Enhancing Quality of Care: Principles and Practices

1. QUALITY OF CARE Sharon Gondodiputro, dr., MARS., MH Department of Public Health Faculty of Medicine Unpad

2. References: • A.F. Al-Assaf, MutuPelayananKesehatan, PerspektifInternasional (Health Care Quality: An International Perspective), alihbahasa: MunayaFauziah & AndriLukman, PenerbitBukuKedokteran-EGC, Jakarta, 2003, Bab 1 dan 2 • Rakish,Longest& Kurt Darr, Managing Health Services Organizations, Health Professions Press, Inc. USA,1992, hlm.407-422

3. What is Quality?

4. some definitions of quality PHILIP CROSBY , ’78 : Mutuadalahpencapaiankepadasuatukeinginanatauspesifikasitertentu (quality is conformance to requirements or specification) AL ASSAF, ’93 : Mutuadalahmelakukansesuatudenganbaikmulaidaripertama kali danmelakukanberikutnyalebihbaiklagi (quality is doing the right thing the first time and doing it better the next)

5. AMERICAN MEDICAL ASSOCIATION,’91 : Mutuadalahpelayanankesehatanmencapaitingkatanprobabilitasdampak yang optimal bagipasien (Quality is the degree to which care services influence the probability of optimal patient outcomes) IBM ’92 : Mutuadalahtercapainyakeinginandaripelanggan, baik internal maupuneksternaluntuksuatuproduk yang sempurna (quality is meeting the requirements of the customer , both internally and externally , for defect free products and services)

6. Key words: Requirements or specification Doing the right thing the first time Defect free products and services Optimal patient outcomes : meeting the requirements of the customer , both internally and externally >> customer satisfaction

7. Who are the customers?

8. Who are the customers? Health workers Patients and their families INTERNAL CUSTOMERS Owners or third payers EXTERNAL CUSTOMERS INTERMEDIATE CUSTOMERS

9. Principles of Quality • DONABEDIAN • DEMING • JURAN • CROSBY • ISHIKAWA

10. DONABEDIAN,BALANCE BENEFIT AND RISKS

11. Dr. Deming's philosophy • Quality = Results of Work efforts Cost • quality tends to increase and costs fall over time. • However, when people and organizations focus primarily on costs, costs tend to rise and quality declines over time.

14. DEMING’S WHEEL PLAN: Design or revise business process components to improve results DO: Implement the plan and measure its performance CHECK/STUDY: Assess the measurements and report the results to decision makers ACT: Decide on changes needed to improve the process             

15. Evalaute “actual Quality performance” • Compare actual performanceto quality goals • Act on the differences JURAN • Determine who the customers are • Determine the needs of the customers • Develop product features that respond to the customer’s need • Develop the process that are able to produce those product features • Transfer the resulting plans to the operating forces • Establish the infrastructure needed to secure anually quality improvement • Identify spesific needs for improvement

16. PHILIP B. CROSBY • : 4 absoluts of quality (zero defect concept ) • Quality is conformance to requirements customer’s real need • PREVENTIONShould have a system of detecting potential problem areas and identifying methods for preventing the occurrence of these problems cost savings • the performance standard is zero defect • the measurement of quality is the price of non conformance cost savings , because non quality causes problems and problems cost money

18. ISHIKAWA CAUSE AND EFFECT DIAGRAM

20. Quality Assurance is to demonstrate that a service or product fulfills or meets a set of requirements or criteria. Actual processes and/or outcomes are compared to pre-defined criteria or pre-selected requirements. • Quality Control refers to the systematic use of methods to ensure that a service or product conforms to a desired standard. Primary emphasis is placed on monitoring processes and/or outcomes. • Quality Improvement refers to the betterment or enhancement of a product or service. When enhancements are ongoing or occur repeatedly over time, the process is known as continuous quality improvement.