1. Quality in Health Care Dr. Abdul Sattar Khan MBBS, MPH, MCPS, DCHM, MRCGP (UK), FRIPH (UK) Assistant Professor Family Medicine Department drsattarkhan@gmail.com

2. Which car would you like to have?

4. Objectives At the end of this course participants will be bale to; Describe the concept of quality Should know that the quality of the output process Describe the quality of health services Count the benefits of quality

5. What is quality? Quality is doing the right things right, first time

6. What is quality? In…. manufacturing, a measure of excellence or a state of being free from defects, deficiencies, and significant variations, brought about by the strict and consistent adherence to measurable and verifiable standards to achieve uniformity of output that satisfies specific customer or user requirements

7. Why? To ensure : The best possible outcome for patients. Satisfaction for all our many customers. Retentions of talented staff. Sound financial performance.

8. Quality in Health Care The proper performance ( according to standards) of interventions that are known to be safe, affordable to the society, and have the ability to produce an impact on morbidity, mortality, disability and malnutrition. WHO, 1988

9. Author/Organization ---Definition Donabedian (1980) ---Quality of care is the kind of care which is expected to maximize an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts. IOM (1990)--- Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Quality in Health Care

10. Author/Organization Definition Department of Health Care (UK) (1997) doing the right things (what) to the right people (to whom) at the right time (when) and doing things right first time. Council of Europe: Quality of care is the degree to which the treatment dispensed (1998) increases the patient’s chances of achieving the desired results and diminishes the chances of undesirable results, having regard to the current state of knowledge. WHO (2000) Quality of care is the level of attainment of health systems’ intrinsic goals for health improvement and responsiveness to legitimate expectations of the population. IOM: Institute of Medicine; WHO: World Health Organization.

11. Quality Principles Principle 1 : Customer focused Principle 2 : Leadership Principle 3 : Involvement of people Principle 4 : Process approach Principle 5 : System approach Principle 6 : Continuous improvement Principle 7 : Factual approach Principle 8 : M utually beneficial supplier relationship

12. Iron Triangle of Health Care Quality Cost Access

13. Dimensions of excellence to assess clinical performance Structure, process, outcome Quality Domains: effectiveness, responsiveness …. Quality of services versus quality of systems Health care helps individuals and populations to realize their potential health Quality relates to compliance of practices with evidence Quality relates to health outcomes attributed to services

14. Quality Indicators Tool to monitor and evaluate all processes Must be measurable, well defined, specific, objective and clearly related to an important aspect of care Indicators can measure quality, adequacy, accuracy, timeliness, effectiveness, customer satisfaction etc.

15. Cycle for quality HEALTH SYSTEM QUALITY QUALITY OF INDIVIDUAL INDIVIDUAL HEALTH CARE HEALTH CARE INFORMATION SUPERVISION/INFORMATION QUALITY OF A HEALTH CARE HEALTH CARE INSTITUTION/CENTRE INSTITUTION/CENTRE

16. MONITORING QUALITY PLANNING OR DESIGN QUALITY IMPROVEMENT CYCLES GROUPS OF ACTIVITIES FOR QUALITY IMPROVEMENT

17. Benefits of maintenance of quality Patient safety Reduction of medication errors Reductions in re-admission rates Reduction the occurrence of complications Provision of Evidence Based Care Maintain healthy community Productive society & country

18. Revision What is quality? How can we maintain quality in health care? What are principles of quality? Define Iron triangle of health care quality?