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QUALITY ASSURANCE PROJECT
What is Quality?
QUALITY ASSURANCE PROJECT
Dimensions of QualityEffectiveness
Efficiency
Technical Competence
Safety
Accessibility
Interpersonal Relations
Continuity
Amenities
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Perspectives on Quality
Client / Family Provider
Health CareAdministration& Management Community
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“The quality of technical care consists in the application of medical science and technology in a way that maximizes its benefits to health without correspondingly increasing its risks. The degree of quality is, therefore, the extent to which the care provided is expected to achieve the most favorable balance of risks and benefits.”
Definition of Quality
• Avedis Donabedian, M.D., 1980
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Definition of Quality
• ODI Consulting
“Doing the right thing, right, the first time. Doing it better the next time.”
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Definition of Quality
• M.I. Roemer and C. Montoya Aguilar, WHO, 1988
“...proper performance (according to standards) of interventions that are known to be safe, that are affordable to the society in question, and have the ability to produce an impact on mortality, morbidity, disability, and malnutrition.”
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“Quality is conformance to requirements or specifications.”
Definition of Quality
• Phil Crosby , 1979
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“Quality is compliance with standards.”
Definition of Quality
• QA Project Contract, 1997
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Quality Definitions
• Meet or exceed standards
• User “fit”
• User expectations
• Technical accuracy
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What is Quality Assurance?
QA, QI, QM, TQM, CQI
Alphabet Soup
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Components of a System
Inputs Processes Outcomes
Outputs Effects Impacts
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Quality Assurance System
INPUTS
•Client expectations
•Organizational structure
•Trained personnel
•Budget
•Standards
•Political support
•Organizational culture
PROCESSES
•Quality Design
•Planning for quality
•Setting standards
•Monitoring quality
•Supervision
•Quality Improvement
•Accreditation
OUTCOMES
•Staff performance monitored
•Compliance with standards
• Increased efficiency
•Culture of quality
• Increased access and utilization
•Satisfied clients
• Improved health outcomes
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SS
PS M
Q A
Problem Solving Monitoring
Standard Setting
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QD
QI QC
Q A
QualityImprovement
QualityControl
Quality Design
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Design
ControlImprove
Quality DesignOrganizational Restructuring
Process RedesignStandard Setting
Audit
Quality Assessment
Monitoring Systems
Supervision
Self Evaluation
Team-Based Problem Solving
Management Action
Feedback
Individual Action
Planning
Q?
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Definition of Quality Assurance
“Process of measuring quality, analyzing the deficiencies discovered, and taking action to improve performance followed by measuring quality again to determine whether improvement has been achieved. It is a systematic, cyclical activity using standards of measurement.”
• Dr. Heather Palmer, US expert in ambulatory care
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• Dr. Avedis Donabedian
“All the arrangements and activities that are meant to safeguard, maintain, and promote the quality of care.”
Definition of Quality Assurance
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• The Quality Assurance Project, 1993
“Quality Assurance is that set of activities that are carried out to set standards and to monitor and improve performance so that the care provided is as effective and as safe as possible.”
Definition of Quality Assurance
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• Drs. Ruelas and Frenk QA work in Mexico
“A systematic process for closing the gap between actual performance and desirable outcomes…”
Definition of Quality Assurance
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Definition of Quality Management
“...a systematic managerial transformation designed to address the needs and opportunities of all organizations as they try to cope with increasing change, complexity and tension within their environments.”
• Dr. Donald Berwick, Institute for Healthcare Improvement
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Definition of Quality Improvement
• Joint Commission on Accreditation of Healthcare Organizations
“…an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others. Synonyms and near synonyms include continuous quality improvement (CQI), continuous improvement, performance improvement, and total quality management. “
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Continuous Improvement
Act Plan
Study Do
Act Plan
StudyDo
Act Plan
Study Do
ActPlan
StudyDo
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Philip Crosby
• Quality is free - remove un-quality things, which are all the actions that involve not doing jobs right the first time
• People-focused interventions targeted at zero defects
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Deming’s 14 Points of Management
• Create constancy of purpose toward quality improvement
• Adopt a philosophy which expects good products and services
• Cease dependence on inspection and build quality into the product or service
• Don’t award business solely on the basis of price tag• Improve constantly the system of production and
service• Institute on-the-job training
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Deming’s 14 Points of Management (cont’d.)
• Institute leadership with an aim to help people and machines do better jobs
• Drive out fear• Break down barriers between departments• Eliminate slogans, exhortations and targets• Eliminate number quotas and management by
objective, substitute leadership• Remove barriers to pride of workmanship• Institute education and self-improvement• Take action to accomplish the transformation
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The Juran Trilogy®
Quality Planning
Quality ControlQuality Improvement
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Shewart Cycle
Plan
Do
Act
Check
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Principles of Managing Quality
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Systems/process focus
Leadership
Principles of Managing Quality
Team work
Data
Client focus
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Leaders and Quality
“In our experience, no quality improvement effort has ever been successful without top management’s involvement.”
J. M. Juran
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Specific Actions for Leaders
• Define the vision - communicate it and model its attainment
• Approve financial investment in improving quality
• Provide and approve time spent in quality pursuits
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Specific Actions for Leaders
• Require training and learning about quality - attend and present it yourself
• Reward quality - look for it, recognize it
• Tie reward systems to quality
• Serve on teams
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Specific Actions for Leaders
• Lead the quality effort
– communicate the plans for quality assessment and improvement
– approve specific improvement projects
– receive / request reports of QI efforts
– “walk the talk”
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Two Major Theories of Client Satisfaction With Health Care
Expectancy-value theory:
Satisfaction = Perceived care > Expectations of care
Exchange theory:
Satisfaction = Value of care > Cost of care
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“In God we trust
All others please bring data”
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“Every system is perfectly
designed to achieve
exactly the results it
achieves”
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Stages of Team Development
FormingForming
StormingStorming
NormingNorming
PerformingPerforming
ClosingClosing
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Components of a System
Inputs Processes Outcomes
Outputs Effects Impacts