Infrastructure for Quality Assurance in Health Care

Quality Assurance Universe – Big including small Small Concepts Methods Application Effectiveness Efficiency Criteria for good care Improvement activities Big Patients Providers Organization Technology Information Costs Risks Innovation

Infrastructural Needs Assessment of actual situation: Structural analysis Rapid need assessment SWOT analysis Programme evaluation Part of certification

Essentials A Policy Document for Quality Assurance A Blue Print for Quality Assurance

Quality Assurance Policy Document Directed to Quality Assurance, not to quality Based on National Needs for Improvement of health services Items: definitions, principles, locus, focus, actors, costs, strategies

Contd….. Size: less than 32 pages Production Time: less than 9 months Easy to understand, no jargon Support by main parties (participants) Distributed widely Updated once in five years

Listing the Infrastructure The Body The Engine The Petrol Assembly line and Maintenance The Route Map The Driver And then ……On the road!

The Engine Policies Planning Mechanisms Implementation strategies Organization Resources Knowledge, skills, attitudes Value systems

The Body The system for quality assurance Information systems Conformity between healthcare system and QA system

The Driver Roles and Functions Education and Training License Rewards Remuneration Accountability Value Systems

The Petrol Epidemiology of Health and disease Epidemiology of quality (ABNA) Willingness to evaluate/be evaluated Willingness to Change and Improve Legislation Value Systems

Epidemiology of Quality Rumours and Hearsay Surveys: Opinions, Dissatisfaction Registration of Facts: Incidents Registration of Facts: Trends ABNA: Achievable Benefit Not Achieved

Maintenance Support mechanisms Research and Development Internal Quality Assurance System Value Systems

Assembling Quality Assurance A Laboratory (be in control) Real Life situations (hope the best) Value Systems Whatever you do, you still need a Manual and a Road Map!

Decision Making in Healthcare Improvement

Key Concerns: To find the decision makers: Who decides about quality? Who decides about quality improvement? To identify the client in health care quality improvement

Roles and Functions in Decision making in Quality Improvement The Consumers The Professionals The Managers The Government, Policy Makers

The Seven Roles of the Consumer Definers of Quality Evaluators of Quality Informants of Care Co-producers of care Targets of Quality Assurance Controllers of Practitioner Behavior Reformers of Health Services

The Seven Roles of the Provider To be accountable To provide quality care (plan, implement) To safeguard the quality of care services To be evaluated by colleagues To evaluate his colleagues To continue learning To collaborate with colleagues and management

Seven Roles and Functions of Management Do their job (Quality Management) Exert leadership Participate in Quality Management Communicate on Quality matters Be accountable re: quality Evaluation of Quality Management Provide resources

Role of Government Still open: Active role with responsibilities Support role with limited responsibilities No role at all

AUDIT Key Tool for QA Implementation

History of Audit Global Development: Until 1980s: the only mechanism available since 1985: superseded by CQI Since 1995: rebirth of audit as tool for professionals in CQI programmes Historical definition: audit is retrospective review of medical care as laid down in the medical record

Audit: a modern definition Is a criterion –referenced review of health care delivery to establish quality followed by, if necessary, specific activities to improve care delivery The method is used by professionals to assess and, if needed, improve the quality of their work

Audit:Applied with little more discipline Practical Solutions: Focusing on relevant health care delivery Focusing on multidisciplinary professional work Retrospective and concurrent in orientation Focus on assessment and improvement Based on reliable and valid data Not more time consuming than others

Audits’ Building Stones A well selected topic A limited number of relevant criteria Well selected reliable and valid data A functioning judgment procedure A will to change when needed Relevant changes leading to improvements

What are benefits in health care? Improvement in health status Increase in satisfaction Elimination of impairment Elimination of disability Elimination of risks Elimination of malfunctioning all due to present health care

What is ABNA? ABNA Maximum conceivable benefit Achievable benefit Benefit not achievable Achievable benefit achieved Achievable benefit not achieved Errors of commission Errors of omission

Well –chosen priorities Priorities for Quality Improvement: Are formulated in a clear mode Identify targets with high ABNA Identify all players in the field including patients Provide insight into attainable improvements Put the responsibility for quality improvement where it should be

Conclusion We should: Focus on generalities, later on specifics! Focus on gaps and weaknesses! Each country gets the quality assurance system it deserves!

Thank You