quality management in health care - nhi
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QUALITY MANAGEMENT IN HEALTH CARE
University of Medicine and Pharmacy – Ho Chi Minh City
Le Thi Quynh Nhi
1. Definition and concept of quality
2. Concept of patient safety
3. Some keywords
4. Questions to ask when addressing
quality
DFINITION AND
CONCEPTS OF QUALITY
1
QUALITY
• Quality is the totality of features and characteristics of a product or
service that bears its ability to satisfy stated or implied needs (ISO
8402)
– Measurable
– Satisfaction is the target
– Expressed or implicit needs
• Quality reflects qualification and method
A few key words:• Products and services• Entreprises, users, clients
« good and bad apples »?
• Triage : a posteriori control
• Control/selection : along the process
• Prevention : doing right at first time
Doing the right thing for the right person the first time
D Berwick .
“Doing the right thing for the right person the first time.”
• Quality control (QC)
– a posteriori verification of product conformity
• Quality assurance (QA)
– Set of activities allowing to detect defaults along the
production process and to implement a priori correction
• quality system
• certification
Steps to implement and develop quality
• Quality management (QM)
– Continuous improvement of quality: the objective is to
improve customer satisfaction, progressively centered
on processes
• Total quality management (TQM)
– an integrative philosophy of management for
continuously improving the quality of products and
processes.
Steps to implement and develop quality
Certification
• Declaration by a qualified authority or organism
that a product, an organism or a person
satisfied predefined criteria
– specification of a product
– quality assurance of products
– Acknowledgment and promotion/marketing tool
– ISO norms
Accreditation
• External evaluation procedure giving
independent appreciation on quality of a
hospital or of one or several departments
in a hospital
Concept of “Patient safety”
2
“First do no harm.”Hippocratic Oath
Major application in hospital:
Risk management
Quality organisation should balance
Quality of service to customer, user, patients
Performance of an organisation, a system
Quality of life at work
Some keywords
• Adverse Event (Biến cố bất lợi)
• Medical Injury (chấn thương y khoa)
• Preventable Adverse Event (Biến cố bất lợi phòng ngừa được)
• Medical Errors (Sai sót y khoa)
• Negligence (Bất cẩn)
• Malpractice (Bất cẩn chuyên môn)
• Medical Mistakes (sai lầm y khoa)
• Slip (sơ suất); lapse (sơ suất kín đáo)
3
Dimensions of Quality
1. Effectiveness
2. Efficiency
3. Acceptability
4. Access
5. Equity
6. Relevance
(Maxwell)
Questions to ask when addressing “quality”
• Why measuring quality?
• What do you actually plan to measure?
• Who are you planning to involve in this whole process?
• Which aspects of quality are you planning to address?
• Whose perspective are you going to consider most?
• Which approch are you planning to use?
• Which dimension: structure, process or outcome?
4
Actions to improve quality of care
• Redaction of references
• Animation of working groups
• Department rounds meetings
• Conducting survey
• Following indicators
• Clinical audit
D Bertrand. Santé publique 1997;9:425-436
What quality is:
• Quality is for products, services
• Quality assurance is for the production processes
– Documentation fixes the references
– Audit of organisation ensures that referenced processes
are in place
– Piloting the correct production according to specification
– Reducing variability, departure from standards
What quality is not:… but is close to
• Security and safety
– Spatial travels, then airplanes flights, nuclear industry
– Availability, reliability, security
• Environmental protection
– Technical (toxicology)
– Management (ISO 14000)
• Ex: products at risk in hospital
• Sustainable development
– Integrating quality, security, environmental approaches
Health services sector
• Requirements for quality management have to be
interpreted differently than for industry and other types
of business:
– Reason 1: Health services are characterised by physical and
mental involvement of the patient in the process of care
provision. Provision of care is based on a continuous
interaction between health care professionals (provider) and
customers.
Health services sector
• Requirements for quality management have to be
interpreted differently than for industry and other types of
business:
– Reason 2: Customer may have little knowledge of the professional
aspects of the service delivered. The relationship between the
patient and the professional is an unequal one considering the
professional input; choices will be highly influenced by the
professional.
Health services sector
• Requirements for quality management have to be
interpreted differently than for industry and other types
of business:
– Reason 3: Commonly, purchase and receipt of health services
are separated (so called “Third party payment”). Provider may
have to satisfy different quality demands from its two main
customers: the patient and the purchaser.
Discussion
• JADE study on adverse drug events
(ADE) in Japan
• Morimoto T et al. Incidence of Adverse
Drug Events and Medication Errors in
Japan: the JADE Study, J Gen Intern Med
26(2):148–53
Q1: What was the rationale?
Q2: What was the type of the study?
Q3: What were the inclusion criteria?
Q4: Can you criticize the exclusion criteria?
Q5: What was the definition of cases?
Q6: What was the statistical unit for analysis?
Q7: What are the observed incidence rates of ADEs?
Q8: What are the most important risk factors identified for ADE ?
Q9: How do these data help for further plan to improve quality?
Acknowledgement
• Prof. F. Gullimen, Ecole de Santé Publique
- Nancy
• Assoc. Prof. Do Van Dung, UMP
• MD. Phan Thi Ngoc Linh, FV hospital
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