management for family physician

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

2. HEALTH CARE QUALITY
MANAGEMENT
Prof. Adel Foda
By

3. DR. Deming 1980s
“If japan can,
why can’t we”

4. T Q M
Q A
Q C
Inspection
SPC
Evolution of concept of quality

5. Definition of Quality
WHO has defined quality as the proper
performance (according to standards) of
interventions that are known to be safe,
affordable to the society, and have the ability to
produce an impact on morbidity, mortality,
disability and malnutrition.
The simplest and the most comprehensive
definition is that used by advocates of total
quality management (TQM); doing the right
things right the first time and every time-
compliance with the standards and every where.

6. Measurable quality : compliance with
the standards.
Appreciative quality : excellence of
performance.
Perceptive quality : by the recipient.
Definition

7. Definition
Fitness for use
1-Freedom from deficiencies
2-Product features
i- Attract & satisfy patients
ii- Distinguish the organization

8. Customers of health services
“Meeting customer's need and expectations”
is another useful definition for quality. Well-
designed services create customer satisfaction
because they provide the features or
characteristics that customers need. Customers’
satisfaction is a high priority for any organization.
a- External customers: i. patients, ii. Third party
payers, insurance companies, government
agencies.
b- Internal customers: are those within the
organization.

9. Perception of quality by the health care service
triad (Community, Health team, and MOH)
A- Quality from the community point of
view means,
- A service that is available all the time.
- Easily accessible.
- Feeling of comfort.
- Politeness of health providers.
- Relieves symptoms and prevent illness.

10. B- Quality is perceived by the health care
providers as,
- Technical skills.
- Availability of resources.
- Suitable work conditions and environment.
- The target outcome.
C- For the health care manager (MOHP),
quality means,
- Best services.
- With least possible cost, and
- Achieving best outcome.

11. Dimensions (attributes) of quality
a- Effectiveness: The degree to which care is
provided in correct manner to achieve the
desired outcome. It is concerned with doing
things right.
b- Efficiency: Efficient services provide the
greatest benefit within the resources available.
c- Equity is a basic principle of PHC
advocating equitable distribution of health
resources among all the population. Equity in
health care entails enabling the people to
receive the complete range of health services
[promotive – preventive - curative (referral or
follow up) and rehabilitative].

12. d- Accessibility is determined by various
factors: geographical, economical, cultural,
social, functional. Appropriate care is
obtainable to meet patient’s needs.
e- Safety: ensures minimizing risks of
injury and harmful side-effects related to
health services delivery e.g. Iatrogenic
risks, nosocomial infections & hazards for
both patient & provider.
f- Acceptability: A health care system
should be acceptable and attractive to its
users.

13. g- Continuity: is the harmony and integrity of
delivery of care at different levels. Clients are
provided with comprehensive, integrated care,
without interruption. Health care is ongoing at
the levels of first contact with health services
(PHCC), referral service, follow up is another
aspect of continuity, which necessitates better
record-keeping and information regarding the
patient or services.
h- Respect and Caring: The degree to which
patients are involved in the decision and the
provider’s reaction to the patient needs and
expectations.
i- Competency: The degree to which
practitioner adheres to professional standards of
care and practice. It refers to skills and actual
performance of health providers

14. j- Safety
k- Time lines

15. The quality management principles
1- Customer focused organization: Quality
management is oriented toward meeting the
needs and expectations of the patient and
community.
2- Leadership: Leaders establish unity of
purpose and direction of organization. People
can become fully involved in achieving
objectives.
3- Involvement of people: Involvement for the
organization’s benefit. Focus on team approach
for problem solving and quality improvement is
essential.

16. 4- Process approach: All work, including
clinical practice, is accomplished through
processes to produce specific outcomes.
Analysis of service delivery process, activities
and tasks will allow health care providers
understanding of the problem and its causes.
5- System approach: Health organizations are
systems. Identifying, understanding and
managing a system of processes improve the
organization’s effectiveness.
6- Continual improvement: Should be a
permanent objective of the organization.
7- Approach to decision making: Effective
decision and actions are based on analysis of
data and information.

17. Dimensions (elements) of quality
assessment: (frame work) and measuring
quality in PHC (primary health care)
1-Structure
=input,
resources
2- Process
= procedures
3-Outcome
= results
leads leads

18. 1- Structure (resources, input)
Refers to both the quantity and the quality
of necessary resources for any program or
activity e.g. health manpower (human
resources)– essential drugs – equipment –
records, files – buildings, organizational
and management plans for activity and the
knowledge, attitude and skills of the health
team, training and qualifications.
Measuring by checklist.

19. 2- Process of care (procedures)
Is the manner in which health care professionals
implement PHC/FM activities. [promotive –
preventive – curative (diagnosis, treatment,
Referral) + rehabilitative]. Collaboration with
health related sectors and community
participation.
Measuring the quality of process: Direct
observation – review of records e.g. coverage by
antenatal care – interview with health team,
patients, community members in the health
center catchments area.

20. 3- Outcome ( end result of care)
- E.g. outcome of disease = 5 Ds =
outcome of medical care: Death – Disease
– Disability – Distress – Dissatisfaction.
- Outcome of community participation.
- Outcome of health related sectors
collaboration.
- Patients satisfaction.
Measuring the quality of outcome:
Morbidity & mortality rates.

21. Standards: are statements of expectations
for the structure, process and outcome f
health care services to have high quality of
care and it is the level of performance that is
desired and achievable.
Indicators: defined measurable dimension
of an aspect of health care.

22. Quality control
Is inspection things after they are produced
Quality assurance
In traditional management (system of audit)
using predetermined standards of
performance

23. Quality assurance (QA):
is a program that evaluates and then
institutes programs to improve care
through monitoring and review. It includes
two activities – an evaluative one i.e.
assessment of quality performance and an
adjustive one i.e. taking action to correct
any deviation from standards.

24. QA: is all activities to maintain and
promote quality of care.
QA: is activities that are carried out
to set standards and to monitor
and improve performance so that
the care provided is effective and
safe.

25. Quality assurance process
1- Planning for quality assurance.
2- Developing guidelines and setting
standards.
3- Communicating standards and
specifications.
4- Monitoring quality.
5- Identifying problems and selecting
opportunities for improvement.
6- Defining the problem operationally.

26. 7- Choosing a team.
8- Analyzing and studying the problem to
identify its root causes.
9- Developing solutions and actions for
improvement.
10-Implementing and evaluating quality
improvement efforts.

27. Key activities in the development
of a quality assurance program
Foster commitment to quality.
Conduct a preliminary review of QA-
related activities.
Develop the purpose and vision for the QA
effort.
Determine level and scope of initial QA
activities.
Assign responsibility for QA.

28. Allocate resources for QA.
Develop a written QA plan.
Strength QA skills and critical management
systems.
Disseminate QA activities.
Manage change

29. Total quality management (TQM)
Is a new paradigm of management. TQM is
both a philosophy and methodology for
managing organizations leading to
implementation of continuous quality
improvement (CQI) within the organization. CQI
is the continuous studying and improvement of
the processes of providing primary health care
services to meet the needs of individuals and
people. TQM goes beyond meeting some
minimal standards.

30. Definition of TQM
It is a broad management philosophy,
espousing quality and leadership commitment,
which provides the energy and the rationale for
implementation of the process of continuous
quality improvement within the organization-wide
quality strategy.
TQM is a holistic management philosophy,
and it is a fundamental organizational change.

31. Philosophy of TQM
TQM characterized by emphasizing the three C’s:
Customers, Culture and Counting.
TQM is customer not specialist driven: customer needs
& expectations are defined.
TQM is emphasizing changes in organizational culture:
TQM focus on improving the processes for the service to
be error free and minimal waste of resources.
Respective views of individual organizational
performance and improving work system.
TQM focus on increasing employee authority through
empowerment rather than enhancing management
authority and on worker training and retraining.
TQM focus on continuous quality improvement.

32. Total Quality management
Quality in Daily Work
Continuous
Quality Improvement
Quality Function
Deployment (innovation)
Quality planning

33. Tools for quality improvement
Process description.
Data collection.
Data analysis.
Team working.

34. Quality management
The three components to provide quality
management process.
Quality Planning
Quality Quality
Improvement Control

35. 1- Quality planning
Service goals.
Identify customers.
Customers needs.
Service features and process.

36. 2- Quality Control/Measurement
Quality control process helps health teams to
understand and control their every day work
processes, and establish a basis for
improvement of these processes. It assure that
routine activities and responsibilities are
performed correctly. It involves the following
steps:
Measuring actual performance.
Compare the results with established standard.
Act on the difference

37. 3- Quality Improvement
This process is the means of raising quality
performance. It involves the following steps:
Identify the improvement project (specific needs
for improvement).
Establish the project (project team & clear
responsibility).
Diagnose the cause.
Remedy the cause.
Hold the gains.
Replicate results & nominate new projects.

38. Quality improvement tools
A) Process tools :
1- Brain storming.
2- Affinity diagram.
3- Delphi technique.
4- Multi voting.
5- Nominal group process.
6- Task list.
7- Flow chart.
8- Prioritization matrix.
9- Cause and effect diagram.
10- Force field analysis.

39. Quality improvement tools
B) Statistical tools :
1- Check sheet / talley sheet.
2- Control charts.
3- Histograms.
4- Pareto chart.
5- Run chart.
6- Scatter diagram.

40. If the others can, why
can’t we
That is to be or we will
never be