Post on 27-Dec-2015
HOW TO DEVELOP QUALITY ASSURANCE PROGRAM IN HEALTH CARE INSTITUTION
Ahmad Fuady
Background
Health care institutions have to provide their best quality of care
Quality assurance (QA) program is critical to improve and maintain quality of care
QA means “all the arrangements and �activities that are meant to safeguard, maintain, and promote the quality of care.” – Donabedian, 1980
Dimensions of quality
Perception of quality Patient, client Health care provider Health care
manager
WHO, Quality Assurance of Health Care In Developing Countries
Your goals
Understanding QA activities Being able to do QA activities Recognizing ways to establish and
maintain QA as an integral, sustainable part of health care institution
Core activities
Silimperi et al, 2002
Defining quality
Developing expectation or standard of quality, and designing system for quality
What standard of quality should be developed?
standard for input, processes, output (outcome), or clinical and administrative
Measuring quality
Quantifying the level of performance or compliance with expected standard
Patient or client satisfaction? How to measure?
Defining indicators Development/adaptation of information
system Analysis Interpretation of results
Improving quality
The application of quality improvement methods and tools to close the gap between current and expected level of quality
Understanding and addressing system deficiencies
How to improve? Individual problem solving Re-design of system/processes Re-structure organization Re-engineering
Simple, but....
Problems in QA
Failed to define quality Choosing inappropriate interventions Not addressing existing resources Minimum involvement of healthcare
staffs Extremely short and unsustainable
program Students often find QA merely as a
burden, not as a learning process
Finish?
Are you sure that your QA program would provide any improvements?
Institutionalizing QA
Silimperi et al, 2002
In this clerkship, you will not be ordered to solve these four elements, but...
you have to recognize these four elements in your analysis and interventions.
Considering these four elements would aid you to develop the most appropriate intervention and to predict the result.
Policy
Does the policy environment explicitly recognize the importance of quality for reaching organizational or system goals?
Does the policy environment provide support, guidance, and reinforcement for QA implementation?
Leadership
Does the clinic manager have vision and provide strategies to future achievement of the clinic?
How the clinic manager lead his/her staffs and programs?
Core values
Does the clinic have its core values? Are the core values clearly understood
by their staffs? Does all staff provide their best
contributions and desire to be part of the efforts?
Resources
Number of staffs? Staffs’ time? Staffs’ capacity and its capacity building
programs? Money required?
Where is your clinics?Silimperi et al, 2002
What should you do?
1. Defining quality The first week Observation and discussion with clinic manager
and staffs Choose the quality item and its problem
The most emerged problem set the priority Problem submitted by clinic manager Consider prior QA activities Similar problems to prior group(s)? Allowed, if
the problem is truly important different approach Confirm to clinic manager and your group
adviser
2. Measuring quality The first week Defining indicators Developing tools to measure Discuss with your group adviser and clinic
manager for the appropriateness and feasibility
Analysis Interpretation of results
3. Improving quality The second week Develop interventions
Considering policy, leadership, core values and resources
Precise target Individual or group interventions What outcomes you expect
Short-term evaluation (in the third/fourth week)
Tips
Share the task to all group member Discuss with clinic manager and your
adviser precisely prepare yourselves prior to discussion
Explore literatures Do not copy and paste from previous
reports Understand what you write Imagine; you are the clinic manager!
How to engage clinic manager and staffs in your QA activities?
Senior staffs tend to be more motivated than frontline employees different approach Discuss with senior staffs and explore what they
expect formal interviews as an organization Offer benefits to frontline employees if your QA
project has been run relaxed, informal manner
Time schedule and well prepared
Greenfield, 2011
Ahmad Fuady, MD, MSc-HEPL
Department of Community Medicine, Faculty of Medicine, Universitas Indonesia
Email : ahmad.fuady01@ui.ac.id
Thank you