unit two.pdf

Principles, Tools and Techniques Principles of Total Quality in Health Care Changing the Health Care Environment Dr. Ganna POLA Introduction A Health Care Organization (HCO) is a complex organization by nature owing to the intangible outcome of service and a blend of diverse professional personnel....

Principles, Tools and Techniques Principles of Total Quality in Health Care Changing the Health Care Environment Dr. Ganna POLA Introduction A Health Care Organization (HCO) is a complex organization by nature owing to the intangible outcome of service and a blend of diverse professional personnel. Quality management in healthcare is a critical requirement in health sector. The principles of quality have been implicit in health care. However, quality is not a physical attribute service. Introduction A quality healthcare system can be defined as “one that is accessible, appropriate, available, affordable, effective, efficient, integrated, safe, and patient related”. Health care is delivered by practitioners in allied health services, dentistry, midwifery, obstetrics, medicine, nursing, optometry, pharmacy, psychology and other care providers. Introduction Quality management in health care is a wide term. Initially it was perceived as directing the healthcare personnel to what to do. However, its current interpretation is to manage the process of care. It refers to observing the organizational functions as an interaction of procedures and processes that can be addressed individually and collectively. Although various models have been put forth, however, the concept of triad of structure, process and outcome proposed by Donabedian remains the foundation of quality assessment today. Introduction Quality management has emerged as the dire need more fiercely than ever in light of the new definition of the quality with patient satisfaction as the outcome of service. The quality of services being provided to patients is highly crucial. The traditional view of quality control aimed at defect detection while the current concept aims at the defect prevention, continuous process improvement, and outcome driven system guided by patients’ needs. Hence there is a crying need to bring about a paradigm shift in quality of health care delivery. The authorities need to step forward to get involved in quality. Currently, the quality has been addressed more in medical field than in the allied fields such as dentistry and nursing and also more in the developing country context. Quality ‘Quality’ has different definitions, ranging from traditional to those that are strategic. The American National Standards Institute (ANSI) and American Society for Quality (ASQ) defines quality as the totality of features and characteristics of a care or service that bears on its ability to satisfy given needs. Quality Quality is a unit less value system interpreted as diverse view-points. It has been conceived as superiority of excellence or lacing patient care and service defect or conformance to requirements i.e. zero defects. The precise meaning of quality of care in HCO is ambiguous. It involves more than the earlier perception of ‘clinical quality’. The technical component is also included. The content quality in health care is determined and evaluated by the expectations of the health care professionals. The delivery quality of the health care service is determined by the patient satisfaction, is based on the patient expectations and linked with training and human interpersonal relations. Quality İn Health Care Medicine is a learned profession and it decides its own content quality. The focus for quality in health care is on simple preventive maintenance rather than total service maintenance. Donabedian proposed the use of triad of structure, process, and outcome to evaluate the quality of health care. The structure component includes the infrastructure, skill and qualifications of health care professionals and administrative systems to deliver the health care. The process encompasses the individual components of care and their interactions. The outcome is the recovery, restoration of function, and survival. Quality İn Health Care To understand quality the key features are reliability, assurance and responsiveness. The seven pillars of quality as presented by Donabedian are efficacy, efficiency, optimality, acceptability, legitimacy, equity, and cost. According to the Institute of Medicine, services are of quality, when they are safe, effective, patient centered, timely, efficient, and equitable Quality İn Health Care Quality management in health care has observed a paradigm shift from expecting errors and defects to considering that perfect patient experience is achievable. Philip Crosby supports the same principle that the system for causing quality is prevention and not the appraisal. Literature indicates that the cause of death for a large number of patients in hospitals is medical negligence and nosocomial infections. These deaths can be easily avoided by incorporating quality assurance programs. Quality İn Health Care System designs are important but are not enough in health care management. High value clinical care results from the most efficient expenditure of resources to achieve an established high level of clinical quality. Six Sigma design produces a yield of virtually zero defects. No single model has been established as superior to others in quality management. However, any mechanism would work if top management and the team are committed to quality. Quality İn Health Care Patient satisfaction is the desirable outcome of quality assurance program that requires patient-centered care delivery and also compliance with the standards and efficient protocols. The Institute of Medicine defines patient-centered care as a type of care that is respectful of and representative to individual patient preferences, needs, and values ensuring that patient values guide all clinical decisions. Another approach is the shared decision-making where clinicians and patients make decisions together using the best available evidence. Quality İn Health Care Patient satisfaction, a blurred term that lacks a clear and agreed-upon definition, is a multidimensional entity and is subjective to great extent.2 Majority of the studies to understand the intricacies of relationship between the three key components of service quality have been carried out in the developed country context, which cannot be generalized in the developing country context due to culture differences. The overall quality of the service provided is one of the key factors that patients consider important when choosing a dentist. Quality İn Health Care Tools can be utilized to continually improve the effectiveness of quality management system. These include internal quality audit, subject feedback and corrective/preventive actions to meet applicable standards. IT-Integrated Health Management Information System and committed leadership facilitates the implementation. The four-step quality model, the plan-do-check-act (PDCA) cycle, also known as the Deming Cycle, is the most widely used tool for continuous quality improvement (CQI). Quality İn Health Care Quality İn Health Care Other methods are Six Sigma, Lean and total quality management (TQM). The Kano model has been adopted to identify patient requirements or enhance their satisfaction with healthcare services. Well defined protocols following standard operating procedures and continually trained staff are the internal measures to control quality, while accreditation is the external evaluation of quality. Total quality management The aim of the quality assurance programs in HCOs is to implement a system that is capable of managing the health care service to deliver a high quality service in a measurable way. The answer lies in TQM, a system that can address all the challenges of the organization. Total Quality Management (TQM) is defined as a management philosophy concerned with people and work processes that focuses on customer satisfaction and improves organizational performance.9 It encompasses Content Quality and Delivery Quality both. It decreases burden of errors, ensures optimal utilization of infrastructure and medical personnel and manages quality control. Total quality management The key principles of TQM are customer focus, obsession with quality, scientific approach, long-term commitment, teamwork, continual improvement systems, education, and training, freedom through control, and unity.10 It addresses not only the direct medical services of diagnosis and treatment but indirect operations as administration and purchase also. The nurses are the main personnel that contribute to achieve the success of implementation of this program. Total quality management The TQM implementation is strengthened by the specific quality department.12 Various instruments have been developed to measure the healthcare service quality. Improved quality benefits all, reduces cost and it identifies problems before they actually cause harm. TQM helps reduce quality waste and imparts a continuous improvement of quality services and the employees. Research on the implementation of TQM has been limited, particularly in developing countries including India. Conclusion Health care is a sacred and scientific enterprise and not fundamentally a commercial one. The competent authorities should enforce the responsibility for ensuring high quality standards and quality of care in healthcare facilities. The authority should consider shaping the curricula to ensure training of future professionals to increase patient satisfaction. To gain the desired momentum, HCOs need to initiate a new Quality Movement to achieve total quality in health care service. It is the need, the challenge and the future direction. Conclusion Quality Management for Health Care Delivery provides a framework to help hospitals organize for, communicate about, monitor, and continuously improve all aspects of health care delivery. It also presents evidence to support the proposition that an organized system to achieve high quality care can lead to lower health care costs. In the present national environment a highly structured approach to the pursuit of quality is essential.