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Presentation on theme: "Raghavan-gilbert/vw1 A MANAGEMENT PERSPECTIVE. raghavan-gilbert/vw2 QUALITY OF CARE & SERVICE A MANAGEMENT PERSPECTIVE pPROGRAMME JUSTIFICATION FOR QUALITY."— Presentation transcript:

1 raghavan-gilbert/vw1 A MANAGEMENT PERSPECTIVE

2 raghavan-gilbert/vw2 QUALITY OF CARE & SERVICE A MANAGEMENT PERSPECTIVE pPROGRAMME JUSTIFICATION FOR QUALITY Demographic approach & unmet needs Is quality the missing link? Target free approach Reward system and donors Wasted resources & opportunity costs Programme sustainability Stakeholders

3 raghavan-gilbert/vw3 HEALTH & SOCIAL JUSTIFICATION FOR QUALITY w Direct relationship between high fertility and maternal & child deaths w Access to and use of FP Services is critical w Determinants of fertility known w Attitudinal & socio-psychological variables w Decision-making processes in human reproductive behaviour

4 raghavan-gilbert/vw4 MORAL & ETHICAL OBLICATIONS Z Ethical concerns Z Heightened Expectations

5 raghavan-gilbert/vw5 Conceptual Framework of Family Planning Programme Impact on Fertility in the Context of Supply and Demand Source: Bertrand,, 1992

6 raghavan-gilbert/vw6 Family Planning Supply Factors Source: Bertrand, et.a., The Evaluation Project 1992)

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8 8 KEY SYSTEMIC FEATURES OF A FP PROGRAMME u High interdependence u Complex service delivery system u Large information gaps between the entities u No consensus on output measure

9 raghavan-gilbert/vw9 SPECIAL INTEREST GROUPS IN FP PROGRAMME j Religious and cultural groups j Political mistrust j Human rights groups j Feminists groups

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11 raghavan-gilbert/vw11 WHY? w Reduces wastage of scarce resources w Provides a fuller understanding of the problem w Prevents recurrence of a problem w Doing it Right the First Time (DRIFT)

12 raghavan-gilbert/vw12 DEFINITION OF QUALITY ISO 8402 (1986) ON QUALITY VOCABULARY The definition advanced by the ISO draws attention to three key embedded concepts: Quality is the totality of features and characteristics of a product or service that bears on its ability to satisfy stated or implied needs. This definition of quality encapsulates its complexity and multidimensionality.

13 raghavan-gilbert/vw13 INDUSTRIAL QUALITY MODEL Quality is conformance to specifications that relate to customer satisfaction. q Five quality dimensions relate to customer satisfaction in industrial quality. Quality measurement in industry necessarily reflects these dimensions. They are: specification (preservice expectation) conformance (in relation to the expectation) reliability (over time) cost (value) delivery (timeliness)

14 raghavan-gilbert/vw14 QUALITY IN HEALTH CARE ] Self regulation ] External Regulation ] Medical Audits ] Quality in FP ] Bruce QOC Model ] Other Models

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16 raghavan-gilbert/vw16 SERVICE CHARACTERISTICS o Intangible Experience o Co-production o Simultaneity of production and consumption o Client decides the continuation of the relationship o Deficiencies, evident during transaction or even later affects perception of quality

17 raghavan-gilbert/vw17 SERVICE CHARACTERISTICS n Quality service requires that critical behind-the-scene activities meet quality critieria before the first client-provider interaction and service experience occurs. This can happen only if organizational processes are predetermined and quality standards preset for the organization, which providers can strive to reach in service production and delivery

18 raghavan-gilbert/vw18 A Conceptual Model of Service Quality (Haywood - Farmer)

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20 raghavan-gilbert/vw20 DIFFICULTIES IN MEASUREMENT OF SERVICE QUALITY p Clients mental model p Courtesy bias p Empowerment of the customers p Diversity of Perspectives on Quality

21 raghavan-gilbert/vw21 INTERPERSONAL PROCESS m The virtues of the interpersonal process of privacy, confidentiality, informed choice, concern, empathy, honesty, tact and sensitivity identified by Donabedian (1988) be applied as programmatic guidelines to assess and improve services in the QOC model

22 raghavan-gilbert/vw22 HEALTH CARE MANAGERS PERSPECTIVE ] The production and maintenance of high quality service ] Non-physician manager ] Clinician manager

23 raghavan-gilbert/vw23 HEALTHCARE MANAGERS PERSPECTIVE v Managers tend to feel that technical competence, efficiency, access and effectiveness are the most important dimensions of quality (Brown et al., 1993). Less importance is given to the interpersonal dimensions of service.

24 raghavan-gilbert/vw24 HEALTH CARE PROVIDERS PERSPECTIVE o Management enabling the internal customers o Commitment & motivation depends on the organization enabling them

25 raghavan-gilbert/vw25 HEALTH CARE PROVIDERS PERSEPCTIVE X Providers tend to focus on technical competence, effectiveness and of course, safety. This is for good clinical, ethical and legal reasons. They need and expect effective and efficient technical, administrative and supportive services in providing high quality service. Providers tend to underestimate the importance of the role they play and the attitudes they and other front-line staff have in shaping the interpersonal experience of the client and her perception of quality.

26 raghavan-gilbert/vw26 DONOR/FUNDER PERSPECTIVE z Major donor interests in family planning, until recently, have been driven mostly by concerns related to reaching numerical targets to measure impact, efficiency and equity, and to a lesser extent by considerations of ethics

27 raghavan-gilbert/vw27 CLIENT PERSPECTIVE i Family planning clients and communities in developing countries often focus on interpersonal process, geographic and financial accessibility, effectiveness of method, continuity of provider and physical amenities as the most important dimensions of quality. May clients in developing countries cannot adequately assess technical competence because power and knowledge asymmetries between provider and client are too large

28 raghavan-gilbert/vw28 SERVICE QUALITY MODEL Quality of service is when clients perception of service received conforms to clients expectation of service w Tangibles: the physical facilities, equipment, appearance of personnel w Reliability: the ability to perform the desired service dependably, accurately and consistently w Responsiveness: the willingness to provide prompt service and help customers w Assurance: employees knowledge, courtesy and ability to convey trust and confidence w Empathy: the provision of caring, individualised attention to customer

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30 raghavan-gilbert/vw30 TOTAL QUALITY MANAGEMENT (TQM) k Systems model of a Quality Loop wMarket research & specifications wQuality management system wQuality control system wInternal quality assurance systems wExternal quality assurance systems

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33 raghavan-gilbert/vw33 MANAGEMENT AND QUALITY ASSURANCE r Finding & fixing problems in processes of work r Identify performance gap r Cyclical continuous activity r Role of Leadership

34 raghavan-gilbert/vw34 Selected Quality Assessment Tools _Case Follow-up _Client Satisfaction Studies _Clinic Management System _Competency testing _Consumer/Client Intercept Studies _Counselor Training Evaluation _Demographic and Health Survey Oversample _Focus Group Discussions _Hypothetical Cases _Management Information Systems _Matrix (CEDPA) _Matrix (Enterprise) _Monitoring Voluntary Surgical Contraception _Procedures _Observation

35 raghavan-gilbert/vw35 Selected Quality Assessment Tools (contd) _Operations Research _Panel Studies _Patient/Client Flow Analysis _Peer Review _Programme Quality Assessment Tool (PQAT) _Quality Definition and Assessment _Record Review _Self-Assessment _Simulated/Mystery Client Studies _Situation Analysis _Structured Interviews/Surveys _Supervision Tool (CARE) _SWOT Analysis _Use and Discontinuation Studies Source: Katz et,al.1993

36 raghavan-gilbert/vw36 The Service Performance Gap Adapted from Berry et al., 1990




40 raghavan-gilbert/vw40 An Example of PQAT use from FHS Nigeria 1990-Clinic 7

41 raghavan-gilbert/vw41 An Example of PQAT use from FHS Nigeria 1990-Clinic 7 (contd)

42 raghavan-gilbert/vw42 An Example of PQAT use from FHS Nigeria 1990-Clinic 7 (contd)

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47 raghavan-gilbert/vw47 Would you tell me please, which way I ought to go from here? That depends a good deal on where you want to get to, said the Cat. I dont much care where, said Alice. Then it doesnt matter which way you go, said the Cat. So long as I get somewhere, Alice added as an explanation. Oh, youre sure to do that, said the Cat, If you only walk long enough. Lewis Carroll, Alice in Wonderland

48 raghavan-gilbert/vw48 1.P.Raghavan-Gilbert, 1997 Service Quality Management in Family Planning: The Program Quality Assessment model, a multipurpose management tool, Doctoral Thesis, University of Exeter 2.Berry, L.L, Parasuraman, A, Zeithaml, V.A.1990 Quality Counts in Services too. In: Clark G (ed), Managing Service Quality. An IFS Executive Briefing, IFS Publications, UK 3.Bruce, J. 1989 Fundamental elements of quality of care: A Simple Framework, The Population Council, Working Papers (1). 4.Network FHI, Vol. 14 No. 1 1993 Quality of Care - Ways to Improve Care Focusing on Clients. Key References: Quality of Care


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