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QUALITY OF CARE. Sharon Gondodiputro, dr., MARS., MH Department of Public Health Faculty of Medicine Unpad. References:.
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QUALITY OF CARE Sharon Gondodiputro, dr., MARS., MH Department of Public Health Faculty of Medicine Unpad
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
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)
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)
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
Who are the customers? Health workers Patients and their families INTERNAL CUSTOMERS Owners or third payers EXTERNAL CUSTOMERS INTERMEDIATE CUSTOMERS
Principles of Quality • DONABEDIAN • DEMING • JURAN • CROSBY • ISHIKAWA
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.
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
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
PHILIP B. CROSBY • : 4 absoluts of quality (zero defect concept ) • Quality is conformance to requirements customer’s real need • PREVENTIONShould 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
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.