3. Learning objectives
By the end of this session, participants should be able to
know:-
Basic concepts of Health Care
Quality
• Healthcare Organizations (CAS)
• Definitions of Healthcare Quality (HCQ)
• Dimensions of HCQ
• Aspects of HCQ
• Resources
• Careers
4. An Indian tale Six Blind Men and the Elephant
http://www.youtube.com/watch?v=qPlJWk8-
b4E
5. All of them were correct,
and all of them were wrong !
6. current debates about HC Reform is like a
modern version of the elephant fable!
• Various groups of stakeholders have
banded together to come up with their
"solution” to the problems of current
healthcare models.
• Too much is spent, outcomes are not good
enough, and too many people are harmed.
• As solutions are presented, not only are
the stakeholders convinced of their merit,
they are also certain that
counterproposals are wrong.
7. A complex adaptive system is
comprised of a heterogeneous and diverse
network of interacting and independent
agents/elements that learn and adapt over
time. Complex system behaviors are often
said to be emergent and subject to self-
organization. In short, the macro-level
behavior of the system is more than the sum
of the micro-level.
8. C – A –
S
Inclusion
of
significant
number of
elements
Capacity to
change and
to learn
from
experience
Set of
connected or
interdependen
t things
13. PerfectionofOne'sWork. The Messenger (peace be upon him)
said: "Allah loves that if one does a job he perfects it."
...... اإلـسحــان
ىإل
اإلـقتـــان
نم ......
14. In practice … … … …
= doing right things right the first time
= the right care for every person
every time
= first NO harm
Definitions of Quality io
n
Healthcare
14
15. HealthcareQuality
The extent to which health
individuals
provided to
populations improve desired
services
and patient
health
outcomes. The care should be based on the
strongest clinical evidence and provided in
a technically
manner with
and culturally competent
good communication and
shared decision making.
IOM 2001
17. Standards are created when experts are
able to understand what the right things
are and now the right things are best
achieved
17
Quality = Compliance with the
Standards
18. Quality of care is
………
Accessible
Effective
Safe
Accountable
Fair
18
19. Why do we need Quality in
Healthcare?
•Increasing costs of healthcare in the
presence of rising demands and limited
resources.
•Variation in quality of medical
performance and outcomes in similar
health organizations.
19
20. Inspection phase
(1920-1940)
Total Quality Management (TQM)
phase (Continuous Quality
Improvement-CQI) (1986 and
currently)
20
Quality Control phase
(1940-1960)
Quality Assurance phase
(1970-1985)
22. Measurable
Qualit
y
Can be defined objectively as compliance with,
or adherence to standards.
•Clinically, these standards may take the form of
CPGs or protocols, or they may establish acceptable
expectations for patient and organizational
outcomes.
•Standards serve as guidelines for excellence.
PROVIDERS ASPECT OF CARE
22
23. Appreciative
Quality
Is the appraisal of excellence beyond minimal
standards and criteria.
•Requires the judgments of skilled, experienced
practitioners and sensitive, caring persons.
•Peer review bodies rely on the judgments of like
professionals in determining the quality or non-quality
of specific patient-practitioner interactions.
PEER REVIEW/ ACCREDITATION BODIES, EXPERTISE
AND SKILLED PERSON ASPECT OF CARE
23
24. Perceptive
Quality
Is the degree of excellence which is perceived
by the recipient or the observer of care rather
than by the provider of care.
Is generally based more on the degree of
caring expressed by physicians, nurses, and
other staff than on the physical environment
and technical competence.
RECEPIENT/ PATIENT ‘customer’
ASPECT OF CARE
24
25. ALL THE THREE ASPECTS OF
QUALITY ARE ABSOLUTELY
ESSENTIAL TO OUR CONSIDERATION
OF THE OUTCOME AND ALL
ASSOCIATED PROCESS AND
STRUCTURE OF HEALTHCARE
DELIVERY
28. 28
Appropriatenes
s
Is the intervention/ setting relevant, correct given the need?
Availability/
accessibility
Is there sufficient access to care? Are there undue restrictions?
Continuity Is care coherent and connected (considered less expensive)?
Are there gaps or redundancies in care (considered more
expensive)? “coordinated care” or “care coordination” in chronic
diseased patients with mutli-morbidities
Effectiveness Does data indicate desired and cost-effective treatment outcomes?
Provide care based on scientific knowledge and EBP
Efficacy Does the proposed treatment have the capacity to produce the
desired
outcome, as demonstrated in the literature? (is it evidence-based?)
Efficiency Are tests and treatments provided in a manner that conserves
resources?
Respect &
Caring
to what extent the patient/designee/family was involved in the
decisions
and care provided, and treated with respect and dignity.
Safety Does care protect patients, reduce risk, and reduce liability?
Timeliness Is care/intervention prompt/provided at the most beneficial
necessary
Dimensions of
Performance
29. EFFECTIVEN
ESS
• Definition: Whether a drug or other
treatment works in real life. Effectiveness
studies of drugs look at whether they work
when they are used the way that most
people take them. Effectiveness means
that most people who have the disease
would improve if they used the
treatment.
• Example: antidepressant drugs are
considered to be effective for the treatment
of depression. These drugs have been
examined in many clinical trials and other
types of research studies (EBP).
30. EFFICA
CY
• Definition: Whether a drug or other treatment
works under the best possible conditions. In a
research study about efficacy, the study
participants are carefully selected, and the
researchers can make sure the drug is taken
properly and stored properly. The study
participants may differ from other people in the
general public who have the disease. A treatment
that has efficacy under the best conditions may
not work as well in a different group of people
with the same
diseas
e.
AHRQ Glossary of
Terms
31. Efficacy
(cont’d)
Example: a recent clinical trial compared people
treated with insulin to people treated with oral
medicine for diabetes. Only people with no other
medical problems were enrolled in the study, and
most were under age 65. The people treated with
insulin had better improvement in their blood glucose
than the people treated with oral medicines.
This study is considered an efficacy study, because
only younger people without any other health
problems were included. Many people who have
diabetes are over age 65 and have other problems
such as heart disease. It is not known whether the
same results would be found in these people.
32. 32
Changing the Healthcare Delivery
System
As part of the agenda for change, the IOM’s Committee
on Quality of Health Care in America established aims
for the 21st century healthcare system. The committee
proposed six improvement aims to address key
dimensions of healthcare quality that were performing
at far lower levels than they should be.
They suggested that healthcare at a
minimum should be: STEEEP !
33. Framework for Quality: Six Key Areas
of
IO
M Report
33
Six key areas of quality of healthcare are
needed to be monitored. Healthcare
should be:
(Acronym: STEEEP)
– Safe
– Timely
– Effective
– Efficient
– Equitable
– Patient-centered
35. A “customer”is one who receives goods
or services .
It is a concept utilized in TQM philosophy to identify
the needs, expectations, and preferences of
all who are affected by the healthcare services we
provide.
Customers are our "dependents"; they rely on us
for a service or product.
35
39. Quality of Care
Standards for Certification
(e.g.. ISO)
o Focus an capability rather than
results
o Thus address structure and
Process than on the outcome.
39
41. 41
Standard
Is defined as an explicit predetermined expectation
set by a competent authority, that describes an
organization’s acceptable performance level.
Standards Should be :
Optimal
Achievable
When met would lead to highest possible quality
in
a system
49. Janet Brown, BA, BSN, RN, CPHQ,
FNAHQ
was active in the healthcare quality field since
1978 as an administrative director, consultant,
and nationally
known educator
http://jbqs.com/about-janet
50. Careers in HCQ (in
USA)
Healthcare Quality Professional
(Academic degrees OR Professional certificates)
• Thomas Jefferson University/ Jefferson School
of Population Health: MS in Healthcare
Quality & Safety
• Northwestern University Feinberg School of
Medicine/ Center for Education in Health
Sciences: Graduate Programs in
Healthcare Quality and Patient Safety (MS,
PhD & certificate)
• National Association for Healthcare Quality:
Certified Professional in Healthcare
Quality
• ISQua: Fellowship Programme
51. C
P
HQ
• Information management
• Performance Improvement
• Strategic leadership and
people management
• Patient safety
• Accreditation and continuous
readiness
• Change management
53. Acknowledgm
ent
Dr. Magdy Gamal Youssef,
MBBCh, MS OBGYN, DTQM, CPHQ
Former Director, Healthcare Quality Directorate, Alexandria
University Hospitals, Alexandria, Egypt
