1. MUNICIPAL CORPORATION OF DELHI
(HEALTH DEPARTMENT)
“QUALITY IMPROVEMENT
IN
HEALTH SERVICES ”
DR.P.P.SINGH
Ex Medical Superintendent HRH &
SDN Hospital Delhi
Ex. DIRECTOR PROJECT
IPPVIII- DELHI

2. MEANNING OF QUALITY
•QUALITY IS A SET OF ATTRIBUTE OF SERVICES.
•TOTALITY OF FEATURES AND CHARACTRESTICS OF
SERVICES THAT BEAR ON ITS ABILITY TO SATISFY GIVEN
NEEDS.
•PROPER PERFORMANCE OF INTERVENTIONS THAT ARE
KNOWN TO BE SAFE, AFFORDABLE TO SOCIETY AND
HAVE ABILITY TO PRODUCE IMPACT ON MORBIDITY
,MORTALITY, DISABILITY AND MALNUTRITION.

3. WHY QUALITY.?
TO ENHANCE UTILISATION OF HEALTH SERVICES TO THE
OPTIMUM.
•SUSTAINABILITY OF SERVICES.
THUS FOR QUALITY , REPRODUCTIVE
SERVICES HAS TO BE:-
HEALTH
1 . EFFECTIVE.
2. EFFIECENT.
3. OPTIMUM.
4. IN PROPER FRAMEWORK.
5.CLIENT SATISFACTION.
OUTCOME.
INTER PERSONNNAL
BEHAVIOUR

4. MODEL OF QUALITY FRAMEWORK
THERE ARE A NUMBER OF FRAMEWORKS:1 .DONABADIAN.
2 .ZUDITH.
3 .I I P F FRAME WORK.
4. I C O M FRAME WORK.
5. U N F P A FRAME WORK.

5. CLIENT
EDUCATION
,SOCIOECONMIC
ENVIORNMENT SOCIAL,
POLITICAL,LEGAL.
TECHNOLOGICAL
MANAGEMENT
FACTOR.
SERVICES
DELIVERY
SYSTEM ORGANSATION
SUFFICIENT POLICIES
TRAINING
TECHNOLOGICAL
SIDE EFFECT/
SAFETY.

6. 1 . DONABEDIAN FRAME WORK. STRUCTURE PROCESS. OUT COME.
2. I I PF FRAME WORK
A. CLIENTS RIGHT– Information
----RIGHT OF INFORMATION
-- RIGHT OF ACCESS.
--Safe Services
--Privacy & confidentiality.
Dignity, Comfort,& expression of Opinion.
B. PROVIDERS NEEDS.-Facilitative supervision & Management
--- Informative Training & development
--- Supplies, Equipment & Infrastructure..
FOR F.P. METHODS (QUALITY AT EACH STEP)
. Choice of methods.
. Information
.Technical competence
.Client Provider Relation ship
.continuity of care. .Appropriate Services.

7. World of
Personnel
mouth
need
Post exposure
expected
Dimension of
PERCEIVED QUALITY
services quality
SERVICES.
reliability
ES<PS(QUALITY)
responsive
ASSURNCE
Perceived
EMPATHY
services
TANGIBLE
ES=PS(SATISFACTORY)
ES>PS(UNACCEPTABLE)

8. CUTOMER SERVICES EXPECTATIOIN
MODEL
ADEQUATE
LEVEL
OF
EXPECTATION
DESIRED
ZONE OF TOLERANCE
LOW
HIGH

9. LEVELS OF QUALITY
1.QUALITY ASSURANCE(QA)
BY MANAGEMENT LEVEL.
2. SYSTEM IMPROVEMENT
3.QUALITY IMPROVEMENT(Qi)
EMPLOYER&EMPLOYEE
BOTH
INVOLVED
4.TOTAL QUALITY MANAGEMENT (TQM)
CORPORATE THINKING.

10. Death Review and CPC.
S Q C – in X RAY & LAB.
Hospital Based Gross Death Rate,
Institutional Death Rates
Anesthetic Death Rates.
Postoperative Mortality Rate.
M M R & I M R in hospital.
Caesarian Rate
Post-operative Infection Rate.
H A I rate.
Bed Occupancy, Average of Stay., Re-admission rate
Recurrence Rate, Autopsy Rate.
MEDICAL AUDITS, EQUIPMENT AUDIT

11. HOW TO UNDERSTAND THE CLIENTS
NEED/PERCEPTION
1.LISTENING,LIFE SITUATION, PREFERANCES, CHOICES
2 SURVEY&FOCUS GROUP DISCUSSIONS WITH COMMUNITY
3.OBSERVATION OF CLIENTS &FEEDBACK ABOUT
SERVICES.
4 .STUDY METHODS/PROCEDURES
5 .STUDY CAUSE OF DISCONTINUATION/NON ACCEPTANCE
OF SERVICES.
6 .BEING CLOSE TO CLIENTS(BEFRIEND)

12. QUALITY ASSURANCE PROCESS
IDENTIFICATION OF
PROBLEM AREA
PRIORITIZATION OF
PROBLEM
ASSESSMENT OF
QUALITY CARE
ACCEPTABLE
IMPLEMENTATION OF
REMEDIAL ACTION
NOT ACCEPTABLE
IDENTIFICATION OF
REMEDIAL ACTION
PROBLEM ANALYSIS
INVESTIGATION

13. QUALITY IMPROVEMENT TOOLS
1.COMPARISION WITH STANDARD AVAILABLE.
2CLIENTS FEEDBACK BY SURVEY,EXIT INTERVIEWS
3.GROUP DISCUSSION
4.FOCUS
5.OPEN DISCUSIONS ON TOPIC PLANNED
6.MYSTERY CLIENT STUDIES.
OPERATION RESEARCH

14. PLANS FOR IMPROVEMENTS
1.BY FLOW CHART ANALYSIS
2.BY CAUSE & EFFECT CHARTS
3. SYSTEM MODEL
(DONABADIAN FRAMEWORK)
ELEMENTS
A INPUT
B. PROCESS
C .OUT
COME
OBSERVATION
CHARACTRESTICS
STADERAD

15. DATA COLLECTION
INDICATOR
SOURCE
METHOD OF
COLLECTION
INPUT
PROCESS
OUTCOME
SAMPLE
FREQUENCY
PERSON
RESPONSIBLE

16. INTERVENTIONS TO IMPROVE THE QUALITY
A.TRAINING----I INDUCTION
IIREFENCE/PERIODIC
TYPE--INTER PERSONNAL
--SKILL
--MANAGEMENT
B,PROPER REFERALS--TIMELY
--SPECEFIC
C.SUPERVISON----FACILITATIVE / SUPPORTIVE
-CHECK LIST.
D.MODEST INVOLVENT OF CLIENTS--VOICE
---CHOICE

17. C O P E METHOD
(CLIENT ORIENTED PROVIDERS EFFECTIVE SERVICES)
A.FORMATION OF COMMITTEE/TEAMS
(AFTER CLIENTS ASSESSMENT)
I.SELF ASSESSMENT.
II.CLIENT INTERVIEWS
IIICLIENT FLOW ANALYSIS
IV.MEDICAL RECORD REVIEW
V. ACTION PLAN.
B. ACTION PLAN STATUS
I.THE PROBLEMS
II.THE CAUSES
III.THE RECOMMENDATIONS
IV. BY WHOM
V.BY WHEN.

18. KEY SUCCESS FACTORS FOR RCH PROGRAMME
1.HEALTH WORKERS
2.TIMELY SUPPLY OF DRUGS,CONTTRACEPTIVES,VACCINE
3,TRAINING
4.SUPERVISION
5.METHOD MIX
.
6.ACCESSIBILITY.

19. KEY INDICATORS
1. TIMELY SUBMISSION OF REPROTS.
2.ADEQUACY OF MONITORING IN THE FIELD.
3ORGANISING I. E.C ACTIVITIES.
PROBLEM SOLVING &MOTIVATION SKILL.

20. Developing a Customer’s or Focus.
Creating Staff involvement and ownership in QI
Emphasis on Improving process and system rather than
blaming individuals.( Environment )
Cost Consciousness and efficiency.
Continuous quality improvement.
Staff development and Capacity building.

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THANK YOU VERY
MUCH
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