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What is quality (Roemer &

Montoya Aguilar, WHO 1988)

Proper performance of intervention that

are known to be safe, that are affordable

to the society, and that have ability to

produce an impact on

Mortality

Morbidity

Disability

Malnutrition

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Quality in health care

Care that meets or exceeds expectations

There are 2 aspects of quality

Technical

Patients satisfaction

The quality of health care delivery may

be evaluated by structure, process and

outcome indicators

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An attempt to protect and enhance qualityIt concerned with patient care that is high inprofessional quality and satisfying the patients

Quality holds the promise of being able to: Deliver the most appropriate and up-to-date medicare

Reduce the chance of unsuitable treatment and care,and an inappropriate variation in the care betweendoctors

Encourage accountability between providers,consumers and founders of health care

Save unnecessary costs by reducing waste,duplication and increasing efficiency

Quality assurance

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Continuing improvement

The steps: Its leader must hold to a shared vision of a

health care system that is undergoingcontinuous improvement

Substantial investment in managerial capital,time and expertise will be required for qualityimprovement

Respect must be established for health-care

worker involved in complex task in a complexsystem

Those served and those serving mustcarefully maintain an open dialogue

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Modern technical, theoretically grounded tools

must be applied to health-care setting

Health-care regulations must be more

sensitive to the cost and ineffectiveness of

relying on inspection to improved quality Professionals must take part in specifying

preferred methods of care that exceed

minimalist standards

Individual physicians must actively participatein the effort for continuous improvement

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QA CYCLE

Implementation of continuing

improvement is done through quality

assurance cycle.

QA cycle is made up of 4 steps

1. Select or review the topic

2. Observe practice

3. Compare practice with explicit standards

4. Implement change

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1. Select or review the topic

QA process begins with setting standards for thetopic under review

Guide for setting standard :

Keep the standard simple

Limit the number of standard Include only essential items

Include items proved effective

Exclude dangerous and ineffective items

Exclude excessive and unnecessary items

Allow the best adoption of provider and patient

resources

Be sure the content is up to date

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2. Observe practice

Data is collected from the practice

Collecting data consist of:

Selection the indicators

Selection the collection method (validity,reliability, feasibility, and acceptability.

Data analysis

It should look at essential aspects of care

Data to be collected must be valid, reliable

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Dimentions of Quality

Technical competence

Access to services

Effectiveness

Interpersonal relations

Efficiency

Continuity

Safety

amenities

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Quality assurance process

Planning for QA

Developing guidelines and settingstandards

Communicating standards andspecifications

Monitoring quality

Identifying problems and selectingopportunities for improvement

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Defining the problem operationallyChoosing a team

Analysing and studying the problem to

identify the root causesDeveloping solutions and actions for

improvement

Implementing and evaluating qualityimprovement efforts