QUALITY IN HEALTH CARE DELIVERY

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QUALITY IN HEALTH CARE DELIVERY

• VIKRAM ANAND
• HOSMAC INDIA PVT.LTD

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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

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• Quality in Health Care Sector
• Key Principles

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HEALTH CARE

• The system that a Nation has built up and
  continuously maintains in order to combat
  (unnecessary) Death,Disease,Disability,Dissatisfac
  tion 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,fin
  anciers and government within their respective
  value systems

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Whats wrong in todays Health Care?

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

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What can we do about it?

• Do nothing
• Better education and training
• Policing,Inspection,Punishment
• Change,Improve,Reward
• Comprehensive ApproachQuality Assurance

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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

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From the beginning there was

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

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Quality Terminology

• Quality Assurance the overall philosophy on
  Quality and its Assurance
• Total Quality Managementone of the newest
  organizational and managerial approaches to
  Quality Assurance in the (not) for profit
  industry
• Continuous Quality Improvementan important
  organizational and managerial mechanism for
  quality assurance in the health sector

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Development in Phases

• In industrialized countries
• Before 1970 the Individual Phase
• 1970-1980 the Professional Phase
• 1980-1990 the Bureaucratic Phase
• 1990-2000 the Industrial Phase
• 2000- the Information Technology Phase

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Continuous Quality Improvement

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

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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

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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,a
  ttitudes,values) values and attitudes are the
  most important

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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

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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
• Todays choiceSURVIVAL

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Mission Statement

• Rationaleprogramme 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

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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

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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

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Train professionals

• Select key professionals
• Design appropriate training
• Organize continuous training sessions
• Evaluate results of training including
  satisfaction
• Reward participants
• Repeat training regularly

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Evaluation

• Includes assessment and improvement
• Orientationwhat are the possibilities?
• SelectionWhat is most appropriate?
• Implement who is doing what?
• Collect and discuss the results
• Disseminate the results inside and outside
• Prepare for the next round

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Improvement of care

• FocusStructure,Process and Outcome
• Structurebetter equipment
• Processdoing the right things better!
• Outcomeobtain better results in
• - effective services
• -costs
• - client and employee satisfaction

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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

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Improvement of Process

• PrincipleDoing 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

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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

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Tools for Improvement

• Motivation
• Insight
• Evaluation methods
• Communication tools
• Dedicated personnel
• Dedicated Management
• Money

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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

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• Infrastructure for Quality
• Assurance in Health Care

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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

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Infrastructural Needs

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

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Essentials

• A Policy Document for Quality Assurance
• A Blue Print for Quality Assurance

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Quality Assurance Policy Document

• Directed to Quality Assurance,not to quality
• Based on National Needs for Improvement of health
  services
• Itemsdefinitions,principles,locus,focus,actors,
• costs,strategies

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Contd..

• Sizeless 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

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Listing the Infrastructure

• The Body
• The Engine
• The Petrol
• Assembly line and Maintenance
• The Route Map
• The Driver
• And then On the
  road!

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The Engine

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

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The Body

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

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The Driver

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

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The Petrol

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

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Epidemiology of Quality

• Rumours and Hearsay
• SurveysOpinions,Dissatisfaction
• Registration of FactsIncidents
• Registration of Facts Trends
• ABNAAchievable Benefit Not Achieved

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Maintenance

• Support mechanisms
• Research and Development
• Internal Quality Assurance System
• Value Systems

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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!

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• Decision Making in Healthcare
• Improvement

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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

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Roles and Functions in Decision making in Quality
Improvement

• The Consumers
• The Professionals
• The Managers
• The Government,Policy Makers

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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

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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

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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

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Role of Government

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

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• AUDIT
• Key Tool for QA Implementation

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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

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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

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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

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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

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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

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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

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Well chosen priorities

• Priorities for Quality Improvement
• Are formulated in a clear ltproblemgt 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

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Conclusion

• We should
• Focus on generalities,later on specifics!
• Focus on gaps and weaknesses!
• Each country gets the quality assurance
• system it deserves!

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• Thank You