Healthcare

Quality
 Quality Concepts

Course International Patient

Content Safety Goals

Quality Improvement
 Basics of Quality
Quality
Concepts
Quality Dimensions, Aspects
Donabedian model

Leadership in Quality
 AHRQ
D o i n g t h e r i g ht t h i n g s R i g ht
f ro m t h e 1 st t i m e a n d e ve r y
t i m e at t h e r i g ht t i m e fo r t h e
r i g ht p e rs o n a n d h av i n g t h e
Definition b e st p o s s i b l e re s u l t .

of Quality
Error free system

Any thing less than ideal is

opportunity for improvement
 Quality

Excellence or Perfection
 Detection Prevention

Quality Control Quality

Assurance
History of
Quality
Total Quality Management

QMS ISO GAHAR

JCI
 QMS Quality Quality
Assurance
Planning

Quality
Management
System
Quality Quality Control
Improvement
 Quality planning is the process of
Quality Planning developing a quality plan for a project.

Product plans

P&P and
Product Development
description
Key risks
Release and
dates
and service
intended processes
market action to address
Responsibilities
to be
quality used for the
expectations these risks.
Distribution
project .
 Quality
Assurance
Application of planned ,systematic quality
activities to ensure that all processes
employed will meet requirements and
standards ( focus on individuals )
Quality Control

Monitoring specific results to determine

whether they comply with the quality
standards and identify ways to eliminate
unsatisfactory results
 Quality
Improvement
A formal approach to the
analysis of performance and
systematic effort to improve it
( system and process focus )
 QMS

Quality
Management
System
 QMS

Quality
System
Management
System

Auditing
 System
QMS

Quality
Management
System

Integrated
Documented Compliance with
Communication
Satisfy customerthe
needs
standards
 Auditing
QMS
Systematic independent documented process ,
to determine the extent to which the audit
Quality criteria are fulfilled
Management
System
 Corrective and preventive actions
QMS Identifica
Analysis tion

Quality
Follow Up Classification
Management
System

Investigation and
Implementation RCA

Action
Plan
Quality Management

Monitor Analysis Improvement

 Quality Management

A planned, systematic, organization wide approach to the

monitoring, analysis, and improvement of organization
performance, there by continually improving the quality
of patient care and services provided and the likelihood of
desired patient outcomes
Quality Management Principles
Sound customer supplier
relationship are
necessary for sound of
quality management
 S C

Surgeon Patient

C S

S C

Surgeon Rad

C S
Total employee
involvement is
critical
 Who is responsible for the healthcare Quality?

How can I evaluate the Culture?

Values Performance
 Who is responsible for the healthcare Quality?

How can I evaluate the Culture?

Values Attitude Behaviors
Values Attitude Behaviors
Values Attitude Behaviors

How can I evaluate the Culture?

A. Monitoring employees' performance
B. Conduct a questionnaire to ask about the values
of individualsP
 Values Attitude Behaviors

Evidence of strong organization culture:

a- Employees commitment to mission and vision P
b- Employees participate in CQI activities
c- Leaders pass the organization values to staff
d- Invite physicians to participate in quality activities
 Values Attitude Behaviors

Hospital A has recently merged with Hospital B. After 6 months it is noted

that Hospital A has successfully transitioned their staff to new organizational
values, while Hospital B still struggles. Hospital A's success can best be
attributed to
A. requiring adoption of new values by all staff.
B. support of both hospitals' mission statements.
C. acceptance of the new mission and vision statements. P
D. integrating technology and databases.
Productive work is
accomplished
through processes
 surgeon
Request for
Pt procedures
Radiology

Input Process Output

Radiologist
Request for
procedures Report
Radiology

Input Process Output

The main source of
quality defects is
problem in system
 Quality control
should focus on the
most vital processes
 Understand the
variability of the
processes is a key
to improve quality
Poor quality is
costly
 They are the features and
characteristics that give your
Quality service or product the value
Dimensions
Quality Dimensions
Effectiveness
 Effectiveness
The degree to which a desired outcome is
reached. “ the positive results of care
delivery ”. It is a qualitative measure for
performance outcome.
“It is the extent to which planned
outcomes, goals, or objectives are
achieved as a result of an activity,
intervention or initiative intended to
achieve the desired effect
Competency
 Competency
The degree to which the practitioner
adheres to professional and/or
organizational standards of care and
practice

KAP
Efficacy
 Efficacy
The potential, capacity, or capability
of the care to produce the desired
effect or outcome, as already
shown”. It is a quantitative measure
for performance outcome.
“It is the ability to produce a desired
amount of the desired effect, or
success in achieving
a given goal
Efficiency
 Efficiency
The relation between the
outcome and the resources.

Achieving the goal With

minimal recourses
Appropriateness
 Appropriateness
The degree to which care provided
is relevant to the patient's clinical
needs
Availability
 Availability
The appropriate care and services
are accessible and obtainable to
meet the patient’s needs.
Timely
 Timely
Reducing waits and harmful delays
for both those who receive and
those who give the care.
Equitable
 Equitable
Providing care that does not vary in
quality because of personal
characteristics such as gender,
ethnicity, geographic location, and
socioeconomic status.
Respect and
Care
 Respect and Care
The provider should respect the
patient’s needs, expectation and
individuals’ differences.
Prevention/Early
Detection
 Prevention/Early
Detection
The degree to which
interventions, including the
identification of risk factors,
promote health and prevent
disease. To be proactive in
providing healthcare
services.
 Patient
centered care
 Patient centered care
Providing care that is respectful of, and
responsive to, individual patient
preferences, needs and values, and
ensuring that patient values guide all
clinical decisions
Safety
 Safety
The degree to which the healthcare
intervention minimizes risks of
adverse outcome for both patient
and provider.
Continuity
 Continuity
The coordination of health services
required for a coherent and
uninterrupted succession of
services.
 Questions

The dimension of quality/performance that is addressed by

introducing a rapid response team in a hospital is

A. Continuity of care.
B. Efficiency.
C. Effectiveness.
D. Prevention and early detection. P
 Questions

Which of the following is an example of patient-centered

care?

A. Bedside rounds P
B. Using two patient identifications
C .Pre-printed discharge instructions
D. Age based dosing
 Questions

Medication is ordered for a diabetic patient. Its capacity to

improve health status, as a Dimension of quality or
performance, is it

a. Effectiveness.
b. Potential.
c. Appropriateness.
d. Efficacy.P
 Questions
If in the continuous improvement process, we increase our
emphasis on customer satisfaction and outcomes of care,
which two dimensions of quality/performance must be
incorporated into all quality management activities?

A. Availability and respect/caring.

B. Respect/caring and competency.
C. Effectiveness and respect/caring.
D. Continuity and competency.
P
 Questions

When JoEllen evaluates how many people in her facility’s

managed care plan were able to receive the flu shot. She is
evaluating, under Dimensions of Performance

A. Appropriateness.
B. Availability.
C. Effectiveness.
P
D. Efficacy.
Quality Aspects Donabedian Model
Quality
Aspects
Actual Performance

Assessment

Standards
Actual Performance

Assessment

Standards
Measurable
It’s an aspect of care which
can be judged by the
provider through
comparative measures
between the actual
performance versus the
standard
 Appreciative
It’s an aspect of care which
can be judged by the
experienced practitioners
who rely not only on
standards but on there
personal judgments and
experience
 Perceptive

It’s an aspect of care which is

perceived/judged by
recipient of care
 Donabedian Model
Causal relationship , healthcare model , Donabedian’s model

‫البداية‬ ‫االجراءات‬
 Donabedian Model
Causal relationship , healthcare model , Donabedian’s model

‫البداية‬ ‫االجراءات‬

Structure Process
 Structure Process

• Staff (Nurse to patient • Timeline • Post surgical

ratio) • Pathway , protocol complication rate
• Equipment compliance • Patient satisfaction
• Supplies • Physician orders • Prevent the 6 Ds (
• Environment • Nursing Care Death , Disease ,
• Medical Record Disability , Discomfort ,
content Dissatisfaction ,
Destitution )
 Structure Process

Focus on care
Effect of healthcare
Physical and delivered to patients ,
on patients and
organization e.g. services ,
population
characteristics diagnosis , treatments
What happens as
where healthcare A series of steps that
result of a process ?
occurs achieve a desired
outcome.
Final, final, Results
Clinical, Functional,
Perceived
A clinical pathway on the management of hip fractures has been developed by
a multi-disciplinary team and implemented in a large teaching hospital. After
monitoring for 6 months, the length of stay continues to exceed the
guidelines. Which of the following should be the next step?

A. Evaluate compliance with the pathway.

P
B. Correlate the pathway with staffing levels.
C. Re-educate the staff on the purpose of the pathway.
D. Continue to monitor and collect additional data.
A policy for "time-outs" in an operating room was initiated in the first quarter.
The second quarter data demonstrated only 40% compliance with all
elements of the process. The first step the Quality Council should take is to

P
A. examine if the policy is clear and user-friendly.
B. ask the nurses to identify non-compliant surgeons.
C. continue to audit to confirm that a problem exists.
D. create a letter for the CEO to send to all surgeons.
Leadership
 Leadership

Governance Level Management Level Medical Staff Level

 Leadership
Leadership is influencing people to
Themake leadership role to
the changes necessary
achieve
[Link].
In another definition,
it is the direction, guidance, and
Culture change.
example given to others to get quality
work done and achieve intended
objectives
 Owners
Shareholders or Stockholders

Governance Level
governance board (GB), governing body, board of governors,
board of directors and board of trustees.
Governance Level
governance board (GB), governing body, board of governors,
board of directors and board of trustees.
 Board
Composition
 Board Composition

Clinical care Finance

Accounting Law
Member of the
People's assembly
Governing body
responsibilities
and roles
 Governing body
responsibilities and roles

Governance board carries the legal and

ultimate responsibilities for all patient
care rendered by all practitioners within
the confines of that organizational
structural and authority. A governing
body may be responsible for one or
more facilities or healthcare
organizations.
 Governing body
responsibilities and roles
• Participate with organization leaders in
development of mission, vision, and
values.
• Establish policy in collaboration with
other leaders.
• Maintain quality of patient care and
safety and promote performance
improvement.
 Governing body
responsibilities and roles

• Provide for organizational

management and planning.
• Adopt corporate bylaws (Discussed
later)
• Provide for necessary resources,
approve the budget.
Corporate
Bylaws
 Management Level

A management and administrative staff develop

organizational goals and objectives and establish
necessary departments and services.
 Management Level
CEO
CMO CNO CRO COO CFO
 Governance Level
governance board (GB), governing body, board of governors,
board of directors and board of trustees.

Management Level
CEO
CMO CNO CRO COO CFO
 Owners
Shareholders or Stockholders
 Medical Staff Level
This level is specific for healthcare facilities. Medical staff has two
meanings, the first meaning is medical departments leaders, and the
second one is all medical staff members from physicians, pharmacist, and
nurses .. etc.

The medical staff bylaws and rules and regulations establish a framework
for medical staff activities and accountabilities and are subject to
governing body approval.
 Medical Staff Level

CMO
ICU OR ER CCU CNO
Commitment is “A willingness to give your time and energy to something
that you believe in”
GB

QD
Leadership
commitment
Quality Specialist
Quality Manager

ML

QD

ER Manager
Medical staff
GB

QD

Financial benefits of Quality

ML

QD
Leadership
commitment
Quality Specialist
Medical staff Quality Manager
 Financial benefits of Quality

cost of Good cost of poor

quality quality

Internal Failure External Failure

Prevention Costs Appraisal Costs
Costs Costs
 Autocratic Leader
The leader makes decisions and
announces them to the group with
little or no subordinate participation.

Rules are strictly enforced.

This leadership style is most effective
in immediate crisis situations or when
very strict control is necessary.
 Laissez-faire
❑ No limits are set, and no decisions
made by the leader/manager.
❑ There is little or no interference
with the group process.
❑ The laissez-faire leadership style
can work satisfactorily if the
individuals in the group are very
self-motivated, united in purpose,
goal-oriented, and innovative.
 Dimocratic Leader

❑ Define the problem, defines limits, ask

for a decision.
❑ Works well
1. Deadlines are flexible.
2. Employee participation is critical.
3. Effective self directed work teams.
 Diplomatic Leader
❑ The leader/manager "sells" the decision
and/or presents the decision and invites
questions.
❑ Involving employees in the action plan.
❑ This leadership style is effective when
employee acceptance of a decision
already made is important for its
implementation.
 Participatory Leader
❑ The TQM Leadership/Management Style
❑ The leader/manager presents a
tentative decision, "draft" of an idea, or
a problem to staff/team, receives
suggestions, and then makes the
decision, based on what is deemed best
for the organization.
 Participatory Leader
❑ A powerful motivator for employees
whose expertise is considered valuable
to the decision-making process;
❑ Participatory management can optimize
the introduction of change.
Thanks