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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
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.
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
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.
CLIENT

EDUCATION
,SOCIOECONMIC

ENVIORNMENT SOCIAL,
POLITICAL,LEGAL.
TECHNOLOGICAL

MANAGEMENT

FACTOR.

SERVICES
DELIVERY
SYSTEM ORGANSATION
SUFFICIENT POLICIES
TRAINING

TECHNOLOGICAL
SIDE EFFECT/
SAFETY.
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.
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)
CUTOMER SERVICES EXPECTATIOIN
MODEL

ADEQUATE
LEVEL
OF
EXPECTATION

DESIRED
ZONE OF TOLERANCE

LOW

HIGH
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.
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
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)
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
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
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
DATA COLLECTION
INDICATOR

SOURCE

METHOD OF
COLLECTION

INPUT
PROCESS
OUTCOME

SAMPLE

FREQUENCY

PERSON
RESPONSIBLE
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
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.
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.
KEY INDICATORS
1. TIMELY SUBMISSION OF REPROTS.

2.ADEQUACY OF MONITORING IN THE FIELD.

3ORGANISING I. E.C ACTIVITIES.

PROBLEM SOLVING &MOTIVATION SKILL.
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.
1

2

8

3
THANK YOU VERY
MUCH
4

7

6

5

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Quality

  • 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.
  • 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)
  • 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
  • 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.