Standards to Govern Quality of Care in Reproductive Health Service Delivery

1
Standards to Govern Quality of Care in
Reproductive Health Service Delivery

• By Joan Meade
• October 2005

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What is Quality of Care

• Doing the right things right
• Offering a range of services that are safe,
  effective and satisfy clients needs and wants
• Offering the greatest health benefits, with the
  least health risks, to the greatest number of
  people, given available resources

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What is Quality of Care (contd.)

• Offering an appropriate array of services
• Meeting minimal standards for adequate care
• Achieving high standards of excellence

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Aspects of Quality

• Technical
• Non-technical
• Waiting time
• Providers attitude
• Access
• Acceptability
• Programmatic elements
• Policies
• Infrastructure
• Access
• Management

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Interpretation

• Quality can be interpreted from different but
  legitimate perspectives depending on whether you
  are provider or client

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Providers

• Technical competence
• Effectiveness
• Safety
• Clients wellbeing
• Logistics
• Record keeping

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Policy Makers and Donors

• Cost
• Efficiency
• Outcomes
• WHO definition
• Performance according to standards
• Safety
• Affordability
• Impact on mortality, morbidity, disability,
  malnutrition

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Clients

• Waiting time
• Privacy
• Confidentiality
• Availability of services needed
• Ease of access

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Bruce-Jain Framework (1990)

• Six elements applied to family planning
• Choice of methods
• Information given to clients
• Technical competence
• Interpersonal relationships
• Mechanisms to encourage continuity
• Appropriate constellation of services

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International Planned Parenthood Federation
Framework

• Clients Rights
• Information
• Access
• Choice
• Safety
• Privacy
• Confidentiality
• Treated with dignity
• Comfort
• Continuity of care
• Opportunity to express their opinions

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International Planned Parenthood Federation
Framework (contd.)

• Providers needs
• Training
• Information
• Infrastructure
• Supplies
• Guidance
• Back-up
• Respect
• Encouragement
• Feedback
• Self-expression

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Benefits of Good Quality

• Safety and effectiveness
• Greater client satisfaction and continuation
• Wider use of contraception or services
• Greater job satisfaction for providers
• Better programme image and competitiveness
• Greater accessibility of services
• Lower costs

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Components of Quality Assurance

• Quality Design Quality designed into product and
  processes
• Quality Control Monitoring, supervision and
  evaluation to ensure standards and consistency
• Quality Improvement Increasing quality and
  raising standards by continually solving problems
  and improving processes

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Additional Considerations

• Most clients lack the knowledge to judge
  technical quality
• Clients life, not just satisfaction and loyalty
  may depend on quality of care
• Additional measures may be necessary
• Licensing
• Standards setting
• Accreditation
• Continuing education

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Requirements for Quality of Care

• Client centred perspective
• Recognises that client is expert on own
  circumstances and wants
• Offers appropriate services based on accurate
  data
• Considers clients preferences
• Values providers expertise

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Requirements for Quality of Care (contd.)

• Management principles that are
• Information based
• Participatory
• Collaborative in decision making
• Focused on systems and processes to enable
  personnel

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Requirements for Quality of Care (contd.)

• Methodology to achieve, maintain and advance good
  quality services by adhering to issues embodied
  in the components of quality assurance

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Requirements for Quality Control

• Measurable indicators of quality
• Timely data collection and analysis
• Effective supervision

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Indicators of Quality

• Input indicators resources used
• Process indicators how well programme
  activities are being implemented
• Output indicators results at programme level
• Outcome indicators short-term and long- term
  impact on population

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Data Collection

• Use existing sources of data
• - registers
• - job performance reviews
• - suggestion boxes
• - informal talks with clients

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Data Collection (contd.)

• Use more formal approaches
• - direct observation and simulated clients
• - Client feedback
• - Clinical audits
• - Inspections and accreditation visits
• - peer review and self-assessment
• - operations research
• - Situation analysis

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Supervision

• Inspection using checklists
• Coaching staff
• Motivating staff
• Problem solving
• Identifying and obtaining training and resources

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Who sets and assesses standards?

• Governments
• Policy Makers
• Donor Agencies
• Advocates and Activists
• Clients
• Service Providers