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QUALITY MANAGEMENT IN HEALTH CARE
University of Medicine and Pharmacy – Ho Chi Minh City
Le Thi Quynh Nhi
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1. Definition and concept of quality
2. Concept of patient safety
3. Some keywords
4. Questions to ask when addressing
quality
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DFINITION AND
CONCEPTS OF QUALITY
1
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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
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A few key words:• Products and services• Entreprises, users, clients
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« 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 .
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“Doing the right thing for the right person the first time.”
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• 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
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• 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
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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
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Accreditation
• External evaluation procedure giving
independent appreciation on quality of a
hospital or of one or several departments
in a hospital
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Concept of “Patient safety”
2
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“First do no harm.”Hippocratic Oath
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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
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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
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Dimensions of Quality
1. Effectiveness
2. Efficiency
3. Acceptability
4. Access
5. Equity
6. Relevance
(Maxwell)
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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
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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
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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
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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
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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.
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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.
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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.
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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
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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?
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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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