2. What is Quality? Product Services Good Perfect Satisfactory
Punctual Robust Beautiful Error free
3. Quality Tea
Product Tea
Process Making tea
Customer Patient
Service FNB
Manufacturer Zesta
4. Quality? Producer or Provider User or Customer The totality
of features and characteristics of a product or service that bear
on its ability to satisfy stated or implied needs (ISO)
5. 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 of
care
6. Process
Step of action intended to achieve a results
History Exam Lab Diagnosis Treatment
7. Process variation Error (Sigma) 3.4 6 230 5 6210 4 66800 3
308,000 2 690,000 1 DPMO S
8. 1. Error of execution - the failure of a planned action to
be completed as intended 2. Error of planning - the use of a wrong
plan to achieve an aim Medical error
9. Medical Error
Harvard Medical Practice Study 84
3.7% of hospitalization resulted in some form of iatrogenic
event of these: 50% preventable, 13.6% fatal
1300.000 disability annually
180,000 death annually
Australian Study 95
16.6% admission adverse event
permanent disability 13.7%
Death 4.9%
51% events were preventable
Institute of Medicine Report 99
44,000 to 98,000 deaths annually due to medical errors
10. Nature of Adverse Events
Operative (47.7%)
Non-operative (52.3%)
medication-related (19.4%)
diagnostic mishap (8.1%)
therapeutic mishap (7.5%)
Patient suicide (16.7%),
Operative and post-operative complications (12.1%),
Medication errors (11.6%),
Wrong-site surgeries (11%),
Patient falls (5.1%)
Leape et al., NEJM 1991
JCAHO 2002
11. Medical error extent of problem
Less than one death per 100 000 encounters
Nuclear power
European railroads
Scheduled airlines
One death in less than 100 000 but more than 1000
encounters
October 1997 JCAHO Board decision to provide international
accreditation
Decision based on work in over 30 countries and consistent
requests form health care organizations to be evaluated against
JCAHO standards, viewed as the benchmark for hospitals
29. P ATIENT- C ENTERED S TANDARDS
Access to Care and Continuity of Care (ACC)
Patient and Family Rights (PFR)
Assessment of Patient (AOP)
Care of Patients (COP)
Patient and Family Education (PFE)
30. H EALTH C ARE O RGANIZATION M ANAGEMENT S TANDARDS (HCO)
Quality Management & Improvement (QMI)
Governance, Leadership & Direction (GLD)
Facility Management & Safety (FMS)
Staff Qualifications & Management (SQE)
Management of Information (MOI)
Prevention and Control of Infection (PCI)
31. A CCESS TO C ARE/ C ONTINUITY OF C ARE (ACC)
Goals:
Correctly match the patients health care needs with the
services available from health care organization.
Integrate and coordinate the services provided to the patient
in the organization.
Plan for discharge and follow-up.
Primary Processes:
Patient entry to organization
Determination and prioritize patient need
Connecting patient care inside organization
Reconnecting patient with community resources
32. P ATIENT AND F AMILY R IGHTS (PFR)
Goals:
Improve patient outcomes by:
Respecting patient rights
Understanding and safeguarding the cultural, psychosocial and
spiritual values of each patient.
Primary Process:
Identify patient and family expectations
Inform patients and family of rights
Obtain informed consent
Involve in care process
Provide ethical business framework
33. A SSESSMENT OF P ATIENTS (AOP)
Goals:
Determine care needs based on assessment
Assessment by qualified individual
Primary Processes:
Assess physical, psychological, social needs of patients -
financial factors
Provide timely laboratory and radiology services
Reassess patients appropriately
34. C ARE OF P ATIENTS (COP)
Goal:
Care is planned, coordinated and provided in a setting that is
supportive and responsive to the unique needs of each patient.
Primary Processes:
Plan and deliver uniform care to all patients - especially
frail and vulnerable
Make care seamless through effective communication
Provide safe anesthesia care
Provide safe surgical care
Use medications safely
Support patient nutrition need
35. P ATIENT AND F AMILY E DUCATION (PFE)
Goal:
Improve patient health outcomes by promoting healthy behaviors
and involving the patient in care and care decisions.
Primary Processes:
Support Patient and family participation in care process
Provide effective education
Use education resources efficiently
36. Q UALITY M ANAGEMENT AND I MPROVEMENT (QMI)
Goal:
Continuously improve patient health outcomes:
Design
Measure
Assess
Improve
Primary Processes:
Provide leadership for quality
Monitor clinical and managerial processes and outcomes
Provide collaborative leadership of the organization
Provide responsible leadership at department and service
level
38. F ACILITY M ANAGEMENT & S AFETY (FMS)
Goal:
Provide a safe, functional and supportive facility for
patients, families, staff members and visitors to:
Reduce and control hazards and risks
Prevent accidents and injuries
Maintain safe conditions
Primary Processes:
Understand facility risks and plan to reduce the risks
Inspect, test, and maintain medical equipment
Inspect, test, and maintain utility systems
Educate staff to participate in risks reduction
39. S TAFF Q UALIFICATIONS & E DUCATION (SQE)
Goal:
An appropriate number of qualified people are available to
fulfill the health care organizations mission and meet the needs of
the patients it serves.
Primary Processes:
Plan the number and types of staff
Orient and educate everyone to their responsibilities
Gather, verify, evaluate, and use medical/dental
credentials
Gather, verify, evaluate, and use nursing credentials
Gather, verify, evaluate, and use other professional
credentials
40. M ANAGEMENT OF I NFORMATION (MOI)
Goal:
To obtain, manage and use information to improve:
Patient outcomes
Individual and overall organization performance
Primary Processes:
Identify information needs
Plan system to meet those needs
Create and use an effective patient clinical record
Combine and compare data and information
41. P REVENTION AND C ONTROL OF I NFECTIONS (PCI)
Goal:
To identify and reduce the risks of acquiring and transmitting
infections among patients, employees, doctors, contract workers,
volunteers, students and visitors.
Primary Processes:
Understand infection risks in entire organization
Plan and implement surveillance and prevention strategies
Provide effective leadership and support
42. WHAT HOW ACCREDITATION ISO
43. Capability Maturity Model (CMM) 1- Initial Ad hoc, chaotic
2- Repeatable tack cost, schedule, function 3 Defined Documented,
standardized 4 Managed 5 - Optimized
44. Hippocratic oath
I swear to practice Quality Medicine to fulfill, to the best of
my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those
physicians in whose steps I walk, and gladly share such knowledge
as is mine with those who are to follow. I will apply, for the
benefit of the sick, all measures which are required, avoiding
those twin traps of overtreatment and therapeutic nihilism. I will
remember that there is art to medicine as well as science, and that
warmth, sympathy, and understanding may outweigh the surgeon's
knife or the chemist's drug. I will not be ashamed to say "I know
not," nor will I fail to call in my colleagues when the skills of
another are needed for a patient's recovery. I will respect the
privacy of my patients, for their problems are not disclosed to me
that the world may know. Most especially must I tread with care in
matters of life and death. If it is given me to save a life, all
thanks. But it may also be within my power to take a life; this
awesome responsibility must be faced with great humbleness and
awareness of my own frailty. Above all, I must not play at God. I
will remember that I do not treat a fever chart, a cancerous
growth, but a sick human being, whose illness may affect the
person's family and economic stability. My responsibility includes
these related problems, if I am to care adequately for the sick. I
will prevent disease whenever I can, for prevention is preferable
to cure. I will remember that I remain a member of society, with
special obligations to all my fellow human beings, those sound of
mind and body as well as the infirm. If I do not violate this oath,
may I enjoy life and art, respected while I live and remembered
with affection thereafter. May I always act so as to preserve the
finest traditions of my calling and may I long experience the joy
of healing those who seek my help.
