Basics of quality in context with healthcare.

1. FUNDAMENTALS of QUALITY
MANAGEMENT
Prepared by
Yagnesh Patni

2. INTRODUCTION

5. QUALITY
 A Measure of EXCELLENCE,
 A State of being FREE from
DEFECTS, DEFIENCY,
 Totality of FEATURES/CHARACTERS of
a product or services,
 Which bears ABILITY TO SATISFY
implied need.

6. DEFECT v/s DEFICENCY
DEFECT is a FLAW
&
DEFICENT is LACK OF.

7. QUALITY
 In nutshell, Quality is an inherent
characteristics with a set of
requirements.
 How good something is compared to
other similar things.
Q. How Much? A. Quantity.
Q. How Good? A. Quality.

8. QUALITY MANAGEMENT
 “Q.M. ensures that an organization’s
product is consistent ”.
 Four Components:
1. Quality Planning
2. Quality Assurance
3. Quality Control
4. Quality Improvement

9. Healthcare Services
hospital,
nursing home,
urgent care clinic,
sanotorium,
ambulance transportation,
diagnostic centers,
laboratories,
dental care,

10. HISTORICAL BACKGROUND
 F.W.Taylor- Manufacturing…
 Walter Shewart- Statistical Quality
System
 W. Edward Deming- Father of Q.M.
 Second World War (1939-1945)
 America rejected, Japan received
 Bring DEMING & JURAN to improve
quality

12. HISTORICAL BACKGROUND
 SHELWART- Plan-Do-Study-Act
 New Concept- Plan-Do-Check-Act
 Through out 1950-60, Japan’s quality focus
followed manufacturers to produce HIGHER
QUALITY goods at LOWER
PRICES.(TOYOTA PRODUCTION SYSTEM-
Minimizing Inventory & Waste)
 In 1987, ISO 9000 was established
 Different versions were introduced since
then…
ISO 9001- Risk Management
ISO 14000- Environmental Management
 Six Sigma Rule by Motorola

13. OBJECTIVES
 Improving quality of products/services,
- High Accuracy, Compliance with
Applicable Standards, High Customer
Satisfaction
 Influencing Organizational Culture,
- Superiors-Sub ordinates
Relationship
- Receptive of Change
- Getting Involved with process of
Improvement

14. OBJECTIVES
 Cost Management,
- By reducing preventable errors, cost will
not go up.
 Improving patient/client satisfaction,
- Improved quality products result into high
satisfaction to clients,
 Ultimate organizational Goals,
- Organizational goals can be achieved by
providing qualitative products like retaining
customers, increase in market share,
exploring new opportunities, earning profit
etc.

15. Quality Care
 “The degree to which health
services for individuals and
populations increase the
likelihood of desired health
outcomes”
 It aims at desired health
outcomes for health services
provided.

16. ISO 9000
 ISO is an independent, non-
governmental international
organization with a membership of
167 national standards bodies.
 H.Q. – Geneva, Switzerland in 1946
 Today, standards are 24399 covering
all aspects of technology and
manufacturing

17. Popular Standards of ISO
9000
 ISO 9000- Quality Management
 ISO 27001- Information Security
Management
 ISO 45000- Occupational Health and
Safety
 ISO 14000- Environmental Management
 ISO 22000- Food Safety Management
 Other Standards are too for Date and
Time(8601), Medical Devices
(13485)Risk Management(31000),
Energy Management(50001), Country
Code(3166)…

18. Benefits of ISO 9000
High Perceived Quality of Custmer Service
Improved Customer Satisfaction
Competitive Edge
Increased Market Share
Greater Quality Awareness
Improved Employee Morale

19. Benefits of ISO 9000
 By assessing their context, org. can
define who is affected by their work and
what they expect.
o This enables clearly stated business obj. &
identification of new business opportunities.
 Org. can identify & address the risks
associated with their org.
 By putting customers first org. can make
sure they consistently meet customer
needs & enhance customer satisfaction.
o This can lead to repeat customers new
clients and increased business for the org.

20. Benefits of ISO 9000
 Org. work in a more efficient way as
all their processes are aligned and
understood by everyone.
o This increases productivity & efficiency,
bringing internal costs down.
 Org. will meet necessary statutory &
regulatory requirement.
 Org. can expand into new markets.

21. Effects of ISO 9000
 Competitive Position:
can bid for contracts specifying ISO 9000
certification,
Competitors lacking certifications can’t bid.
 Customer Satisfaction:
Q.A. leads to better quality products and
results in higher satisfaction.
Higher product quality means fewer
customer service calls, but customers who
contact you, experience improved service
levels,
It further increases customer satisfaction.

22. Effects of ISO 9000
 On Employees:
Face challenges in requiring additional
training & learning new procedures to
establish responsibility for carrying out
work.
Carry out their work with confidence
based on adequate training,
Follow clear standards with explicit
objectives,
It also improves morale of employees.

23. Effects of ISO 9000
 Controls:
Achieve results through implementation
of internal controls that ensure activities
lead to desired results.
Controls are based on documentation of
actions, verification that work was
carried out according to the established
procedures/standards.
 Monitoring of outcomes for
discrepancies:

24. Effects of ISO 9000
When you implement standards to
ensure that product quality is high, the
effects spread to functions, not directly
involved, such as finance & H.R.
because they have to contact with the
opponent departments and satisfy their
requirements.

25. ISO 9000
LIST OF ACCREDITED HOSPITALS in INDIA:
 Apollo Hospitals Bangalore Apollo Hospitals,
Bangalore, India
 Wockhardt Hospital hyderabad, India
 Fortis Hospital, Delhi, India
 Escorts Heart Institute Hospital, Delhi, India
 Manipal Hospital, Bangalore, India
 Narayana Hrudayalaya Heart Hospital, Bangalore,India
 Artemis Hospital, Gurgaon ( Delhi ) , India
 Max Super Specialty hospital, Delhi, India
 Max Devki Devi Heart and Vascular hospital, Delhi,
India

26. Present Scenario In India
 National standardization activity started
in India in 1947 with the establishment of
the Indian Standards Institution (ISI) as a
society under the Societies Registration
Act 1860,
 To prepare and promote the adoption of
national standards.
 In 1952, the Institution was also given
the responsibility of operating a
certification marking scheme under an
Act of Parliament.

27. Present Scenario In India
 In 1986 the national authorities made a review of
the structure and status of ISI and assessed the
impact made by it on the national economic
development and the technological growth of
various sectors of Indian industry.
 The Government of India felt that a new thrust
had to be given to standardization and quality
control activities,
 A national strategy had to be evolved for giving
appropriate recognition and importance to
standards and for integrating them with the
growth and development of production and
exports in different sectors.

28. Present Scenario In India
 The Government of India therefore
decided to create a statutory
organization as the national standards
body which was named as the Bureau of
Indian Standards (BIS), with adequate
autonomy.
 As well as flexibility in its operations to
achieve harmonious development of the
activities of standardization, certification
marking and connected matters.
 The Bureau of Indian Standards Act was
passed by the Parliament in 1986 and
BIS came into being on 1 April 1987.

29. Distinction b/w scenarios
Quality
in
Yesteryears Key Quality
Focus on purchase &
sales
Corrective method
used
Responsibility lies with
Quality Department
Quality as function
Result was important
Quality was
considered to be a
tool. Quality
in
21
st
Century
Key Consumer
requirement
Focus on all business
tasks
Preventive method
used
Responsibility lies with
every employee
Quality as strategy
Process was important
Quality is considered
to be a process
philosophy.

30. Quality Care
“The degree to which health services for individuals and
populations increase their likelihood of desired health
outcomes and care, consistent with current professional
knowledge.”

31. Quality in Yesteryears
Quality was the key
Focused on Purchase & Sales
Corrective Methods used
Responsibility lies with quality
department
Quality as function
Result was important
Quality was considered to be a tool.
Quality in 21st Century
Consumer requirement is the key
Focused on all Business Tasks
Preventive Methods
Responsibility lies with every
employee
Quality as strategy
Process is important
Quality is considered to be a
process philosophy.
Present Scenario of Q.M.S.

32. Organization
Top Level
Management
Middle Level
Management
Bottom Level
Management

33.  Org. must make an intentional efforts to
measure, assess and improve
performance
 Not only an organization’s board of
trustees but also senior management
 High Performing Health Care Org. –
Committed to success and continually
produces outstanding results and high
level of customer satisfaction
 Org. must have a Q.M.S. or framework
that defines and guides all
measurement, assessment and
improvement activities.
Organization of Q.M.S.

34.  Variables that affect Org. of the Quality
framework:
1. Type of Org.- Manufacturing, retailing
etc.
2. Size of Org.- Small, Medium, big etc.
3. Avail. Resources – Raw materials etc.
4. Quality Requirement – Pre decided
standards
5. Internal Quality Improvement Priorities
Q.M. of Health Care Organizations vary
according to their governance and
management structure.
Organization of Q.M.S.

35. The Board
Administration
Coordinating Committee
Medical Staff
Departments
Quality Support Services
Organization of Q.M.S.
:Management Roles:

36.  Which oversees and supports
measurement, assessment and
improvement activities.
 Governing body called the board of
trustees, board of governors, or board of
directors,
 Ultimate legal authority and responsibility
for the operation of the H.C. Org.
Key Responsibilities:
o Defining Org. Commitment to continuous
improvement of patient care and
services in the mission statement
THE BOARD

37. o Prioritizing org. quality goals(with
medical staff and administration)
o Incorporating results of assessment,
o Learning approaches to and methods of
continuous improvement
o Financial Support for
M.A.I.(Measurement, Assessment &
Improvement)
o Evaluating org. progress towards its
quality goals
o Reviewing effectiveness of the quality
management program
THE BOARD

38. Implementing quality management
activities throughout the organization
The C.E.O., C.O.O., V.P. and other
senior leaders.
They take care day to day quality
management operations
Key Responsibilities:
o Defining Org. quality management
infrastructure,
o Assigning q.m. responsibilities and
holding people accountable for them,
ADMINISTRATION

39. o Allocating resources necessary to
support q.m.
o Promoting physician and employee
about the concepts and techniques of
q.m.
o Using performance data for strategic
planning purposes
o Improvement opportunities
o Keeping the board informed of quality
and patient safety issues.
ADMINISTRATION

40.  Often called the QUALITY COUNCIL,
PERFORMANCE IMPROVEMENT COMMITTEE
or QUALITY and PATIENT SAFETY
COMMITTEE
 Guiding M.A.I. activities.
 Sometimes, an individual rather than a
committee fulfills this role,
Key Responsibilities:
o Meeting periodically to direct the activities
o Setting expectations, developing plans, ensuring
implementation of processes to measure and
assessing and improving the quality of the org.
governance, management, clinical and support
purposes by…
COORDINATING COMMITTEE

41.  analyzing summary of reports
 setting improvement priorities and chartering
interdepartmental, multi disciplinary
improvement teams,
 directing resources necessary for M.A.I
 establishing quality goals for the organization
 coordinating and communicating all q.m.
activities throughout the org.
Evaluation of q.m. programms’ effectiveness
in meeting org. quality goals,
Communicating q.m. activities to the board of
trustees
COORDINATING COMMITTEE

42. COMPOSITION of Quality
Coordinating Committee
Teaching Hospital
Chief Operating Officer
Vice President of Medical Affairs
Vice President of Nursing
Vice President of Clinical Support
Services
Medical Staff President
Director of Quality
Neighborhood Health
Clinic
Medical Director
Senior Staff Nurse
Clinic Manager
Director of Health Information
Management
It comprises of physicians, nurses, other clinicians, and
administrative representatives. It depends upon the size
of the Healthcare organization.

43. It comprises physicians, dentists, and
other professional medical personnel
who provide care to the hospital’s
patients independently.
It is delegated the responsibility of
evaluating the quality of patient care
provided by physician and other medical
professionals and advising the board of
the results.
In short, a formal org. of physicians and
dentists with the delegated
responsibilities and authority to maintain
proper standards of medical care and
plan for continued betterment of that
MEDICAL STAFF

44.  All departments participate in q.m. activities,
 Managers of these departments and services are
responsible for overseeing performance in their
respective areas.
Key Responsibilities:
o Providing leadership oversight for departmental q.m.
activities,
o M.A.I. clinical and operational performance,
o Ensuring the competence of people working in the
department,
o Identifying opportunities to improve performance in the
department and in the org.
o Reporting the results to departmental staff, oversight
committees, and the board.
DEPARTMENTS

45.  Many individuals in a healthcare org. assist
with q.m. activities.
 Their job titles and areas of expertise vary
considerably among org.
 A list of these roles:
1. Quality Director:- Administrative Head,
Internal Consultant
2. Patient Safety Coordinator:- Patient safety
office, co-ordinates flow of patient safety
information
QUALITY SUPPORT
SERVICES

46. 3. Physician Quality Advisor: Medical Director assigns, provides
input to senior administrative team and medical staff
4. Case Manager/Utilization Reviewer: determines
appropriateness of medical care and gather information on
resource use.
5. Patient Advocate: Primary customer service contact for patients
and staff members for resolution of problems
6. Risk Manager: Protects org. from financial losses that may
result from exposure of risk through initiatives aimed at
preventing harm to patients, visitors, and staff.
7. Compliance Officer: Interprets accreditation standards and
government regulations pertaining to quality management.
8. Others: Data Analysts, Infection Control Co-ordinator.
QUALITY SUPPORT
SERVICES