a mistake

1 Cost of the immediate correction, that be-á to say during the consultation

10 Cost of the correction of the cares while the patient is again in the center of health

100 Cost of the correction if the patient must come back to the center to correct the mistake

INTRODUCTION TO QUALITY INSURRANCE

But, quality assurance ?

• All disposition and activity of which the goal • is to protect, to maintain and to promote • the quality of the cares" By Avedis Donabedian

The insurance of quality

• These are the activities that review periodically or continually the conditions in which the cares are them - same well stocked while following the effects of these cares. While using the insurance of Quality, one can note the deficiencies, to find and to correct their reasons and hence, to improve health and the well-being. In this sense, the insurance of quality is a cyclic process." —Donabédian

Definition of the quality insurance

• "The systematic process to fill the gap between the wanted performance and the one effective .

• Drs. Ruelas and Frenk QA work in Mexico

ctd• The insurance of quality is the set of the

activities undertaken to put the norms and a process of follow-up in place, and to improve the performance so that the well stocked cares are as efficient and healthy as possible."

• The Quality Assurance Project, 1993

Quality Assurance

• Together of the activities that permit to define some norms, to follow and to improve the performance of the services and agents so that the cares of health are as efficient and sure as possible

Logical of an Approach Insurance Quality

• To define the Quality (Norms of quality) One cannot improve what one doesn't measure • To measure the Quality (Gap to the norms) One cannot measure what• To improve the Quality one doesn't define(Adherence to the norms)

Difine• Organizational restructuring

QA

Definition of the Quality

PlanificationElaboration de normes

Audit

Evaluation de la Qualité

The interventions of the quality management

• Difine the quality • Gestion de la Qualité

• Améliorer la qualité Mesurer la qualité

Traditional management and AQ management

People are the guilty parties The problems come of the systems Encourage the initiatives SavingsControl of the staff • Wastes

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• Definite quality according to the objectives of a program

• Decisions valued by the leaders • Reaction to a situation of crisis• Quality defined by the needs and waitings of

the customers • Resolute problems in team • Continuous improvements

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• The customers are not consulted • Individual work • Authority encouraged• The customers are partners • Team work • Capacities encouraged

DEFINITION of NORMS

• To define the Quality we cannot improve what(Norms of quality) one doesn't measure• To measure the Quality (Gap to the norms) we cannot measure what one doesn't define• To improve the Quality (Adherence to the norms)

What is a norm?

A statement of the quality waited Who must make what, of what manner, to what

level of the health system and to what moment

Why does need we the norms?

• The norms make explicit the definition of the quality wished for a service or particular system => to Fix a goal

• The norms provide a point of reference to compare and to value the performance => to Measure the attack of this goal

How the norms us help us to define the quality?

• By l 'identification of the inputs essentiels• By l 'identification of the necessary processes to d 'obtenir the results escomptés• By the description of the extrant wanted

RELATION BETWEEN THE MEASUREMENTS OF THE QUALITY

AND THE NORMS• These are the norms that clearly define and

precisely the level to reach for every dimension of the quality to provide the cares or the compatible services with the wanted quality

Types of norms

• Clinics • Norms of input Description of stations Specifications • Norms of process Instructions of clinical practice Protocols • Norms of results Evolution of the patient

• Administrative or of management • Norms of input Administrative policies Rules and regulations Qualifications • Norms of process Procedures of standard working • Norms of results Results discounted

Clinical norms

• Norms of treatment • Protocols d 'opération strangled d 'une hernia • Taken in integrated charge of the illnesses of the

childhood • Taken in charge of the cases of tuberculosis • Norms of hold in charge of the hospitalized

diabetics • Norms of hold in charge of a tooth supernumerary

at a child of less than five years.

Implicit or explicit norm?

• Implicit Is not written officially Something that the agents "simply" know • Clarify Written officially

Feature of a good norm

• Valid: Based on proofs scientific or other acceptable experience

• Reliable: Succeeds to the same result every time that she/it is applied

• Claire: Included in the same way throughout the world; don't lead to erroneous interpretations

• Realist: Can be applied with the existing resources

Conclusion

• To define the quality from the nomes is essential to measure and to improve the quality

• The norms must be explicit and must communicate well

• The norms are adaptable to the local context • L 'AQ is the improvement of compliance to

the norms

The 4 principles of the Quality insurance

• To put the accent on the customer • To put the accent on the decisions based on

the data • To put the accent on the Team work • To put the accent on the analysis of the

Process and the System

DEFINITION OF CLIENT

• A "customer" is an organization, a community or any individual who will make some judgments on the quality of your products and/or services and / or will use them.