MEDICAL CARE QUALITY ASSURANCE

MINISTRY OF EDUCATION AND SCIENCE OF UKRAINE

SUMY STATE UNIVERSITY

DEPARTMENT OF PUBLIC HEALTH

Sumy, 2021

Lecturer: assistant, рh.d.

Piven Svetlana Nikolaevna

The problems of organization, management and effective

functioning of medical care quality (MCQ) assurance system

are relevant not only for Ukraine, but also for many other

countries, regardless of their political and ideological

assessment and type of health care systems.

LEGAL SUPPORT OF MCQ

(INTERNATIONAL DOCUMENTS)

1. Universal Declaration of Human Rights

2. European Social Charter

3. International Code of Medical Ethics

4. Lisbon Declaration on Patient Rights

5. WHO Policy - Health-XXI: Fundamentals of Health for All Policy in the European Region

LEGAL SUPPORT OF MCQ (STATE

DOCUMENTS)1. Constitution of Ukraine

2. Law of Ukraine "Fundamentals of the legislation of Ukraine on health care"

3. Law of Ukraine “Protection of the population from infectious diseases”

4. Licensing conditions for conducting business activities in medical practice, approved by the Order of the State Committee of Ukraine for Regulatory Policy and Entrepreneurship and the Ministry of Health, Ukraine dated February 16, 2001 № 38/63 [21].

5. The procedure for state accreditation of a health care institution, approved by the Resolution of the Cabinet of Ministers of Ukraine dated July 15, 1997 № 765

6. Order of the Ministry of Health of Ukraine dated 28.09.2012 №752 "On the procedure for quality control of medical care"

Quality of medical care Glossary, 1999 is a set of

characteristics, confirming compliance of medical care

needs of the patients (population), according to their

expectations, current level of medical science and

technology.According to the system of standardization (ISO 9000), medical

care is «an activity to repair the biological systems of the

human body».

The most common method to ensuring the quality of

medical care is control.

Departmental

Non Departmental

Public

Mechanisms for ensuring the quality of medical

care

Licensing

Accreditation

Certification

Standardization

Clinical audit

Benchmarking

Licensing is the process by which government authorizes a practitioneror health care organization (usually after verifying compliance withminimum mandatory standards).

In Ukraine, licensing applies to all legal entities, regardless of theirlegal form and individual entrepreneurs who conduct business inmedical practice.

Accreditation of medical institutions is designed to ensurecontinuous quality improvement and aims to achieve optimalstandards. The National Accreditation Body, through independentexternal evaluation, publicly confirms the achievement of accreditationstandards by an institution.

In Ukraine, accreditation is not carried out by an independentorganization, as it is done in the EU countries, but by the Ministry ofHealth.

Certification confirms the compliance of health care facilities with

the international standards ISO 9000. The existence of such a system

in the field of health care helps to ensure clarity and transparency of

its activities, significantly increase the effectiveness of treatment,

reduce its cost and increase patient satisfaction with health care.

Standardization provides for availability of clinical recommendations

(guidelines), medical standards (MS) and medical care protocols. Ukraine is

harmonized with the world practice of developing medical and

technological documents.

Clinical audit (internal and external). The task of the clinical

audit is to compare existing clinical practice with the advanced

one for the sake of improving medical services. The audit may

include an assessment of the health care delivery process and/or

its outcome (according to the aim and objectives.

THE FUNDAMENTAL DIFFERENCE

BETWEEN CONTROL AND CLINICAL AUDIT

CONTROL

1. Matching one or more parameters.

2. Formalized process.

3. The purpose of control is to establishcompliance with a pre-established level.

4. As a rule, external procedure is conductedin relation to the executor, however self-control is not excluded.

CLINICAL AUDIT

1. Collection and analysis of objective information on professional activity.

2. A process that requires an informal creative approach, but the use of formalized criteria is not excluded.

3. The purpose of the audit is to determine the level to which one should aspire.

4. As a rule, a component of activity of the medical worker, however external audit is also possible.

BENCHMARKING

Benchmarking is the study of best practices.

In this option, the organization's team or individual

employees visit another organization that is a leader in

TQM implementation and study their processes and

success factors. Based on this information, the

management of the organization develops a management

model adapted to its working conditions.

QUALITY CHARACTERISTICS

1. Technological performance: the degree of compliance with

technical quality requirements (compliance with standards) by

workers and institution

2. Impact of services: the degree of achievement of the desired

result

3. Efficiency of services: correlation of services result to wastes

for their provising.

3. Safety of patient is help with the prevention of traumas,infection, side effects and other undesirable results of medicalintervention.

4. Availability is the degree of unobstructed care regardless ofgeographic, economic, social, organizational or languagereasons.

5. Personal relationships are the sences of trust, respect,privacy, sympathy, ability to listen and understand betweenthose who provide and those who receive medical care.

6. Continuity of services - receiving of appropriate care without

interruption, unnecessary repetitions of examination or treatment and

appropriate and in-time connection between provider and receiver of

medical service.

7. Infrastructure and comfort: outlook of medical institution, cleanliness,

comfort, privacy and other aspects, important for patients impression.

8. Choice: a possibility of receiver to choose service provider, insurance

type or kind of medical care

THE QUALITY COMPONENTS

DONABEDIAN,1980

The quality of structure

The quality of process

The quality of results

STRUCTURE

Finance Organisa-tional structure

Informa-tion Room equipment, medicines, source

material

Human resour-ces

Medical technologies (standards)

System of medical care quality

PROCESS

1. Keeping MC standards, professional norms

Staffing

2. Choice of diagnostics test

3. Choice of medical intervention

4. Patient`s involvement into MC

process

PatientTechnologies

RESULT

Covering of all needs and expectations Health state

In the organization of production of medical services in

health care the completion of the treatment and diagnostic

process, achieving a result in the form of a completed case

is a production cycle.

Quality assurance cycle

(Deming-Schuhart cycle)

Evidence-based changes approach

Plan

Do

Check

Act

EDWARD DEMING &

WALTER SCHUHART

WHAT IS THE RESULT LOW QUALITY OF

MEDICAL CARE?

0

10

20

30

40

50

60

70

1st Qtr0

10

20

30

40

50

60

70

80

90

1st Qtr

1. Limits the possibility of impact on

public health

2. Wasteful use of limited funds of

system

Negative effects

The result should rise using indicators at all stages of implementation of

standards of structure, process and results of medical care in order to

continuously improve quality of medical care to the population.