Improving Quality in Healthcare Delivery: Key Principles

1. QUALITY IN HEALTH CARE DELIVERY VIKRAM ANAND HOSMAC INDIA PVT.LTD

2. Contents :Quality in Health Care Delivery • Quality in Health Care Sector-Key Principles • Infrastructure for Quality Assurance in Health Care • Decision Making in Health Care Improvement • Audit –Key Tool in Q.A • Conclusion

3. Quality in Health Care Sector : Key Principles

4. HEALTH CARE • The system that a Nation has built up and continuously maintains in order to combat (unnecessary) Death,Disease,Disability,Dissatisfaction and (social) Disruption • A collection of curative,preventive,rehabilitative and promotive services • Health care is a social and economical endeavor encompassing activities by providers,consumers,financiers and government within their respective value systems

5. What’s wrong in today’s Health Care? • Avoidable errors • Underutilization of services • Overuse of services • Variation in services • Communication problems • Lack of Evidence • Dissatisfied clients

6. What can we do about it? • Do nothing • Better education and training • Policing,Inspection,Punishment • Change,Improve,Reward • Comprehensive Approach:Quality Assurance

7. Definition of Quality Why define quality of care? • Reach consensus among employees • Avoid confusion and in-house fighting • Allow for sound evaluation • Allow consumers to make a choice

8. From the beginning there was • chaos • quality assessment • quality assurance • quality improvement • continuous quality improvement • Information technology • values

9. Quality :Terminology • Quality Assurance: the overall philosophy on Quality and its Assurance • Total Quality Management:one of the newest organizational and managerial approaches to Quality Assurance in the (not) for profit industry • Continuous Quality Improvement:an important organizational and managerial mechanism for quality assurance in the health sector

10. Continuous Quality Improvement Important elements: • External and internal customer satisfaction • Management leadership • Involves all personnel • Uses statistical methods • Focuses on improvements

11. Definition of healthcare quality • Quality is working according to specifications • Quality is providing effective services with a minimum of unnecessary use of resources • Quality is to satisfy customers

12. The Core Principles The essentials are: • Assuring(I.e assessing and improving) quality is the responsibility of the provider • Quality assurance is an evaluation and improvement process • Of all the necessary attributes(knowledge,skills,attitudes,values) values and attitudes are the most important

13. TOTAL QUALITY The end point of a development in phases: • Focus on professional quality • Focus on client satisfaction • Focus on system effectiveness • Focus on interconnections • Organizational and societal unification

14. Why improve my quality • Because I know it is needed • because I am told to do so • because I must survive • Because I need to follow the rules Today’s choice:SURVIVAL

15. Mission Statement Rationale:programme SURVIVAL My programme is dedicated to • Provide high-quality service to the members of the community • Employ well-trained professionals • Maintain a high safety record • Provide a customer –friendly environment

16. Plan high –quality services • Identify priorities,goals and customers • Set up working groups • Describe service according to: -consumer and client needs - structure,process,outcome • Make plans for evaluation

17. Quality Planning • Establish Quality project: goals and team • Identify customers • Determine client needs • Design services to be provided • Design delivery process • Determine information need • Use and evaluate

18. Train professionals • Select key professionals • Design appropriate training • Organize continuous training sessions • Evaluate results of training including satisfaction • Reward participants • Repeat training regularly

19. Evaluation • Includes assessment and improvement • Orientation:what are the possibilities? • Selection:What is most appropriate? • Implement: who is doing what? • Collect and discuss the results • Disseminate the results inside and outside • Prepare for the next round

20. Improvement of care • Focus:Structure,Process and Outcome • Structure:better equipment • Process:doing the right things better! • Outcome:obtain better results in - effective services -costs - client and employee satisfaction

21. Improvement of structure • Includes building,equipment,personnel,manuals, information systems,rules and regulations • Includes new provisions,and updating and refurbishing of old provisions • Need to include recording of inputs and costs

22. Improvement of Process Principle:Doing the right things better! • Doing the right things more effective! • Doing the right things more efficient! Includes: • Appropriate use of technology • Appropriate use of personnel • Client/provider relationship

23. Improvement of outcome Focus: • Programme effectiveness • Programme efficiency • Consumer and employee satisfaction • Consumer and employee education • Building and technology safety • Community relations • Information and communication needs

24. Tools for Improvement • Motivation • Insight • Evaluation methods • Communication tools • Dedicated personnel • Dedicated Management • Money

25. That implies: • Quality improvement is essential for survival • Customer satisfaction is important for survival • Monetary support will come only after well-executed quality assurance studies

26. Infrastructure for Quality Assurance in Health Care

27. 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

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

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

30. 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

31. 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

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

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

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

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

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

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

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

39. 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!

40. Decision Making in Healthcare Improvement

41. 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

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

43. 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

44. 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

45. 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

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

47. AUDIT Key Tool for QA Implementation

48. 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

49. 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

50. 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