lecture 1_220725_184445.pdf

Quality Assurance in health care Course objectives: ➢ Define quality in healthcare and identify its dimensions and the principles. ➢ Understand Quality organization structure ➢ Determine the strategies for quality improvements using tools and methods in quality control and develop performance indic...

Quality Assurance in health care Course objectives: ➢ Define quality in healthcare and identify its dimensions and the principles. ➢ Understand Quality organization structure ➢ Determine the strategies for quality improvements using tools and methods in quality control and develop performance indicators ➢ Learning various methods used in quality controls ➢ Apply (Focus PDCA) methodology as a management method for quality improvement. ➢ Illustrate Healthcare policy and procedures ➢ Identify the tasks and responsibilities of Quality Management office ➢ Understand the role of accreditation in improving the quality of healthcare ➢ understand basic infection control (IC) concepts. Quality: ❖ In general quality means: • Doing the right things (what) • To the right people (to whom) • At the right time (when) ❖ Doing things right from the first time ❖ Quality is the extent to which health care services provided to individuals and patient populations be safe and affordable and improve desired health outcomes in reducing morbidity, mortality, disabilities and malnutrition’.) World Health Organization( Quality from different points of view The patient and his family Service providers Quality Health institution management The society Quality from the patient's point of view: The totality of features and characteristics of a health care product or services, that bear on its ability to satisfy stated or implied needs of the patient and a treatment that relieves his pain, and illness and The right to be treated fairly and with respect. Quality from a service provider's point of view : Availability of the required resources to help him provide the service efficiently and easily Quality from health institution management point of view : Providing the best health services at the lowest possible costs Quality from society point of view: It is about assessing whether service is good enough and if it is fit for its purpose Efficient service delivery Effectiveness of care Timing Appropriateness safety Dimension of quality in health care prevention and early detection Technical competence Respect and care Dimensions of quality in health care 1- Availability and Appropriateness: The availability of a needed test, procedure, treatment, or service to the patient in his needs. Appropriateness It is the relationship between intervention care and the individual's medical needs according to the current state of knowledge For example: The patient should be properly evaluated by the service providers The appropriates investigations and procedures should be done for the patient according to his age, disease, and circumstances 2-Safety: The safety of the patient and staff. The degree to which the risk of an intervention in the care environment are reduced for the patient and others, including the healthcare provider. • Safety means that when providing health services, it reduce to the barest minimum injuries, infections, harmful adverse effects and other dangers to clients and staff. This dimension is the main driver of the quality movement in the world Medical errors are among the top ten causes of death in the world, including HIV/AIDS, cancer, traffic accidents, heart disease and coronary artery disease. The Institute of International Medicine in the United States of America reported that medical errors are the main cause of death and that there are 98,000 deaths annually due to medical errors that can be avoided and the main cause of errors is the system, not individual errors or mistakes. 3-Technical competence: The ability of the practitioner to provide health care to patients in the correct manner. The degree to which the practitioner adheres to the professional and regulatory standards of care and practice Ensuring the efficiency of employee in the health institution over the time, through continuous learning and training, to be highly qualified to provide medical service 4-Respect and care: The patient judges the quality of the health service through this dimension, when he comes to a health institution and finds the service providers treat him with respect, fulfill his needs considering expectations, individual differences, and the degree of involvement of the patient or his representative in his care decisions. 5-Prevention and early detection : The prevention and early detection of mistakes that may occur before they reach the patient, thus ensuring safe carefree of errors or mistakes that may affect the safety of the patients. Prevention is better than care For example Examine the patient properly before entering the operating room Checking medications before giving them to the patient, checking the name of the patient and ensure that he is the correct one which the specific procedure will be performed for (such as an operation or taking a blood sample) Public safety such as fire prevention through training of employee to deal with fire and the presence of systems that early detect fire Exposure to harmful chemicals substances. 6- Timing: The degree to which the needed test, procedure, treatment, service, or healthcare intervention is provided to the patient, at the most beneficial or necessary time Carrying out the work or procedure in a timely manner, and this greatly affects the service provided to the patient and the safety For example: Giving the patient medication, conducting x-rays, issuing reports in a timely manner, to take the necessary measures to deal with emergency cases. Timing affects patient satisfaction, for example, the patient does not like to wait for long periods of time for examination, x-rays, or analyzes. 7- Effectiveness of care: The degree to which the care/intervention is provided in the correct manner, based on the current state of knowledge, to achieve the desired outcomes. • Type of care that produces positive change in the patient's health or his/her quality of life. The uses of treatments & procedures that are known to be effective with best possible efficacy in relation to the patient’s condition. This is to confirm that the medical care provided to the patient has achieved its desired goal 8- Efficiency: )System efficiency ( It is the ratio of health care outputs or service to the costs related to providing this service or care and it means the optimal use of resources (human - financial - material) to provide the best health care to the patient and achieve the greatest benefit within the available resources. Principles of quality management principles of quality management customer focus process and procedures Data and information usage Team work 1- Customer focus: The focus should include current—and future—customers. Besides continuously meeting or exceeding customer expectations, companies should measure customer satisfaction. Conversely, failing to meet customer expectations should also be tracked. Every function and department should be involved. Internal customers: Doctors, nurses, technicians, pharmacists, and administrators in the health institution External customers: Patients, families, and the community Knowing the needs of internal and external customers and how to meet them through the health system 2- Processes and procedures: Deming's 85/15 rule: 85% of faults lie with systems, processes, structures, and practices in an organization Only 15% of the problems in the workplace are caused by issues pertaining to an individual (issues such as laziness, carelessness, etc.) In other words, 85% of a worker's effectiveness is determined by the system he works within, only 15% by his own skill. Therefore, to avoid mistakes in the future it requires a strong system for workers and service providers to adhere to it. This principle of quality clarifies that best results (output) are achieved by correctly setting the process and procedures. Usually in the health service there is less control over the inputs (human - material financial) and the results unless working on the processes and procedures Most standards set for procedures and processes, are more than the standards set for inputs and outputs. 3- Data and information usage: Information management chart Application Understanding information and linking it to experiences Knowledge Information Response and decision making Organizing Analyzing Implementation Measuring decision effectiveness Output Data Data collections Feedback This principle clarifies the importance of information and data use to make the right decisions The decision making depend on the accuracy of data collection there is no wrong decision and correct decision, but there is correct data and wrong data, if the correct data provided to the management of health institution in most cases, the correct decision will be taken and vice versa, therefore, this is an important principle that needs time to build. 4- Team work: Quality needs teams to work on, not an individual work, and this was the concept of quality in the beginning that quality was related to a department or office responsible for quality, but now the perception of quality is that quality is everyone's responsibility and the quality of health service must be provided through work teams. Positive Outcomes of Effective Teamwork on Health Care • Reduced length of stay. • Higher quality of care. • Better patient outcomes. • Greater ability to meet family member needs. • Improved patient experience with care scores. Barriers to Team Effectiveness Working Conditions: • • • • Lack of coordination or follow-up. Distractions. Misinterpretation of cues. Shift changes. Resources • • • • Lack of time. Workload. Processes. Technology. Team Composition • • • • • • • • Inconsistency in team membership. Lack of role clarity. Defensiveness. Conventional thinking. Conflict. Fatigue. Varying communication styles. Personality.