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Healthcare Quality: Basic concepts

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In the name of Allah. Most Gracious, Most Merciful1QMD/ CPD Program


Dr. Yasser Sami AmerMBBCh, MS Pediatrics, MS HC Informatics, CPHQSupervisor, R&D, QMD, KSUMCCPGs Advisor , KSUHs, AUHsMember, 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 QualityHealthcare Organizations (CAS)Definitions of Healthcare Quality (HCQ)Dimensions of HCQAspects of HCQResourcesCareers

An Indian tale Six Blind Men and the Elephant

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

HEALTHCARE ORGANIZATIONS (HCO) are Complex adaptive systems


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

12Nov 08HCQ712 - Healthcare Quality ManagementsAcademy of Healthcare SciencesPerfection of One's Work. The Messenger (peace be upon him) said: "Allah loves that if one does a job he perfects it."

...... ......

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 o14

14Nov 08HCQ712 - Healthcare Quality ManagementsAcademy of Healthcare SciencesHealthcare 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 2001KAIZEN

KAI = change, ZEN = good/ for the betterKAIZEN = 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 Standards1717Nov 08HCQ712 - Healthcare Quality ManagementsAcademy of Healthcare SciencesQuality of care is AccessibleEffectiveSafeAccountable Fair 18

18Nov 08HCQ712 - Healthcare Quality ManagementsAcademy of Healthcare Sciences

19Why 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.19Nov 08HCQ712 - Healthcare Quality ManagementsAcademy of Healthcare Sciences20Inspection 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)21Three Aspects of Quality

22Measurable QualityCan 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

23Appreciative 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.


24Perceptive 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.



Key Dimensions of Quality26SafeTimelyEffectiveEfficientEquitablePatient-centeredEfficacy AppropriatenessAvailabilityContinuityRespect and CaringKEY DIMENSIONS OF QUALITY CARE PERFORMANCE27Is the intervention/ setting relevant, correct given the need?AppropriatenessIs there sufficient access to care? Are there undue restrictions?Availability/ accessibilityIs 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 ContinuityDoes data indicate desired and cost-effective treatment outcomes?Provide care based on scientific knowledge and EBPEffectivenessDoes the proposed treatment have the capacity to produce the desired outcome, as demonstrated in the literature? (is it evidence-based?)EfficacyAre tests and treatments provided in a manner that conserves resources?Efficiencyto what extent the patient/designee/family was involved in the decisions and care provided, and treated with respect and dignity.Respect & CaringDoes care protect patients, reduce risk, and reduce liability?SafetyIs care/intervention prompt/provided at the most beneficial necessary time?Timeliness

Dimensions of Performance28EFFECTIVENESSDefinition: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: antidepressantdrugsare considered to beeffective for the treatment of depression. These drugs have been examined in manyclinical trialsand other types of research studies (EBP).AHRQ Glossary of Terms

EFFICACYDefinition: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 (contd)Example:a recentclinical 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 anefficacystudy, 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 IOMs 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

33Framework for Quality: Six Key Areas of IOM ReportSix key areas of quality of healthcare are needed to be monitored. Healthcare should be:(Acronym: STEEEP)Safe TimelyEffectiveEfficientEquitablePatient-centered33Nov 08HCQ712 - Healthcare Quality ManagementsAcademy of Healthcare SciencesThe Healthcare Customer

35A customeris 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 Customers:Outside the organizationReceive servicesLike patient, family, vendors

Internal Customers:Within the organizationPerform work or provide servicesLike clinicians, nurses, clerks

Think of other examples of customers in a Healthcare Provider Organization..36Healthcare System


Quality of CareStandards for Licensure

Addresses the structure

3838Quality of CareStandards for Certification (e.g.. ISO)Focus an capability rather than results Thus address structure and Process than on the outcome. 39

39Quality of CareStandards for Accreditation Addresses Structure, Process and Outcome of care.


40StandardIs defined as an explicit predetermined expectation set by a competent authority, that describes an organizations acceptable performance level.

Standards Should be :Optimal Achievable When met would lead to highest possible quality in

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