Infrastructure for Quality Assurance in Health Care

1. Infrastructure for Quality Assurance in Health Care

2. 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

3. Infrastructural Needs Assessment of actual situation: • Structural analysis • Rapid need assessment • SWOT analysis • Programme evaluation • Part of certification

4. Essentials • A Policy Document for Quality Assurance • A Blue Print for Quality Assurance

5. 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

6. 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

7. Listing the Infrastructure • The Body • The Engine • The Petrol • Assembly line and Maintenance • The Route Map • The Driver And then ……On the road!

8. The Engine • Policies • Planning Mechanisms • Implementation strategies • Organization • Resources • Knowledge, skills, attitudes • Value systems

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

10. The Driver • Roles and Functions • Education and Training • License • Rewards • Remuneration • Accountability • Value Systems

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

12. Epidemiology of Quality • Rumours and Hearsay • Surveys: Opinions, Dissatisfaction • Registration of Facts: Incidents • Registration of Facts: Trends • ABNA: Achievable Benefit Not Achieved

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

14. 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!

15. Decision Making in Healthcare Improvement

16. 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

17. Roles and Functions in Decision making in Quality Improvement • The Consumers • The Professionals • The Managers • The Government, Policy Makers

18. 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

19. 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

20. 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

21. Role of Government Still open: • Active role with responsibilities • Support role with limited responsibilities • No role at all

22. AUDIT Key Tool for QA Implementation

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

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

31. Thank You