QUALITY IN HEALTH CARE DELIVERY

VIKRAM ANAND

HOSMAC INDIA PVT.LTD

Contents :Quality in Health Care Delivery

Quality in Health Care Sector-Key Principles Infrastructure for Quality Assurance in Health

Care Decision Making in Health Care Improvement Audit –Key Tool in Q.A Conclusion

Quality in Health Care Sector :

Key Principles

HEALTH CARE

The system that a Nation has built up and continuously maintains in order to combat (unnecessary) Death,Disease,Disability,Dissatisfaction and (social) Disruption

A collection of curative,preventive,rehabilitative and promotive services

Health care is a social and economical endeavor encompassing activities by providers,consumers,financiers and government within their respective value systems

What’s wrong in today’s Health Care?

Avoidable errors Underutilization of services Overuse of services Variation in services Communication problems Lack of Evidence Dissatisfied clients

What can we do about it?

Do nothing Better education and training Policing,Inspection,Punishment Change,Improve,Reward Comprehensive Approach:Quality Assurance

Definition of Quality

Why define quality of care? Reach consensus among employees Avoid confusion and in-house fighting Allow for sound evaluation Allow consumers to make a choice

From the beginning there was

chaos quality assessment quality assurance quality improvement continuous quality improvement Information technology values

Quality :Terminology

Quality Assurance: the overall philosophy on Quality and its Assurance

Total Quality Management:one of the newest organizational and managerial approaches to Quality Assurance in the (not) for profit industry

Continuous Quality Improvement:an important organizational and managerial mechanism for quality assurance in the health sector

Continuous Quality Improvement

Important elements: External and internal customer satisfaction Management leadership Involves all personnel Uses statistical methods Focuses on improvements

Definition of healthcare quality

Quality is working according to specifications Quality is providing effective services with a

minimum of unnecessary use of resources Quality is to satisfy customers

The Core Principles

The essentials are: Assuring(I.e assessing and improving) quality

is the responsibility of the provider Quality assurance is an evaluation and

improvement process Of all the necessary

attributes(knowledge,skills,attitudes,values) values and attitudes are the most important

TOTAL QUALITY

The end point of a development in phases: Focus on professional quality Focus on client satisfaction Focus on system effectiveness Focus on interconnections Organizational and societal unification

Why improve my quality

Because I know it is needed because I am told to do so because I must survive Because I need to follow the rules

Today’s choice:SURVIVAL

Mission Statement

Rationale:programmeRationale:programme SURVIVAL

My programme is dedicated to Provide high-quality service to the members of

the community Employ well-trained professionals Maintain a high safety record Provide a customer –friendly environment

Plan high –quality services

Identify priorities,goals and customers Set up working groups Describe service according to:

-consumer and client needs

- structure,process,outcome Make plans for evaluation

Quality Planning

Establish Quality project: goals and team Identify customers Determine client needs Design services to be provided Design delivery process Determine information need Use and evaluate

Train professionals

Select key professionals Design appropriate training Organize continuous training sessions Evaluate results of training including

satisfaction Reward participants Repeat training regularly

Evaluation

Includes assessment and improvement Orientation:what are the possibilities? Selection:What is most appropriate? Implement: who is doing what? Collect and discuss the results Disseminate the results inside and outside Prepare for the next round

Improvement of care

Focus:Structure,Process and Outcome Structure:better equipment Process:doing the right things better! Outcome:obtain better results in

- effective services

-costs

- client and employee satisfaction

Improvement of structure

Includes building,equipment,personnel,manuals,

information systems,rules and regulations Includes new provisions,and updating and

refurbishing of old provisions Need to include recording of inputs and costs

Improvement of Process

Principle:Doing the right things better! Doing the right things more effective! Doing the right things more efficient!

Includes: Appropriate use of technology Appropriate use of personnel Client/provider relationship

Improvement of outcome

Focus: Programme effectiveness Programme efficiency Consumer and employee satisfaction Consumer and employee education Building and technology safety Community relations Information and communication needs

Tools for Improvement

Motivation Insight Evaluation methods Communication tools Dedicated personnel Dedicated Management Money

That implies:

Quality improvement is essential for survival

Customer satisfaction is important for survival

Monetary support will come only after well-executed quality assurance studies

Infrastructure for Quality

Assurance in Health Care

Quality Assurance Universe – Big including small

Small

Concepts

Methods Application Effectiveness Efficiency Criteria for good care Improvement activities

Big•Patients•Providers•Organization•Technology•Information•Costs•Risks•Innovation

Infrastructural Needs

Assessment of actual situation: Structural analysis Rapid need assessment SWOT analysis Programme evaluation Part of certification

Essentials

A Policy Document for Quality Assurance

A Blue Print for Quality Assurance

Quality Assurance Policy Document

Directed to Quality Assurance,not to quality

Based on National Needs for Improvement of health services

Items:definitions,principles,locus,focus,actors,

costs,strategies

Contd…..

Size:less than 32 pages Production Time: less than 9 months Easy to understand ,no jargon Support by main parties(participants) Distributed widely Updated once in five years

Listing the Infrastructure

The Body The Engine The Petrol Assembly line and Maintenance The Route Map The Driver

And then ……On the road!

The Engine

Policies Planning Mechanisms Implementation strategies Organization Resources Knowledge,skills,attitudes Value systems

The Body

The system for quality assurance Information systems Conformity between healthcare system and QA

system

The Driver

Roles and Functions Education and Training License Rewards Remuneration Accountability Value Systems

The Petrol

Epidemiology of Health and disease Epidemiology of quality(ABNA) Willingness to evaluate/be evaluated Willingness to Change and Improve Legislation Value Systems

Epidemiology of Quality

Rumours and Hearsay Surveys:Opinions,Dissatisfaction Registration of Facts:Incidents Registration of Facts: Trends ABNA:Achievable Benefit Not Achieved

Maintenance

Support mechanisms Research and Development Internal Quality Assurance System Value Systems

Assembling Quality Assurance

A Laboratory (be in control) Real Life situations(hope the best) Value Systems

Whatever you do , you still need a Manual and a Road Map!

Decision Making in Healthcare

Improvement

Key Concerns:

To find the decision makers:

Who decides about quality?

Who decides about quality improvement? To identify the client in health care quality

improvement

Roles and Functions in Decision making in Quality Improvement

The Consumers

The Professionals

The Managers

The Government,Policy Makers

The Seven Roles of the Consumer

Definers of Quality Evaluators of Quality Informants of Care Co-producers of care Targets of Quality Assurance Controllers of Practitioner Behavior Reformers of Health Services

The Seven Roles of the Provider

To be accountable To provide quality care(plan,implement) To safeguard the quality of care services To be evaluated by colleagues To evaluate his colleagues To continue learning To collaborate with colleagues and

management

Seven Roles and Functions of Management

Do their job(Quality Management) Exert leadership Participate in Quality Management Communicate on Quality matters Be accountable re: quality Evaluation of Quality Management Provide resources

Role of Government

Still open: Active role with responsibilities Support role with limited responsibilities No role at all

AUDIT

Key Tool for QA Implementation

History of Audit

Global Development: Until 1980s : the only mechanism available since 1985: superseded by CQI Since 1995: rebirth of audit as tool for professionals in

CQI programmes

Historical definition: audit is retrospective review of medical care as laid down in the medical record

Audit: a modern definition

Is a criterion –referenced review of health care delivery to establish quality followed by, if necessary, specific activities to improve care delivery

The method is used by professionals to assess and, if needed, improve the quality of their work

Audit :Applied with little more discipline

Practical Solutions: Focusing on relevant health care delivery Focusing on multidisciplinary professional work Retrospective and concurrent in orientation Focus on assessment and improvement Based on reliable and valid data Not more time consuming than others

Audits’ Building Stones

A well selected topic A limited number of relevant criteria Well selected reliable and valid data A functioning judgment procedure A will to change when needed Relevant changes leading to improvements

What are benefits in health care?

Improvement in health status Increase in satisfaction Elimination of impairment Elimination of disability Elimination of risks Elimination of malfunctioning

all due to present health care

What is ABNA?

ABNA

Maximum conceivable benefit

Achievable benefit Benefit not achievable

Achievable benefit achieved Achievable benefit not achieved

Errors of commission Errors of omission

Well –chosen priorities

Priorities for Quality Improvement: Are formulated in a clear <problem> mode Identify targets with high ABNA Identify all players in the field including patients Provide insight into attainable improvements Put the responsibility for quality improvement

where it should be

Conclusion

We should: Focus on generalities,later on specifics!

Focus on gaps and weaknesses!

Each country gets the quality assurance

system it deserves!

Thank You