بســـــم الله 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 objectivesBy 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 banded

together to come up with their "solution” to the problems of current healthcare models.

• Too much is spent, outcomes are not good enough, and too many people are harmed.

• As solutions are presented, not only are the stakeholders convinced of their merit, they are also certain that counterproposals are wrong.

A complex adaptive system is comprised of a heterogeneous and diverse network of interacting and independent agents/elements that learn and adapt over time. Complex system behaviors are often said to be emergent and subject to self-organization. In short, the macro-level behavior of the system is more 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.

12

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

14

Healthcare QualityThe 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

17

Quality of care is ………AccessibleEffectiveSafeAccountable Fair

18

19

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.

20

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)

21

Three Aspects of QualityMEASURABLE

PERCEPTIVEAPPRECIATIVE

22

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

23

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

24

Perceptive QualityIs the degree of excellence which is perceivedby the recipient or the observer of care ratherthan by the provider of care.

Is generally based more on the degree ofcaring expressed by physicians, nurses, andother staff than on the physical environmentand 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

26

1. Safe2. Timely3. Effective4. Efficient5. Equitable6. Patient-centered7. Efficacy 8. Appropriateness9. Availability10.Continuity11.Respect and Caring

KEY DIMENSIONS OF QUALITY CARE PERFORMANCE

27

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

28

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 research study about efficacy, the study participants are carefully selected, and the researchers can make sure the drug is taken properly and stored properly. The study participants may differ from other people in the general public who have the disease. A treatment that has efficacy under the best conditions may not work as well in a different group of people with the same disease. AHRQ Glossary of Terms

Efficacy (cont’d)

Example: a recent clinical trial compared people treated with insulin to people treated with oral medicine for diabetes. Only people with no other medical problems were enrolled in the study, and most were under age 65. The people treated with insulin had better improvement in their blood glucose than the people treated with oral medicines.This study is considered an efficacy study, because only younger people without any other health problems were included. Many people who have diabetes are over age 65 and have other problems such as heart disease. It is not known whether the same results would be found in these 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 !

32

33

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

35

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 CustomerExternal Custom

ersOutside organiza

tion

Patient, family,

vendors

Internal Custom

ersWithin

organization

Clinicians,

nurses, clerks

Healthcare System

Quality of Care

Standards for Licensure

Addresses the structure

38

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.

39

Quality of Care

Standards for Accreditation Addresses Structure, Process and Outcome of care.

40

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 in a system

41

Resources in HCQ

AHRQuality Indicators

CPGs

www.qualityforum.org/Home.aspx

ISQua http://www.isqua.org/

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 of Population Health: MS in Healthcare Quality & Safety

• Northwestern University Feinberg School of Medicine/ Center for Education in Health Sciences: Graduate Programs in Healthcare Quality and Patient 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