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