2. LEARNING OBJECTIVES
By the end of the session you should be able to:
1. Define quality, quality planning, quality
assurance, quality control, and total quality
management
2. Explain the dimensions or the criteria of quality
in health care
3. Describe quality improvement steps & cycle
3. Quality Management
Definition:
Quality is the degree of adherence to pre-
established criteria or standards.
Or
Doing the right thing right at the 1st
time in the
planned time & every time for the right person
and having the best quality result.
(
”
31
9. QUALITY PLANNING
Defined as the art of
quality management
focused on setting
quality objectives
and specifying
operational
processes and
related resources to
fulfill quality
objectives
10.
11. Quality control
Is a set of activities for ensuring quality in products.
The activities focus on identifying defects in the actual
products produced.
QC is a reactive process aims to identify (and
correct) defects in the finished product.
The goal of QC is to identify defects after a product is
developed and before it's released
12.
13. Quality assurance
QA
Is a set of activities for ensuring quality in the processes
by which products or services are developed.
QA is a proactive process aiming to prevent defects.
The goal of QA is to improve development and
test processes
so that defects do not arise when the product is being
developed.
15. Total Quality management (TQM)
(
Is a comprehensive management of service processes
aiming to
To maintain a desired level of excellence and
reduce costs.
To Ensure complete customer satisfaction at every
stage, internally and externally, the first time and every
time.
16. TQM aims cont.
TQM focuses on preventive measures, not
detection of problems i.e. proactive rather
than reactive actions.
TQM ensures quality standards from the
beginning and in every step (planning,
implementation, supervision and output).
TQM is comprehensive and includes
implementing of QA, QC, and Q
Improvement.
19. Quality improvement
Is a management process and set of tools and
techniques that are coordinated to ensure that
departments consistently meet health needs
of their communities.
20. Steps for quality improvement
1. Develop a plan with SMART objectives
2. Set standards which include:
Practice guidelines
Administrative procedure, rules and
regulations
Specifications & distribution of
responsibilities.
Performance standards
21. Steps for quality improvement (cont.)
3. Communicate standards for the workers.
4. Monitoring of implementation;
continuous supervision.
5.Identify problems, and put priorities (pareto
technique).
6.Analyze each problem to identify its root
causes (fish bone diagram)
6. Define the problems
7. Choosing a team to solve the problem
22. Steps for quality improvement (cont.)
8-Develop solution & alternatives
9-Implement & Evaluate
10-Repeat the cycle after success in another
area.
29. Health care quality
Healthcare quality is defined “as the extent
to which health services provided to
individuals and patient populations to
improve desired health outcomes”.
(The USA, Institute of Medicine (IOM)
The care should be based on the strongest
evidence and provided in a technically and
culturally competent manner with good
communication and shared decision making.
30. WHY we should apply
Q. I. in health care?????????????
To Improve patient safety
To reduce medical errors
To reduce waste and insufficiency
To reduce cost because of scarce resources
For spread of evidence based guidelines
34. 1. Accessibility ( geographical, Financial,
Cultural, Functional)
2. Appropriateness
3. Acceptability
4. Effectiveness
5. Equity
6. Efficiency
7. Continuity
8. Caring& respect
9. Competency
10. Support
11. Safety
3 A
3 E
3 C
2 S
35. Accessibility
Four elements are important
1. Physical accessibility which means that the
service is located within reach of
individuals walking or by using transport.
2. Financial / economic accessibility is the
affordability of the cost of service.
3. Cultural accessibility is the acceptability of
the service by the clients.
4. Functional accessibility means that the
right kind of care is available to those who
need it whenever they need it.
38. Effectiveness
This refers to the degree to which care
is provided in correct manner to
achieve the desired outcome or the
desired objective.
In health programs it can be measured
by indicators (e.g. Morbidity and
mortality rates).
39. Efficiency
Efficiency refers to the best use of
resources to minimize cost and
achieve cost containment and
economy.
(efficiency= effectiveness per cost
unit).
41. Continuity
The clients are provided with
comprehensive, integrated care,
without interruption. Day & night
(24h per day), all days of the week.
For all ages (from womb to comb).
42. Caring & respect
The degree to which pts are
involved in the decision & the
provider’s reaction to the patient
needs & expectations.
Avoid negligence & lack of
attention during dealing with the
pts.
48. Learning Objectives:
At the end of this unit the student should be able
to:
1)Define health economics
2)Understand cost-effectiveness analysis.
3)Enumerate the criteria of evaluation of the
financing system.
4) Demonstrate how to reduce cost of health
care system.
49. Definitions
Economy : art & science of studying inputs, the
expenditures & the output.
Economics is the study of how people and
society choose to employ resources, usually
scarce / limited resources. Economics analyze
the costs and benefits.
Health economics is the application of economic
principles to the health field. It is an important
component of health management.
50. Major aspects or components of
health economics
I. Financing Health care.
II. Cost Analysis.
III. Cost Effectiveness.
IV. Cost containment
51. I-FINANCING HEALTH CARE
The four major methods for
financing are:
1. Governmental financing.
2. User fees (user’s charges).
3. Health insurance .
4-Other sources could be the non-
governmental organization (NGO's) and
the donations .
52. Criteria of evaluation of the financing
system
Equity
Effectiveness
Efficiency
Sustainability
Quality
These are the principles of the “Health Sector
Reform” in Egypt.
53. a .Equity: Fair and Just
People should be able to utilize health care
when they choose to do so
Equity in finance: According to
ability to pay
Equity in delivery of health care:
Health care distributed according
to need, rather than willingness
and ability to pay
54. b- Effectiveness
The extent that health intervention is
successful to reach the desired objective,
or,
Simply the percent of success
55. c. Efficiency
A measure of how well resources
are used to produce the desired
results.
It relates inputs to outputs of the
health service
57. d. Sustainability
A health service is
sustainable when
operated by an
organizational system
with long term ability to
mobilize and allocate
sufficient resources
despite changes in the
outside environment
58. e. Quality
Quality of care is the extent to which actual
care is conforming with preset criteria or
standards for good care.
Assessment of quality of the health system
The structure of the health system
Resources and inputs
Process
Outcome and impact on health
Satisfaction of the clients and providers
59. II-Health COST
classification
Classification of cost by inputs:
Fixed cost
covers salaries and wages.
Direct cost
all cost directed for the patient
Capital cost
It includes buildings ( owned not rented), and
equipment.
60. Cost Parameters
Direct costs
Medical care
visits
Hospitalizations
Ambulance/paramedic
MD visits
Dental
Physical Therapy
Prescription Drugs
Mental health care
Productivity losses
Work losses
Household productivity losses
61.
62. III-COST-EFFECTIVENESS analysis
Effectiveness is a measure of the extent
to which objectives are achieved.
Cost effectiveness analysis (CEA)‑
is an analytical tool to help decision
makers, assess and compare the costs
and effectiveness of alternative ways of
achieving an objective.
It is a technique to identify the most
effective use of limited resources.
63. Cost Effectiveness Analysis
Measures the benefits associated with
an intervention relative to its cost
Average Cost-effectiveness ratio (CE
ratio):
oninterventiofBenefits
on)interventibyavertedCosts-oninterventiofCost(
Saved by intervention
64. The Cost Effective Plane
+ I
-
-
+
Less effective
and less expensive
More effective and
more expensive
Less effective
and more expensive
More effective
and less expensive
IV
IIIII
DifferenceincostDifferenceincost
Differences in effectiveness
Note: Origin is reference intervention
65. The Cost Effective Plane
+
-
-
+
Less effective
and less expensive
More effective and
more expensive
Cost Saving
IV I
IIIII
DifferenceincostDifferenceincost
Differences in effectiveness
Dominated
67. Morbidity reduction: decreased
incidence or prevalence of disease
The number of days disability
prevented: if the treatment can decrease
or prevent number of days lived with
disability.
Mortality reduction which can be
quantified as the number of averted (Saved)
deaths; can be adjusted to measure the
potential years of life gained.
68. Causes of rise of health care spending
‑ Demographic changes producing populations
that are older.
‑ A changing pattern of disease towards chronic
illness.
‑ Advances in medical technology and highly
sophisticated equipment.
‑ Rising public and professional expectations
connected with technological advances.
‑ Increased utilization of curative health
services rather than self or community care.
69. Causes of rise of health care
spending
‑ Higher wages and salaries.
‑ Higher cost for drugs and supplies.
‑ Lack of cost conscious behavior by providers.
‑ Insurance coverage introducing a third party
in the health financing system (over-
utilization & increased cost).
- Inefficiency and inadequate management of
resources. Overstuffing, health workers are
badly deployed and supervised, hospital beds
are underutilized.
70. Measures of decreasing health cost
Cost effective actions.
Training of mangers
Appropriate technology.
Rationalized investigations &
MEDICATIONS .
Reform health insurance system.
71. EXAMPLES OF COST EFFECTIVE
ACTIVITIES IN PUBLIC HEALTH
IMMUNIZATION: in the 1st
year of life
School based health services
Programs for smoking cessation
HE about proper nutrition
Primary Health Care is better than five stars
hospitals
Using head helmets to prevent accidents
complication
Seat belts ……………………
organizations should be aware that there are many different aspects to quality; CCHSA has selected these 8 dimensions as being important
when trying to evaluate quality there are a number of different factors to look at or think about
competence – providers have the necessary skills and knowledge
acceptability – meeting clients expectations
effectiveness – extent to which intervention achieves desired outcome
appropriateness – relevant to client and based on established standards
efficiency – cost-effective use of resources
accessibility – service provided at right time, place etc.
continuity – uninterrupted coordinated services
safety – risks are avoided or minimized
Productivity losses are calculated using the HC approach and are based on the average mean earnings by age and gender. Imputed value of housekeeping based on wages for housekeepers.
