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1. Managing Quality
in Health care
Ashenafi H (Assi’t Professor)

2. 2
Objectives
Bytheendofthisclass,studentshavetobeable
to:
Definequalityinthecontextofhealthcare
Describethecomponentsofqualityinhealthcare
Discussdifferentmodelsofqualitymanagementin
healthcare
AnalyzequalityofhealthcareinEthiopiancontext
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3. 3
Outline
Defining quality
Components of Quality in Healthcare
Managing quality in healthcare
Why QM/QI in healthcare
Models of QM
QM in the Ethiopian health sector
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4. 4
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5. 5
Definition of Quality in healthcare
Quality in the health sector is a major concern
for:-
Patients
Publichealthofficials
Healthcareproviders
Fundingagenciesand
Governments.
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6. 6
Definition of Quality in healthcare
However,theconceptisamongthoselacking
standarddefinitionanddescription.
Whatconstitutesqualityinhealthcare?
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7. 7
Definition cont…
Whatconstitutesqualityinhealthcare?
Differentfordifferentgroupsofstakeholders/actors
healthcareproviders
healthcarefinancers/donors
Patients
Others
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8. 8
Definition cont…
Wide range of different views exist even within a specific
group of stakeholders
Definitions depend on what people value more
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9. 9
Definition cont…
Focusofstakeholders
Patients
Focusonphysician-patientinteraction
Physicalenvironment
Time
Distance
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10. 10
Definition cont…
Focusofstakeholders…
Healthworkers
Appropriatenessofprovidedcare
Provisionofappropriatecare
Fulfillmentofrequiredequipmentsandmedical
supplies
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11. Focus of stakeholders cont…
Funding agents
Emphasizetheimportanceofefficiencyand
accessibilityofcare
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12. 12
Qualityisthedegreetowhichasetofinherent
characteristicsofsomethingcomplywithasetof
expectations.
Itisarelativeconceptwhichcannotbedefinedina
vacuum.
http://www.praxiom.com/iso-definition.htm#Quality
ISO 9000
Definitions
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13. 13
Components of healthcare Quality
AccordingtoDonabedian,qualityofhealthcarehas
sevenpillars/components
Acceptability
Legitimacy
Equity
Efficacy
Effectiveness
Efficiency
Optimality
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14. 14
Components cont…
Efficacy:
Istheabilityofthescienceandtechnologyofhealthcareto
achievedesiredoutcomesunderbestcircumstances.
“Bestcircumstances”isalwaysdifficulttodefineand
Controllingotherfactorsisalwayschallenging
Substitute“specifiedcircumstances”for“bestcircumstances”
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15. 15
Components cont…
Effectiveness:
Isthedegreetowhichattainableoutcomesareattainedin
reality.
Itisthecomparisonbetweenwhatisachievedinrealitywith
whatispotentiallyachievablewiththe‘best’careprovided
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16. 16
Components cont…
Efficiency
Abilitytoachieveattainableoutcomesofcareata
lowercost.
Improvingefficiencymeansdecreasingthecostof
carewithoutcompromisingachievementof
maximumattainableresults
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17. 17
Components cont…
Efficiency
Thiscanbedoneby:
Improvingthetechnologyofhealthcare(producingmore
efficientdrugs,diagnosticalgorisms,etc)
Improvingtheprocessofhealthcaretoavoidmedical
errors(harmful,uselessorlesseffectivedecisions)
Appropriateuseofresourcesforhealthcare
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18. 18
Components cont…
Optimality
Thebalancingofimprovementsinhealthagainstthe
costandothernegativeconsequencesofsuch
improvements
Optimizing benefits
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19. 19
Components cont…
Acceptability
Isthelevelofconformitytothewishes,desiresand
expectationsofpatients
Include:-
Accessibilityofservices
Empatheticprovider–patientinteraction
Time,expense,physicalcomforttoreceiveservices
Patientpreferencesregardingtheeffects,risksandcosts
ofcare
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20. 20
Components cont…
Legitimacy
Istheconformityofhealthcaretosocialpreferencesas
expressedinethicalprinciples,values,norms,lawsand
regulations
Istheequivalentofacceptabilityasappliedtothe
society
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21. 21
Components cont…
Equity
Conformitytoaprinciplethatdetermineswhatisjust
andfair
Dointerventionsfacilitatethefairdistributionofhealth
servicesand
Benefitsoutofhealthcarefairlyamongdifferent
segmentsofthepopulation?
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22. 22
Quality Management
Includesalltheactivitiesthatorganizationsusetodirect,
controlorcoordinatequality.
InHealthcareitinvolvestheprocessof:
Definingwhatconstitutesbesthealthcare
Investingforitsachievement
Continuouslymeasuringprogresswiththepurposeof
improvingprocessesandoutcomes
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23. Quality Management: Why?
Three areas of gaps in healthcare
Overuse of healthcare
Underuse of healthcare
Misuse of healthcare
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24. Quality Management: Why?
Whateverareaofhealthcareisstudied,inappropriate
carewilllikelyrangebetween10-30%.
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25. 25
Quality Management Models
There are different models of QM in healthcare
Licensing
Certification
Accreditation
Continuous quality improvement
Mostofthetime,countriesimplementacombinationofthese
models.
Nosinglemodelcaneffectivelyimprovehealthcarequality,a
combinationofmodelsisusuallyimportant.
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26. Quality Management in the Ethiopian
Health Sector
26
ExternalQualityControl
HealthRegulatoryAgency:FMHACA(previously
DACA)
Responsibleforregistrationandlicensingofhealth
careprovidersandinstitutions
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27. Quality Management in the Ethiopian
Health Sector …
27
InternalQualityImprovementProcesses
OneofthemajoractivitiesundertheMonitoringand
EvaluationSub-Process
Expectedathealthfacilitylevel(HealthPost,Health
Center,Hospital)
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28. 28
CQI (IQIP) in Ethiopia
Involvescontinuousmeasurementandimprovement
ofhealthcarequality
Qualitymeasurementbasedontwosetsofquality
indicators
National quality of care indicators
Locally relevant quality of care indicators
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29. 29
CQI (IQIP) in Ethiopia
Qualityimprovementprocessesathealthfacilitylevel
(HealthPost,HealthCenter,Hospital)
UsetheS-P-Dcycle-asimplifiedadaptationofthe
Deming'sCycle
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30. 30
Deming’s Cycle
Act Plan
Study Do
April 2012 Managing Quality in Helathcare

31. 31
DO
Implement quality
improvement plan
PLAN
Investigate
underlying root
causes; identify
solution and action
points to improve the
situation
SEE
Use national and
local quality
indicators to assess
opportunities for
improvement
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32. 32
SEE
Doestheobservedlevelofqualityneedimprovement?
Whichoftheareasneedimprovement?
Whichofthemneedtobemaintainedand
benchmarked?
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33. 33
PLAN
Setprioritiesforimprovement
Identifyrootcausesoftheobservedqualityproblems
Listthepossiblesolutionsfortheobservedproblems
Prepareanactionplanforthemosteffectiveandfeasible
solution
CommunicateimprovementplanwiththePerformance
MonitoringTeamandothersrelevant
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34. 34
DO
Puttingplanedactivitiesinpractice
Thenthecyclerestarts.
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35. CQI in the Ethiopia cont…
CurrentstatusofPMQI
CQIconsideredasoneofthebloodlinesinHSDPIV
“Excellenceinqualityassurance”inHSTP
Qualityimprovementconsideredasonefocusarea
intheprocessofhospitalreform
ManyhospitalsassignedQualityImprovement
Officers
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42. 42
Recommended reading materials
AvedisDonabedian,2003.AnIntroductiontoQualityAssuranceinhealthcare.
(editedbyRashidBashshur)
WHO,2004.QualityImprovementinPrimaryhealthcare:APracticalGuide.
Available on line from
http://www.emro.who.int/publications/Book_Details.asp?ID=150
Amodernparadigmforimprovinghealthcarequality
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