HOW TO DEVELOP QUALITY ASSURANCE PROGRAM IN HEALTH CARE INSTITUTION Ahmad Fuady

Background  Health care institutions have to provide their best quality of care  Quality assurance (QA) program is critical to improve and maintain quality of care  QA means ““all the arrangements and activities that are meant to safeguard, maintain, and promote the quality of care.” – Donabedian, 1980

Dimensions of quality  Perception of quality  Patient, client  Health care provider  Health care manager WHO, Quality Assurance of Health Care In Developing Countries

Your goals  Understanding QA activities  Being able to do QA activities  Recognizing ways to establish and maintain QA as an integral, sustainable part of health care institution

Core activities Silimperi et al, 2002

Defining quality  Developing expectation or standard of quality, and designing system for quality  What standard of quality should be developed?   standard for input, processes, output (outcome), or clinical and administrative

Measuring quality  Quantifying the level of performance or compliance with expected standard  Patient or client satisfaction?  How to measure?  Defining indicators  Development/adaptation of information system  Analysis  Interpretation of results

Improving quality  The application of quality improvement methods and tools to close the gap between current and expected level of quality  Understanding and addressing system deficiencies  How to improve?  Individual problem solving  Re-design of system/processes  Re-structure organization  Re-engineering

 Simple, but....

Problems in QA  Failed to define quality  Choosing inappropriate interventions  Not addressing existing resources  Minimum involvement of healthcare staffs  Extremely short and unsustainable program  Students often find QA merely as a burden, not as a learning process

 Finish?  Are you sure that your QA program would provide any improvements?

Institutionalizing QA Silimperi et al, 2002

 In this clerkship, you will not be ordered to solve these four elements, but... you have to recognize these four elements in your analysis and interventions.  Considering these four elements would aid you to develop the most appropriate intervention and to predict the result.

Policy  Does the policy environment explicitly recognize the importance of quality for reaching organizational or system goals?  Does the policy environment provide support, guidance, and reinforcement for QA implementation?

Leadership  Does the clinic manager have vision and provide strategies to future achievement of the clinic?  How the clinic manager lead his/her staffs and programs?

Core values  Does the clinic have its core values?  Are the core values clearly understood by their staffs?  Does all staff provide their best contributions and desire to be part of the efforts?

Resources  Number of staffs?  Staffs’ time?  Staffs’ capacity and its capacity building programs?  Money required?

Where is your clinics? Silimperi et al, 2002

What should you do? 1. Defining quality  The first week  Observation and discussion with clinic manager and staffs  Choose the quality item and its problem The most emerged problem  set the priority Problem submitted by clinic manager Consider prior QA activities Similar problems to prior group(s)?  Allowed, if the problem is truly important  different approach  Confirm to clinic manager and your group adviser

2. Measuring quality  The first week  Defining indicators  Developing tools to measure  Discuss with your group adviser and clinic manager for the appropriateness and feasibility  Analysis  Interpretation of results

3. Improving quality  The second week  Develop interventions Considering policy, leadership, core values and resources  Precise target Individual or group interventions What outcomes you expect  Short-term evaluation (in the third/fourth week)

Tips  Share the task to all group member  Discuss with clinic manager and your adviser precisely  prepare yourselves prior to discussion  Explore literatures  Do not copy and paste from previous reports  Understand what you write  Imagine; you are the clinic manager!

How to engage clinic manager and staffs in your QA activities?  Senior staffs tend to be more motivated than frontline employees  different approach  Discuss with senior staffs and explore what they expect  formal interviews as an organization  Offer benefits to frontline employees if your QA project has been run  relaxed, informal manner  Time schedule and well prepared Greenfield, 2011

Ahmad Fuady, MD, MSc-HEPL Department of Community Medicine, Faculty of Medicine, Universitas Indonesia Thank you