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VIDEO PRESENTATION ON THE TOPIC

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AUDIO PRESENTATION ON THE TOPIC

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TEXT PRESENTATION ON THE TOPIC

Theme: quality management in healthcare-module 1

Lesson: Quality Improvement in the Context of a Dynamic Healthcare Sector

Topic: introduction to quality

Facilitator: Dr. Ernest K. Asiedu

Section objectives

• 1. Understand the global history and evolution of quality and Ghana’s quality healthcare journey.
  • a. We will be able to define quality and quality healthcare and what it means to different stake holders including health professionals, clients, non-clients, the policy makers etc. and we establish why we focus on quality healthcare and why we cannot do it any time than now.

Introduction

Quality is a familiar term, and most people identify with it all the time. This term comes to play when we have to buy gadgets, we think of durability and something we call quality e.g. When we buy a vehicle, we look out for quality. If we buy any equipment within the health space, we also look out for something quality.

What is quality?

From the diagram above, we can see some definitions of quality.

1. Quality is the standard of something as measured against other things of similar kind. E.g., if you want to buy a phone, you look for an opportunity to compare.
2. Quality is the extent to which a product or service satisfies a person or a group (i.e., how much satisfaction the person gets from the service). So we are drifting in the direction of saying quality lies in the eyes of the beholder or quality is the perspective of the judgement of a person who is going for the product.

Looking on the extreme right of the diagram, we will see some of the words used to describe quality e.g. beautiful, attractive, durable, meet the standards, healthy and has value for money.

In a different context, if a person buys food or fruit, we may use terms such as healthy, organic, has value for money.

When it’s about healthcare, we see terms such as

• 1. The environment is beautiful,
• 2. Clean,
• 3. The people working there are nice (smiles at you)
• 4. Respectful

Quality through the lens of GESI and UHC

looking at quality in the lens of Gender Equality and Social Inclusion (GESI) as far as Universal Health Coverage (UHC).

Quality and standard are based on different/individual needs which varies from person to person with different needs. i.e.

• 1. What does quality care mean to men, women, girls, boys?
• 2. What does quality mean to persons with various types of disabilities?
• 3. How can the quality of care be defined and delivered from a human centered approach.

What is quality?

1. Meeting the needs and exceeding the expectations of the people we serve by the absence of waste and continual removal of cost that add no value to the people we serve (institute for healthcare improvement)
2. Doing the right thing, at the right time for the right person, and having the best possible result (agency of healthcare research and quantity) to the extent that patient always know that they might not always be cured but they do not expect that they will be harmed when seeking healthcare.
3. Doing it right when no one is looking (Henry Ford). This is one of the most critical parts of the health quality journey within the health system. For instance, if we were aware that the Minister of Health was coming to access services, people will put their best and so henry ford defined quality as doing the right thing when no one is looking.
4. Beauty lies in the eyes of the beholder and behind every set of eyes there is a different world (Jack Mauldin). So, we need to open for the consumer to tell us what quality means to them.

The graph above is a typical bell-shaped graph that represents any normal distribution curve. We do know that some patients will come to hospital without any problem, some will come with severe conditions, and few will come to hospital with general conditions. This tells us that there will be some minimal standard that every institution should meet. So, within the health space, there is some minimal standard.

The first graph looks at a normal distribution curve that typically with extreme left shows the frequency on the y axis which is the numbers. And on the right is x axis where We have the level of quality we want to see. So if people had come to the hospital we would have said that the minimal standard that will show that that hospital is quality is responses patients receive from prescribers. e.g., smiles, care, patient examination etc. anything above that we can say that it is quality. But ultimately there will be some services that may be considered by the consumer as of high quality, but the line “r” tells what the minimum standard is supposed to be, above which is the acceptable traditional quality assurance.

when you move on to continuous quality improvement in the second graph you shall see that the minimal is way exceeded which describe one of the definitions of quality i.e., exceeding the expectation of the consumer so the level of quality in the second graph have been moved exceeding above the expectation.

Quality planning

Quality planning is an aspect of total quality management which is looking at;

• 1. Setting aims
  • Coming up with leadership
  • Governance related issues
• 2. Selecting the improvements project, we even want to run

Quality planning looks at quality in the lens of 3 different ways;

• 1. Quality control
• 2. Quality assurance
• 3. Quality improvement

Quality control: defined as regulatory process through which we measure actual quality performance and compare it with the quality goals and ultimately act on the difference (Juran 1988).

Juran define the control as;

• 1. Units of measurement e.g., hours spent, fuel efficiency, no. of errors, hours spent by NHIS member to register for a card, patient to seek healthcare etc. people can renew their card on the phone reducing the time spent.
• 2. Specific measurement (x no. of errors)
• 3. Standard of performance (against which to measure any deviations)

Quality improvement (QI): Is the organized creation of beneficial change; the attainment of unprecedented levels of performance (Gibbons 1994) where the unprecedented signifies something that has not been seen before.

The improvement talks about;

• 1. Prove of need for improvement
• 2. Identify the specific projects that we want to work in
• 3. Select the appropriate project team because you can’t do it alone.
• 4. The charter for the project team activities
• 5. Providing recognition for the team
• 6. Track and follow-up to sustain improvement, which also means monitoring and extended ones become evaluation.

Juran puts all together and called it trilogy as shown in diagram below

The first part of the diagram i.e. A which looks at quality planning typically focusing on leadership, governance etc. So, the cost of poor quality i.e., if you do not provide high quality then the negative impact that the institution is likely to suffer.

Then in the middle portion B where we look at the controls i.e., the original zone of quality control. If its in terms of how long people might stay out there for the service i,e., days, hours people might stay to be registered for the NHIS card for example.

There are instances that there could be sporadic spikes due to uncontrollable circumstances like network challenges delaying the registration process’.

But with quality improvement, we can move from one level of performance to another level as shown in section C and if you are looking at time, there will be new zone of quality control that now can minimize and allow new opportunity for prediction. So, we know that with innovations like mobile renewal by NHIS, hospital management systems etc., service time can be predicted like within five minute one can renewal card, patient history record can be pulled in minutes.

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RESOURCE MATERIAL

Ghana National Quality Strategy (2016 – 2017)

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