The document discusses the history and importance of quality in health care, tracing its development from the 1860s to the present. It defines key terms related to health care quality, outlines reasons for rising costs, and compares traditional quality assurance with total quality management. Additionally, it highlights four key health care-related quality goals and provides steps and methods for improving quality in health care systems.

1. Quality in Health Care
Kiran Hanjar
1MS12MIA03
II sem, IEM
MSRIT

2. Introduction
• The history of quality in health care may be traced back to the
1860s
• In 1914, in the Untied States E.A. Codman (1869–1940) studied
the results of health care with respect to quality, and
emphasized the issues
• Over the years, many other people have contributed to the field
of quality in health care
• Each year billions of dollars are being spent on health care
worldwide. For example, in 1992 the United States spent $840
billion on health care, or 14% of its gross domestic product
(GDP)

3. Health Care Quality Terms and
Definitions
• Health care. This is services provided to individuals or communities for
promoting, maintaining, monitoring, or restoring health
• Quality. This is the extent to which the properties of a product or
service generate/produce a desired outcome
• Quality assurance. This is the measurement of the degree of care
given (assessment) and, when appropriate, mechanisms for improving
it.
• Total quality management. This is a philosophy of pursuing continuous
improvement in each and every process through the integrated efforts
of all concerned individuals associated with the organization
• Quality of care. This is the level to which delivered health services
satisfy established professional standards and judgements of value to
consumers
• Quality improvement. This is the total of all the appropriate activities
that create a desired change in quality

4. Health Care Quality Terms and
Definitions
• Clinical audit. This is the process of reviewing the delivery of care
against established standards to identify and remedy all deficiencies
through a process of continuous quality improvement
• Cost of quality. This is the expense of not doing effectively all the right
things right the first time.
• Quality assessment. This is the measurement of the degree of quality at
some point in time, without any effort for improving or changing the
degree of care.
• Dimensions of quality. These are the measures of health system
performance, including measures of effectiveness, appropriateness,
efficiency, safety, continuity, accessibility, capability, sustainability, and
responsiveness.
• Adverse event. This is an incident in which unintended harm resulted to
an individual receiving health care.

5. Reasons for
the Rising Health Care Cost
Medical
malpractice
Use of new
technology
Aging
population
REASONS
Other
specialization
of physicians
Cost of poor
quality
Variance in
practice and poor
incentives to
control cost

6. Comparisons of Traditional Quality Assurance
and TQM with Respect to Health Care
No.
Area
(characteristic)
Traditional quality
assurance
Total quality
management
1
Purpose
Enhance quality of patient
care for patients
Enhance all products and
services quality for patients
and other customers
2
Aim
Problem solving
Continuous improvement,
even when no deficiency/
problem is identified
3
Leadership
Physician and clinical
leaders (i. e., clinical staff
chief and quality assurance
committee)
All leaders (i. e., clinical
and
non-clinical)
4
Customer
Customers are review
organizations and
professionals
with focus on
patients
Customers are review
organizations,
patients, professionals,
and others

7. Continued…
No.
Area
(characteristic)
Traditional quality
assurance
Total quality management
5
Scope
Clinical processes and
outcomes
All processes and systems
(i. e., clinical and nonclinical)
6
Focus
Peer review vertically
focused by clinical process
or department
Horizontally focused peer
review for improving all
processes and individuals
7
People involved
Appointed committees
and quality assurance
program
Each and every person
involved
with process
8
Methods
Includes hypothesis testing,
chart audits, indicator
monitoring, and nominal
group techniques
Includes checklist, force field
analysis, quality
function deployment, control
chart, fishbone diagram,
Pareto chart
9
Outcomes
Includes measurement and
monitoring
Includes also measurement
and monitoring

8. Comparisons of quality assurance and quality
improvement in health care institutions
No.
Area (characteristic)
Quality improvement
Quality assurance
1
Goal
Satisfy customer requirements
Regulatory compliance
2
Participants
Every associated person
Peers
3
Viewpoint
Proactive
Reactive
4
Focus
All involved processes
Physician
5
Review technique
Analysis
Summary
6
Customers
Patients, caregivers, payers,
technicians, support
staff, managers, etc.
Regulators
7
Performance measure
Need/capability
External standards
8
Direction
Decentralized through the
management line of authority
Committee or central coordinator
9
Functions involved
Many (clinician and support
system)
Few (mainly doctors)
10
Action taken
Implement appropriate improvements
Recommend appropriate
improvements
11
Defects studied
Special and common causes
Outliers special causes

9. Health Care-related
Quality Goals
Four important health care-related quality goals
•Aim to maximize patients’ and families’ involvement in the care
experience by using shared decision making and improving patient
involvement in care choices.
•Ensure, in an effective manner, the assessment of employee,
patient, and medical staff satisfaction periodically by incorporating
survey standards and benchmarking.
•Implement recommendations concerning compassionate care of
dying and carefully address the spiritual needs of patients and
families through pastoral care.

10. Health Care-related
Quality Goals
Goal I: Provide a good
person-centered
compassionate care that
respects dignity of all
individuals
Goal IV: Engage all
employees, physicians
and board members in
system efforts to
implement TQM
GOALS
Goal II: Establish a good
system perspective on
analyzing and
communicating
information, data on the
quality, cost of care
Goal III: Effectively
support a quality
management
mechanism that is useful
for further coordination
of care across the
continuum of providers

11. Ten steps that can be used in improving quality in the
health care system

12. Quality Tools for Use in Health Care
Cost
benefit
analysis
Multivoting
Force
field
analysis
Brainstorming
Check
sheets
Methods for
improving quality
in health care
Prioritization
matrix
Cause &
effect
diagram
Scatter
diagram
Affinity
diagram
Process
flow chart
Control
chart
histogram

13. Implementation of Six Sigma Methodology in Hospitals
Steps involved in the implementation of DMAIC Six Sigma

14. Potential advantages of implementation of
Six Sigma
methodology in hospitals
• Measurement of essential health care performance
requirements on the basis of commonly used standards.
• Establishment of shared accountability with respect to
continuous quality improvement.
• The implementation of the methodology with emphasis
on improving customers’ lives, could result in the
involvement of more health care professionals and
support personnel in the quality improvement effort.
• Better job satisfaction of health care employees.

15. Implementation Barriers
Poor support
from
physicians
Governmental
regulations
Rather long
project ramp
up times
Risk of
methodology
Barriers
Difficulty in obtaining
base-line data on
process performance
Nursing
shortage
Costs(start-up
&
maintenance)

16. Reference:
•Applied Quality and Reliability, B.S.Dhillon