Prepared by
Miss / Walaa Gamal
Outlines: -
Introduction
Definition
Quality application
Why quality improvement
Importance of quality
Benefits of quality
Population indicators for improvement-
Model for improvement
Quality at public health
Difficulties in Quality Improvement Process
References
Introduction
Increasing the effectiveness and efficiency of the public health systems isimportant
to ensure health and well-being of the people. Quality improvement is based on an
understanding of the system in which we function, the complexity of dealing with
people, the variation of outcomes created by the system and the use of knowledge
to influence those outcomes. Quality improvement in public health is the use of a
deliberate and defined improvement process, such as Plan-Do Check-Act, which is
focused on activities that are responsive to community needs and improving
population health. QI refers to a continuous and ongoing effort to achieve
measurable improvements in the efficiency, effectiveness, performance,
accountability, outcomes, and other indicators of quality in services or processes
which achieve equity and improve the health of the community. When an
organization implements an effective QI program, the result can be a balance of
quality, efficiency, and profitability in its achievement of organizational goals.
Definition of Quality Improvement (QI):
Is an effective way to improve care for patients, residents and clients, and to
improve practice of staff. QI should be a continuous process and an integral part of
everyone’s work, regardless of role or position within the organization. OR is an
integrative process that links knowledge, structures, processes and outcomes to
enhance quality throughout an organization.
Three common applications of the term Quality:
Quality: Is a result of comparison between what was required and what was
provided. It is judged by the receiver not the provider.
Quality Control: set of procedures intended to ensure that a performed
service adheres to a defined set of quality criteria or meets the requirements. Is a
reactive process (Focus on identify and correct defects).
Quality Assurance: refers to the confirmation that specified requirements have
been met by a service such as setting out a Quality Management System. Is a
proactive process (Focus on prevention of defects)
Why QI?
QI can help answer key questions in public health:
Are we using our resources (staff, money, time) in the best way?
Are we “work smarter, not harder”
Are we getting the intended outcomes?
Importance of Quality Improvement:
Quality Improvement helps organization to achieve:
Client satisfaction
Efficient use of resources
Measurable outcomes
Community impact
Benefits of quality to clients:
Improved services
Improved choices
Expectations met
Friendlier atmosphere
Benefits of quality to workers:
Job satisfaction
Improved communications
Streamlined work processes
Increase motivation
Benefits of quality to the organization:
Improved/expanded services
overconfidence in services delivered
Improve reputation
Improved client and community relations
Lower costs and save efforts
Improved funding
Population Indicators for QI
Longer life span
Increased quality of life
Increased health equity
Less diseases
Less premature deaths
Healthier choices
Safer environment
Healthier homes
Quality improvement model
Defining the (Aim):
Every QI initiative needs a clearly defined aim. The aim should
answer the question, “What are we trying to accomplish?” It should
also have the following characteristics:(SMART)
S - Specific
M – Measurable
A - Achievable
R - Relevant
T- Time-based
Identifying the measures:
Measures tell you whether the changes you make are actually leading to tangible
improvement. They give you concrete evidence to support change.
Types of measures
QI initiatives should use three types of measures to help create targets and achieve
their aims:
• Outcome measures are the “voice of the patient or client” and capture system
performance. In other words, what are the results? Examples include infection
rates, wait times and falls rates.
• Process measures are the “voice of the workings of the system.” In other words,
are the steps in the processes that support the system performing as planned?
Examples include compliance rates, supply and demand and high-risk patient
intervention rates.
Defining the changes: what changes can we make that will result in improvement
Change ideas are specific changes that focus on improving specific steps of a
process. They are practical ideas that can be readily tested.
Change concepts are the broader principles that provide general direction for
planning improvements.
PDSA for Quality Improvement
PLAN Phase:
The purpose of the PLAN phase is to investigate the current situation (including
collection and examination of baseline data that help to describe the current state);
fully understand the nature or root cause of any problem to be solved and develop
potential solutions to the problem that will be tested.
DO Phase: The DO phase involves implementing the solutions or interventions
that were developed and collecting data along the way. This is the “testing” part of
the cycle.
CHECK Phase: Check (or study) entails comparing post-intervention data to the
baseline data to determine whether an improvement was achieved.
ACT Phase: The ACT phase marks the culmination of the planning, Testing and
analysis that determines whether the desired improvement was achieved. The
purpose is to act upon what has been learned, if intervention was successful,
adapting the intervention and retesting it, or abandoning this particular course and
returning to the plan phase.
Quality at public health practice
Quality is the result of Worthy Work Well Done
Worthy = we must have a clear direction (Strategic Plan)
Work = our work should have an intelligent direction based on evidence and best
practices.
Well done = our work should be carried out by a skilled and competent workforce
and measured to improve our performance.
Public Health Prioritization (Worthy)
Set priorities among health needs based on the size and seriousness of the
problems, and the acceptability, economic feasibility and effectiveness of
interventions. Effective Prioritization always
- Focuses on health problems that are the highest priority for the community.
- Selects strategies that are both effective and acceptable.
- Demonstrates that services delivered and works performed are of the highest
quality.
- Considers the expectations of our funders and stakeholders.
Evidence-based Public Health: “The process of integrating science-based
interventions with community preferences to improve the health of populations"
Difficulties in Pursuing a Quality Improvement Process Plan
Here are some of the common difficulties in following through with a QI plan:
Expectations are not clear.
There is insufficient time and resources to properly implement the initiative.
In healthcare settings, some physicians don’t implement new systems until they
have confidence in new processes.
There is an inadequate emphasis on the importance and use of new measures.
There is a poor level of collaboration between teams.
People underestimate the time required to implement a program.
Specific improvement cycles can’t be evaluated.
Costs can’t be evaluated.
Solving some problems creates additional problems.
Targets are overly ambitious and therefore difficult to achieve.
References: -
Advances in Quality Improvement: Principles and Framework. (2019); issue of
the Quality Assurance Project's QA Brief.
Chalice, R. (2011). Improving Healthcare Using Toyota Lean Production Methods:
Steps for Improvement. Milwaukee, WI: American Society for Quality Press.
Pande, PS., Neuman, RP., & Cavanagh, RR. (2018). The Six Sigma Way: How
GE, Motorola, and Other Top Companies Are Honing Their Performance. New
York, NY: McGraw Hill Books.
Performance Measurement: Accelerating Improvement (Pathways to Quality
Health Care Services) (2016) Board on Health Care Services (HCS). Blumenthal,
David and Kilo, Charles M. A Report Card on Continuous Quality Improvement.
Milbank Q 76: 625–648, 1998. [PMC free article] [PubMed]
The Institute of Medicine of the National Academics; http://www;
http://www.iom.edu/About IOM.aspx
Learning to make a difference: introducing quality improvement methods to core
medical trainees. Clin Med (Lond). 2012; 12: 520-525.
