Transcript Infrastructure for Quality Assurance in Health Care Quality Assurance Universe – Big including small Small  Concepts  Methods  Application  Effectiveness  Efficiency  Criteria for good.

Infrastructure for Quality
Assurance in Health Care
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
Infrastructural Needs
Assessment of actual situation:
 Structural analysis
 Rapid need assessment
 SWOT analysis
 Programme evaluation
 Part of certification
Essentials
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A Policy Document for Quality Assurance
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A Blue Print for Quality Assurance
Quality Assurance Policy Document
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Directed to Quality Assurance, not to
quality
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Based on National Needs for Improvement
of health services
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Items: definitions, principles, locus, focus,
actors, costs, strategies
Contd…..
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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
Listing the Infrastructure
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The Body
The Engine
The Petrol
Assembly line and Maintenance
The Route Map
The Driver
And then ……On the road!
The Engine
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Policies
Planning Mechanisms
Implementation strategies
Organization
Resources
Knowledge, skills, attitudes
Value systems
The Body
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The system for quality assurance
Information systems
Conformity between healthcare system and
QA system
The Driver
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Roles and Functions
Education and Training
License
Rewards
Remuneration
Accountability
Value Systems
The Petrol
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Epidemiology of Health and disease
Epidemiology of quality (ABNA)
Willingness to evaluate/be evaluated
Willingness to Change and Improve
Legislation
Value Systems
Epidemiology of Quality
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Rumours and Hearsay
Surveys: Opinions, Dissatisfaction
Registration of Facts: Incidents
Registration of Facts: Trends
ABNA: Achievable Benefit Not Achieved
Maintenance
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Support mechanisms
Research and Development
Internal Quality Assurance System
Value Systems
Assembling Quality Assurance
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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!
Decision Making in Healthcare
Improvement
Key Concerns:
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To find the decision makers:
Who decides about quality?
Who decides about quality improvement?
To identify the client in health care quality
improvement
Roles and Functions in Decision
making in Quality Improvement
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The Consumers
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The Professionals
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The Managers
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The Government, Policy Makers
The Seven Roles of the Consumer
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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
The Seven Roles of the Provider
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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
Seven Roles and Functions of
Management
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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
Role of Government
Still open:
 Active role with responsibilities
 Support role with limited responsibilities
 No role at all
AUDIT
Key Tool for QA Implementation
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
Audit: a modern definition
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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
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
Audits’ Building Stones
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A well selected topic
A limited number of relevant criteria
Well selected reliable and valid data
A functioning judgment procedure
A will to change when needed
Relevant changes leading to improvements
What are benefits in health care?
Improvement in health status
 Increase in satisfaction
 Elimination of impairment
 Elimination of disability
 Elimination of risks
 Elimination of malfunctioning
all due to present health care
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What is ABNA?
ABNA
Maximum conceivable benefit
Achievable benefit
Benefit not achievable
Achievable benefit achieved
Achievable benefit
not achieved
Errors of commission
Errors of omission
Well –chosen priorities
Priorities for Quality Improvement:
 Are formulated in a clear <problem> mode
 Identify targets with high ABNA
 Identify all players in the field including
patients
 Provide insight into attainable
improvements
 Put the responsibility for quality
improvement where it should be
Conclusion
We should:
 Focus on generalities, later on specifics!
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Focus on gaps and weaknesses!
Each country gets the quality assurance
system it deserves!
Thank You