1. QUALITY & ACCREDITATION
Dr. Mahmoud Radwan
CPHQ

2. Quality is the result of a carefully constructed culture; it has to be the fabric of the organization-not part of the fabric, but the actual fabric.
Quality in a product or service is not what the supplier puts in. It is what the customer gets out & is willing to pay for.

3. What is Quality?

4. Doing:
the right thing
right
from the first time

5. Juran defines quality as both:
I) Freedom from deficiencies:
Causes of customer dissatisfaction
Hospital acquired infections
Lost lab results
Excessive waiting time
Cold meals
Premature discharge

6. II) Product features:
Attract & satisfy customers
Pleasant waiting area
Knowing what to expect
Care coordination
Computerized health record
Follow up care

7. Juran trilogy (TQM cycle)
Quality
planning
Quality
control
Quality
Improvement
Continuous
Circular
All parts depend on each other

8.  Quality Planning:
Identifying customers
Identifying customer needs & expectations
Setting quality goals
Designing or redesigning systems & functions
Setting priorities
What we will do?

9.  Quality Control
Developing performance measures
Monitoring current performance
Comparing actual to intended performance
Performing data analysis
Providing feedback
How we are doing?

10.  Quality Improvement
Improving existing processes
Using scientific problem solving methods
Analyzing causes of failures or errors
Analyzing data for best practice
Finding optimal solutions for chronic problems
How to improve continuously?

11. IOM: Quality of care
Quality of care is the degree to which health services for individuals & populations increase the likelihood of desired health outcomes & are consistent with current professional knowledge

12. Aspects Of Healthcare Quality
Map of quality
Measurable quality
Appreciative quality
Perceptive quality

13. I) Measurable Quality:
Compliance with standards
Such as protocols or practice guidelines
Basis for licensure or accreditation
Serving as guidelines for excellence

14. II) Appreciative Quality:
Appraisal of excellence
Going beyond minimal standards & criteria
Judgment of like professionals
Peer review

15. III) Perceptive Quality:
Degree of excellence
Perceived by recipient of service
Respect & care are the most important
Essential to prevent dissatisfaction

16. Key Dimensions Of Quality
Appropriateness
Availability
Competency
Continuity
Efficacy
Effectiveness
Efficiency
Prevention/early detection
Respect & care
Safety
timeliness

17. Services VS Products
In which quality is more sensitive?
Products
Services
Objects
Performances
Homogenous
Heterogeneous
inventoried
Not inventoried

18. Why Now?

19. Many pressures affect healthcare organizations making quality as a necessity to survive in the market
Utilization management
Risk management
Concept of value

20.  Utilization Management (UM)
•Managed care
•Prospective payment systems
•Case management
•Use of economic indicators
Length of stay
Use of expensive drugs or technologies
Adherence to CPG & protocols

21.  Risk Management (RM)
Increased risk pressures due to:
•Customer awareness of patient rights
•Media coverage
•Increased claims & law suits
•Corporate liability
•Advanced technology in healthcare

22.  Concept of value
Value = Quality of care + outcome
Cost

23. What Changed?

24. Traditional quality assurance programs have points of weakness
Joint Commission (JCI) started a major change agenda in early 1990s
The main concept is CQI

25.  Traditional common weaknesses
Focus on clinical aspects of care only
Compartmentalization of QA activities
Focus on performance of individuals
Reactive activities
Separating the quality care dimensions
What to do?

26.  Opportunities for change
Include ALL aspects of care
Cross-functional approach
Focus on performance of processes
Proactive activities
Integrating all quality dimensions
What is the result?

27. Change in the focus
Was monitoring two elements:
1)What of care = patient care given
2)Who of care = patient care giver
Now monitoring also:
1)How of care = care processes
2)Result of care = care outcome

28. Basic Principles

29.  Work is done through processes
In any process:
Supplier Processor Customer
Inputs
Feedback
Feedback
Outputs

30.  Customer-supplier relationship
Necessary for sound quality management
Everyone plays the three roles( Ex: the patient)
Giving history or feedback
Taking medications
Receiving care
Supplier
Processor
Customer

31. Quality defects due to processes
Main source is problems in the process
Old assumption:
people do the right things wrong
New assumption:
people do the wrong things right
85/15 theory by Deming

32.  Poor quality is costly
Poor quality results in:
Decreased customer satisfaction
Decreased revenue & market share
Lost time & resources
Lost pride & image
Increased liability
High quality is less costly than poor quality

33.  Process variability
Using SPC to differentiate two types of process variation:
I) Common cause variation
Intrinsic in stable processes
Reduce
II) Special cause variation
Extrinsic in unstable processes
Eliminate or implement

34.  Focus on vital processes
Bad news:
Not everything is going to get done
Good news:
Not everything has to get done
Focus on:
High risk
High volume
High cost
Problem prone

35.  Empowering Employee
The most knowledgeable
Encourage creative thinking & innovation
Continuous training & education
Cease dependence on mass inspection

36.  New organizational structures
Quality council
Quality coordinator
Patient safety officer

37.  Juran trilogy (TQM cycle)
Quality
planning
Quality
control
Quality
Improvement
Continuous
Circular
All parts depend on each other

38. What is Accreditation?

39.  Accreditation is:
Voluntary commitment
To standards
Representing optimum quality of care
Determined by experts

40. License & Accreditation
Accreditation
License
Voluntary
Mandatory
Standards
Laws
Optimum
Minimum

41. Two Types
International
Joint commission accreditation (JCI)
National
Egyptian healthcare accreditation program

42. How to be accredited?

43.  Preparedness Plan
Leadership
Knowledge Readiness
Communication

44.  Periodic self-assessment
Walk around inspections
Interviews/Focus groups
Organized binder
Correcting noncompliance issues
Review documentation
Staff education

45. Why to be accredited?

46.  Organization
Pride & positive image
Increased customer satisfaction
Decreased risks
Decreased waste
Increased market share
Increased revenue

47.  Customer
Increased confidence
Active participation
High quality
Patient safety
Patient rights
Satisfaction

48.  Staff
empowerment
Self respect
Motivated
Continuous education & training
Staff satisfaction
Staff retention

49. Accreditation process will be a necessity for healthcare organizations to survive in a rapidly changing market with high competition & increasing pressures to achieve best quality with the available limited resources
Accreditation = survival

50. Thank you