1. / 251 Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine Quality in Family Medicine Dr. Zekeriya Aktürk zekeriya.akturk@gmail.com www.aile.net

2. / 252 Objectives At the end of this session, the trainees should be able to; –define terms related with quality –express the benefits of quality –explain the quality diagram Plan-Do-Check-Act –discuss ways to improve quality in primary care –describe quality circles/peer review groups –describe workflow –describe processes

3. / 253 2000 BC: Eat this root... 1000 AC: The root is useless, come do this prayer... 1850 AC: Prayer is superstition...Take, drink this elixir... 1940 AC: The elixir is snake oil...Use this drug... 1985 AC: The drug is ineffective...Take this antibiotic.. 2000 AC: Antibiotics are not working...“Eat this root..." The Story of Drugs

4. / 254 What is Quality?

5. / 255 peculiar and essential character an inherent feature degree of excellence a distinguishing attribute Quality Websters Dictionary

6. / 256 Appropriateness for work. (Dr. J.M. Juran) Quality

7. / 257 Appropriate for the conditions. (P.B.Crosby) Quality

8. / 258 The level you can cover the needs. Quality

9. / 259 Meeting the requirements at the first time, all the times and at the correct time. Quality

10. / 2510 Customer satisfaction. Quality

11. / 2511 Some terms ISO 9001:2000 Quality assurance Quality improvement Total quality management Process Procedure Instructions Documentation Quality circles

12. / 2512 Stakeholders Patients Managers QUALITY Workers

13. / 2513 Quality Cycle W. Edwards Deming

14. / 2514 Quality is a process

15. / 2515 Corrective system 1 2 3 4 Analyze customer needs Corrective actions Control the process Marketing Quality approaches

16. / 2516 Preventive System 1 2 3 4 Analyze customer needs Design and improve Control the process Marketing

17. / 2517 An external customer is the person or organization who receives and pays for a product, a service, or information. For example, the external customer of a movie theater is the moviegoer; the external customer of a car dealership is the new car buyer. An internal customer is an employee or department within an organization who receives an output in the form of a product, service, or information from another employee or department in that same organization. For example, the internal customer of a graphic designer may be the marketing representative who requests a new product brochure. Or the internal customer of a welder may be the operator performing final assembly. Benefits of TQM Benefits to Customers

18. / 2518 Toplam Kalite Yönetiminin Yararları Benefits to Organizations Logically, healthy profits are critical to any organization’s survival and must be factored into key business decisions, including the decision to implement quality. Though quality’s benefits extend beyond the financial realm, organizations should ultimately implement quality because it makes good business sense.

19. / 2519 Toplam Kalite Yönetiminin Yararları Benefits to Employees Product quality leads to: Greater pride in products and services. Sense of satisfaction in a job well done. Process quality leads to: Improvements in internal communication. Reduction in frustration caused by repetitive problems and rework. Streamlined work processes that make sense to the employees who use them.

20. / 2520 Customer satisfaction leads to: –Opportunity to serve real versus perceived customer needs. –Happier customers who are more gratifying to serve. –Strengthened relationships with repeat customers. Profit leads to: –More stable organizations. –Greater job security. –Potential for enhanced employee benefits (higher compensation, better health coverage, more competitive investment plans, etc.). –An additional benefit to learning and applying quality practices is that, in doing so, employees gain valuable knowledge and skills desired by other quality-minded organizations in the job market.

21. / 2521 Three areas in quality Structure –The structure of health system is important. Economical and political restrictions will effect the quality of services Process –What are we doing for our patients in reality? Can we accomplish our responsibilities? Outcomes –Is our practice really making any change? What about patient satisfaction, mortality, morbidity…? Rajakumar MK. Asia Pacific Family Medicine 2002; 1: 74–78

22. / 2522

23. / 2523 Summary What is quality? Describe the quality cycle How did Donabedian define Structure, Process, and Outcome? What is ISO? What are quality circles?

24. / 2524 Question Which one is not a feature of preventive quality approach? a. Customer need analysis b. Design and improvement c. Correcting encountered errors d. Process control e. Marketing

25. / 2525 “I think I have said enough to show how we have progressed and how each one of us is only a link in a chain that began long before us and will continue long after we have gone. Therefore, we must honor our predecessors and delight in those who shall follow.” “Quality is very simple. It is love – love of knowledge, love of man, and love o God.” Avedis Donabedian Spanish Journal of Health Care and Quality, 1999