بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. Sohag Faculty of MedicineQuality Assurance Project First Quality Awareness Session Prepared by Prof. Dr. Mohammad EL-Torky Head of Community Medicine Department & Quality Assurance Project Director

3. Session Objectives • Presenting the concepts of Quality & Quality Assurance. • Presenting The QA project contents • Presenting the major departmental responsibilities. • Opening discussion.

4. What is quality?

5. What is quality? WHO (1988) has defined quality as the proper performance (according to standards) of interventions that are known to be safe, affordable to the society, and have the ability to produce an impact on morbidity, mortality, disability and malnutrition.

6. What is quality? Juran in (1989): added an important dimension of quality to its definition, which is customer satisfaction. According to Juran Institute quality is defined as both freedom from deficiencies and undesired product features (fitness for use).

7. Whatis quality? The Institute of Medicine, (1990) collected and analyzed over 100 definitions of quality of care and came to a consensus definition: Quality of care is the degree to which health services for individuals and populations increasethe likelihood of desired health outcomes and are consistent with current professional knowledge.

8. Whatis quality? (TQM); doing the right things right the first time and every time, (Brown, 2001). What are the right things? How are the right things done right? To answer these questions standards were created, so that quality can be said to be, at least in part, compliance with standards.

9. Whatis quality?

10. Whatis quality? “Meeting customer’s needs and expectations” is another useful definition for quality. Well-designed services create customer satisfaction because they provide the features or characteristics that customers need.

11. Who are the customers of health care? • External Customers: Patients are the most obvious external customers in healthcare. However, there are other customers as well such as third-party payers, insurance companies, employers or government agencies (who pay the bills for most patients).

12. Who else? Internal Customers: Internal customers are those within your organization who are affected in some way by your work. Satisfaction of our external customers will not be achieved without satisfying the needs of our internal customers.

13. Perception of quality • Quality from the community point of view means: - A service that is available all the time. - Easily accessible. - Feeling of comfort. - Politeness of providers. - Achieving its goals.

14. Perception of quality • Quality is perceived by the health care providers as: - Technical skills. - Availability of resources. - Suitable work conditions and environment. - Achieving the target outcome.

15. Perception of quality • For the health care managers quality means: -Best service. -With least possible cost, and -Achieving best outcome.

16. What is quality?

17. What is quality? • A characteristic that has multiple dimensions and can be measured. • When present it will lead to maximizing the desired service outcome (and minimizing the undesired outcome)

18. DIMENSIONS OF QUALITY Joint Commission on Accreditation of Healthcare Organizations (JCAHO, 1991) published key dimensions of quality care according to which quality in any health care setting can be judged upon.

19. DIMENSIONS OF QUALITY 1- Appropriateness: The degree to which the care/intervention is relevant to the patient’s clinical needs given the current state of knowledge. It is concerned with doing the right things in accordance with the purpose.

20. DIMENSIONS OF QUALITY 2- Access to service: The degree to which appropriate care/intervention is obtainable to meet the patient’s need. It means that health care services are unrestricted by geographic, economic, social, cultural, organizational, or linguistic barriers.

21. DIMENSIONS OF QUALITY 3- Competency: The degree to which practitioner adheres to professional standards of care and practice. It refers to skills, capability, and actual performance of health providers, managers, and support staff. (This is not a Joint Commission dimension).

22. DIMENSIONS OF QUALITY 4- Continuity: It means that the client receives the complete range of health services that he or she needs, without interruption, cessation, or unnecessary repetition of diagnosis and treatment.

23. DIMENSIONS OF QUALITY 5- Effectiveness: The degree to which care is provided in correct manner to achieve the desired outcome. Effectiveness answers the questions, “ Does the procedure or treatment, when correctly applied, lead to the desired results? It is concerned with doing things right.

24. DIMENSIONS OF QUALITY 6- Efficacy: The power of a procedure or treatment to improve health status, as already shown through scientific research (evidence based) findings.

25. DIMENSIONS OF QUALITY 7- Efficiency: Efficient services provide the greatest benefit within the resources available. It is the relation between outcomes and the resources used to deliver care. It is concerned with the delivery of a maximum number of “units” of health care for a given unit of health resources.

26. DIMENSIONS OF QUALITY 8-Respect and Caring: The degree to which patients are involved in the decision and the provider’s reaction in the meantime to the patient needs and expectations.

27. DIMENSIONS OF QUALITY 9- Safety: The degree to which the organization environment is free from hazards. It is concerned with minimizing risks of adverse outcome for both patient and provider as a result of healthcare intervention.

28. DIMENSIONS OF QUALITY 10- Timeliness: The degree to whichneeded care and services are provided to the patient at the most beneficial or appropriate time.

29. Appropriateness Access to service Competency Continuity Effectiveness Efficacy Efficiency Respect and Caring Safety Timeliness DIMENSIONS OF QUALITY

30. The Quality Management Principals 1- Customer Focused Organization:should understand current and future needs and strive to exceed customer expectation. 2- Leadership:establish unity of purpose and direction. Create and maintain the proper internal environment. 3- involvement of people:Those who knowthe most about process details must be empowered to improve it. Focus on team approach for problem solving and quality improvement is essential.

31. The Quality Management Principals 4- Process Approach:Focusing on the analysis of service delivery process, activities and tasks will allow health care providers to develop in-depth understanding of the problem and its root causes. 5- Systems Approach:Health organizations are systems! In-order to understand any system; it is necessary to find out its components.

32. The Quality Management Principals 6- Continual improvement: should be a permanent objective of the organization. 7- Factual Approach to Decision Making:Effective decision and actions are based on analysis of data and information. 8- Mutually Beneficial Supplier Relationship:An organization and its suppliers are interdependent, and a mutually beneficial relationship enhances the ability to create value.

34. Quality Assurance

35. Quality Assurance Definition of Quality Assurance • All the arrangements and activities that are meant to safe-guard, maintain, and promote quality of care. Donabedian, 1980 • A systematic process for closing the gap between actual performance and desired outcomes. Ruelas & Frenk, 1989 • QA is that ‘set of activities that are carried out to set, to monitor and to improve performance so that the care provided is effective and as safe as possible’ QA project, 1993

36. Quality Assurance Quality assurance is based on sound system design followed by continuing performance evaluation leading to appropriate educational-motivational activities and readjustment of system design.

37. Quality Assurance • Quality assurance is mainly a system of audits using predetermined standards (problem-focused approach to measure quality). • CQI is a management philosophy to improve the level of performance of key processes in the organization (continuous study and improvement of the processes of providing health care to meet the needs of patients and community).

38. Quality Assurance The 10 steps of QA: 1- Planning for quality assurance 2- Developing guidelines & setting standards 3- Communicating standards & specifications 4- Monitoring quality 5- Identifying Problems and selecting opportunities for improvement 6- Defining the problem operationally 7- Choosing a team 8- Analyzing and studying the problem to identify its root causes 9- Developing solutions and actions for improvement 10- Implementing and evaluating quality improvement efforts

39. Quality Assurance TheQA processincludes 3 main activities: • Quality design: step 1-3 • Quality monitoring: step 4 • Quality improvement: step 5-10

40. Quality Assurance Step 1: Planning for QA Developing implementation plan • Determine which services should be addressed • Decide where to begin • Decide what kind of activities will be undertaken • Determine who will be responsible (QA committee) • Commit resources

41. Quality Assurance Step 2 : Setting standards A standard is defined as statement of expected quality. • Example: The medical school must ensure adequate clinical experience and the necessary resources, including sufficient patients and clinical training facilities. Good standards should be valid, reliable, realistic, current, clear

42. Quality Assurance Standards and indicators: • Indicators are quantitative measures of a specific part of a process or an outcome. They can also measure one or more of the dimensions of performance. • Example: percent of students passing a course

43. Quality Assurance Step 3 : Communicating standards • Employee manuals • Training • Conferences • Supervision • Newsletter • Informal talk • job aids

44. Quality Assurance Step 4 : Monitoring Quality Monitoring is the collection and analysis of data for selected indicators which enables managers to determine whether key activities are being carried out as planned.

45. Quality Assurance A well-designed monitoring system should : • Monitor only key indicators • Collect only needed data • Not overburden staff • Gather data that is easy to interpret • Provide timely feedback

46. Quality Assurance • Step 5 : Identifying problems and selecting opportunities for improvement Through looking at: • Available data of monitoring • Community surveys • Explore known areas of frustration • Suggestion boxes • Meeting & focus groups • Customer feedback or complains • Brainstorming

47. Quality Assurance Step 6 : Defining the problem operationally The problem statement should answer the following: • What is the problem • How frequent or how long the problem existed • How you know when the problem is solved • Where the problem begins and ends Problem statements should never indicate cause, imply solutions or affix blame.

48. Quality Assurance • Step 7 : Choosing a team The team should comprise persons who understand the problem & have technical expertise: • Those affected by the process • Those who work in the process • Those who make decision related to the problem • Those who identified the problem

49. Quality Assurance Step 8 : Analyzing & studying the problem to identify its root causes • Identify the actual steps of the process • Tools of analysis include: - Flow charts - Cause effect diagrams - In depth studies (clinical records reviews, health center register data, staff & patient interviews, service delivery observations) Problem solving teams need to display and interpret data using some basic statistical tools like pie chart, bar chart, pareto chart, scatter diagrams , etc.

50. Quality Assurance Step 9 : Developing solutions & actions for improvements • should be a team effort • Involve personnel responsible for processes related to the root cause • Procedural redesign may be needed