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بســـــم هللا الرحمـــــن الرحـــــيم
In the name of Allah. Most Gracious, Most Merciful
QMD/ CPD Program
HEALTHCARE QUALITY BASIC CONCEPTS
Dr. Yasser Sami AmerMBBCh, MS Pediatrics, MS HC Informatics, CPHQ
Supervisor, R&D, QMD, KSUMCCPGs Advisor , KSUHs, AUHs
Member, NAHQ, USAMember, G-I-N Adaptation & Implementation Working Groups
Learning objectives
By the end of this session, participants should be able to know:-
Basic concepts of Health Care Quality• Healthcare Organizations (CAS)
• Definitions of Healthcare Quality (HCQ)
• Dimensions of HCQ
• Aspects of HCQ
• Resources
• Careers
An Indian tale Six Blind Men and the Elephant
http://www.youtube.com/watch?v=qPlJWk8-b4E
All of them were correct,and all of them were wrong !
current debates about HC Reform is like a modern version of the elephant fable!
• Various groups of stakeholders have bandedtogether to come up with their "solution” tothe problems of current healthcare models.
• Too much is spent, outcomes are not goodenough, and too many people are harmed.
• As solutions are presented, not only are thestakeholders convinced of their merit, they arealso certain that counterproposals are wrong.
A complex adaptive system iscomprised of a heterogeneous and diversenetwork of interacting and independentagents/elements that learn and adapt over time.Complex system behaviors are often said to beemergent and subject to self-organization. Inshort, the macro-level behavior of the system ismore than the sum of the micro-level.
C – A – S
Inclusion of significant number of elements
Capacity to change and to
learn from experience
Set of connected or
interdependent things
HEALTHCARE ORGANIZATIONS (HCO) are Complex adaptive systems
C – A – S
Nursinga good example of complex adaptive system
Quality “as dictionary defined”
Noun peculiar and essential character, superiority of kind, degree or grade of excellence
Adjective having a high degree of excellence.
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Perfection of One's Work. The Messenger (peace be upon him) said: "Allah loves that if one does a job he perfects it."
......من اإلتقــــان إلى اإلحســـان ......
In practice …………
= doing right things right the first time
= the right care for every person every time
= first NO harm
Definitions of Quality in Healthcare o
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Healthcare Quality
The extent to which health services
provided to individuals and patient
populations improve desired health
outcomes. The care should be based on the
strongest clinical evidence and provided in
a technically and culturally competent
manner with good communication and
shared decision making.
IOM 2001
KAIZENKAI = change, ZEN = good/ for the better
KAIZEN = continual improvement
Standards are created when experts are able to
understand what the right things are and now
the right things are best achieved
Quality = Compliance with the Standards
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Quality of care is ………AccessibleEffectiveSafeAccountable Fair
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Why do we need Quality in Healthcare?
•Increasing costs of healthcare in the presence of rising demands and limited resources.
•Variation in quality of medical performance and outcomes in similar health organizations.
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Inspection phase
(1920-1940)
Total Quality Management (TQM) phase(Continuous Quality Improvement-CQI)
(1986 and currently)
Quality Control phase
(1940-1960)
Quality Assurance phase
(1970-1985)
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Three Aspects of Quality
MEASURABLE
PERCEPTIVEAPPRECIATIVE
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Measurable Quality
Can be defined objectively as compliance with,
or adherence to standards.
•Clinically, these standards may take the form of
CPGs or protocols, or they may establish acceptable
expectations for patient and organizational
outcomes.
•Standards serve as guidelines for excellence.
PROVIDERS ASPECT OF CARE
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Appreciative Quality
Is the appraisal of excellence beyond minimal
standards and criteria.
•Requires the judgments of skilled, experienced
practitioners and sensitive, caring persons.
• Peer review bodies rely on the judgments of like
professionals in determining the quality or non-quality
of specific patient-practitioner interactions.
PEER REVIEW/ ACCREDITATION BODIES, EXPERTISE
AND SKILLED PERSON ASPECT OF CARE
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Perceptive Quality
Is the degree of excellence which is perceived
by the recipient or the observer of care rather
than by the provider of care.
Is generally based more on the degree of
caring expressed by physicians, nurses, and
other staff than on the physical environment
and technical competence.
RECEPIENT/ PATIENT ‘customer’
ASPECT OF CARE
ALL THE THREE ASPECTS OF
QUALITY ARE ABSOLUTELY
ESSENTIAL TO OUR CONSIDERATION
OF THE OUTCOME AND ALL
ASSOCIATED PROCESS AND
STRUCTURE OF HEALTHCARE
DELIVERY
Key Dimensions of Quality
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1. Safe
2. Timely
3. Effective
4. Efficient
5. Equitable
6. Patient-centered
7. Efficacy
8. Appropriateness
9. Availability
10.Continuity
11.Respect and Caring
KEY DIMENSIONS OF QUALITY CARE
PERFORMANCE
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Is the intervention/ setting relevant, correct given the need?Appropriateness
Is there sufficient access to care? Are there undue restrictions?Availability/ accessibility
Is care coherent and connected (considered less expensive)?Are there gaps or redundancies in care (considered more expensive)?“coordinated care” or “care coordination” in chronic diseased patients with mutli-morbidities
Continuity
Does data indicate desired and cost-effective treatment outcomes?Provide care based on scientific knowledge and EBP
Effectiveness
Does the proposed treatment have the capacity to produce the desired outcome, as demonstrated in the literature? (is it evidence-based?)
Efficacy
Are tests and treatments provided in a manner that conserves resources?Efficiency
to what extent the patient/designee/family was involved in the decisions and care provided, and treated with respect and dignity.
Respect & Caring
Does care protect patients, reduce risk, and reduce liability?Safety
Is care/intervention prompt/provided at the most beneficial necessary time?
Timeliness
Dimensions of Performance
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EFFECTIVENESS• Definition: Whether a drug or other treatment
works in real life. Effectiveness studies of drugs look at whether they work when they are used the way that most people take them. Effectiveness means that most people who have the disease would improve if they used the treatment.
• Example: antidepressant drugs are considered to be effective for the treatment of depression. These drugs have been examined in many clinical trials and other types of research studies (EBP).
AHRQ Glossary of Terms
EFFICACY• Definition: Whether a drug or other treatment works
under the best possible conditions. In a researchstudy about efficacy, the study participants arecarefully selected, and the researchers can make surethe drug is taken properly and stored properly. Thestudy participants may differ from other people in thegeneral public who have the disease. A treatment thathas efficacy under the best conditions may not work aswell in a different group of people with the same
disease. AHRQ Glossary of Terms
Efficacy (cont’d)
Example: a recent clinical trial compared people treatedwith insulin to people treated with oral medicine fordiabetes. Only people with no other medical problemswere enrolled in the study, and most were under age 65.The people treated with insulin had better improvementin their blood glucose than the people treated with oralmedicines.This study is considered an efficacy study, because onlyyounger people without any other health problems wereincluded. Many people who have diabetes are over age65 and have other problems such as heart disease. It isnot known whether the same results would be found inthese people.
Changing the Healthcare Delivery System
As part of the agenda for change, the IOM’s Committee on Quality of Health Care in America established aims for the 21st
century healthcare system. The committee proposed six improvement aims to address key dimensions of healthcare quality that were performing at far lower levels than they should be.
They suggested that healthcare at a minimum should be: STEEEP !
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Framework for Quality: Six Key Areas of IOM Report
Six key areas of quality of healthcare are needed to be monitored. Healthcare should be:
(Acronym: STEEEP)
– Safe
– Timely
– Effective
– Efficient
– Equitable
– Patient-centered
The Healthcare Customer
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A “customer”is one who receives goods
or services .
It is a concept utilized in TQM philosophy to identify
the needs, expectations, and preferences of
all who are affected by the healthcare services we
provide.
Customers are our "dependents"; they rely on us
for a service or product.
The Concept of the Customer
Healthcare System
Quality of Care
Standards for Licensure
Addresses the structure
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Quality of Care
Standards for Certification(e.g.. ISO)
o Focus an capability rather than results
o Thus address structure and Process than on the outcome.
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Quality of Care
Standards for Accreditation Addresses
Structure, Process and Outcome of care.
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StandardIs defined as an explicit predetermined expectation set by a competent authority, that describes an organization’s acceptable performance level.
Standards Should be :Optimal
Achievable
When met would lead to highest possible quality ina system
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Resources in HCQ
AHRQuality Indicators
CPGs
Janet Brown, BA, BSN, RN, CPHQ, FNAHQwas active in the healthcare quality field since 1978 as an administrative director, consultant, and nationally
known educatorhttp://jbqs.com/about-janet
Careers in HCQ (in USA)Healthcare Quality Professional
(Academic degrees OR Professional certificates)
• Thomas Jefferson University/ Jefferson School ofPopulation Health: MS in Healthcare Quality &Safety
• Northwestern University Feinberg School ofMedicine/ Center for Education in Health Sciences:Graduate Programs in Healthcare Quality andPatient Safety (MS, PhD & certificate)
• National Association for Healthcare Quality:Certified Professional in Healthcare Quality
• ISQua: Fellowship Programme
CPHQ
• Information management
• Performance Improvement
• Strategic leadership and people management
• Patient safety
• Accreditation and continuous readiness
• Change management
Questions? Tanong? सवाल? ?سواالت
Acknowledgment
Dr. Magdy Gamal Youssef,MBBCh, MS OBGYN, DTQM, CPHQ
Former Director, Healthcare Quality Directorate, Alexandria University Hospitals, Alexandria, Egypt
Dr. Yasser Sami AmerEBCPGs Advisor & Trainer
yasser3amer@yahoo.comyamer@ksu.edu.sa
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