DR HANAN ABBBAS Assistant professor of family medicine

Excellence is never and accident. It is always the result of high intention, determined effort and skilled execution. Chinese Proverb

Reducing the population growth rate Improving the geographical distribution of the population Upgrading population characteristics Reducing the demographic, social, and economic gaps among population groups and different geographic

1. Family Planning and Reproductive Health 2. Child Health and Child Survival 3. Education and Illiteracy Elimination 4. Women Empowerment 5. Adolescent and Youth 6. Family Support and Protection 7. Information, Education and Communication 8. Environment Protection 9. Redistribution of Population 10. Decrease social and economic gaps 11. Information and Research Support

Application of quality improvement program at each of MOHP health unit so that services are delivered in accordance with standards of practice. This in addition to quarterly evaluation through supervisory teams at the governorate and district levels.

Quality of health care consists of proper performance according to standards of interventions that are safe, affordable to society and have the ability to produce impact on mortality, morbidity and disability .

Technical quality of care Non technical quality aspect of service 1. client waiting time 2. Provider attitude 3. Programmatic elements : policies, management, access ,infrastructure .

Safety and effectiveness Quality attract revenue Client satisfaction and longer continuation Wider use of services Job satisfaction for providers Better program reputation and competitiveness Expand access to services Raising clients expectations Behavior modeling

Providers think they know better for clients because they have more education, higher social class. They doubt clients ability to make wise choices therefore they control counseling session Ask question, giving directions and not encouraging client to participate

Providers dont learn enough about client situation to advice them well Client may not learn enough to make informed decisions and may simply agree to whatever the provider suggest. Good quality of service reduce clients fears, increase confidence in care, and generate loyalty to clinic.

Quality design :a planning process ,to define organizations mission (client, service), allocates resources, set standards Quality control :monitoring, supervision, and evaluation. Every worker, every work unit meets these standards. Quality improvement : increase quality and raise standards by solving problems and improving processes .

1-Identify area for improvement

2-Define problem boundaries

7-Monitor results

3-Establish desired outcome

6-Take corrective action

4-Select steps to study

5-Collect and analyze data

1-Client feedback: exit interviews, focus group discussions, satisfaction surveys, and suggestion boxes. 2- Clinical audits: Are a long-standing approach to ensuring quality of medical care. They are conducted by staff members. These audits critically review medical records.

3-Inspection and accreditation visits: accreditation and monitoring systems generally rely on supervisors or inspection teams who visit a service site and check an extensive list of indicators, they review the entire operation of a facility. Outside experts may not fully understand the local Situation or be able to gain the trust of staff, thus staff members may conceal problems from inspectors and reject their recommendations.

4-Peer review and individual self assessment: These techniques have proved to be both accurate measures of provider performance and effective forms of feedback that can substitute for outside supervision. 5- Situation Analysis and the Rapid evaluation Method

What are we trying to Accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement?

 Catch the bad apple Improve a persons performance Selected departments and elements of quality Shaped by accreditation requirements

CQI focuses on making an entire system's outcomes better by constantly adjusting and improving the system itself, instead of searching out getting rid of "bad apples".

 Prevention not inspection Improve system or process Meet regulations and customer expectations Organization-wide

What team will accomplish Teams mission Team membership Team meetings

 Provides a baseline - Where are we? Answers the question - Which changes result in improvements? Facilitates communication with other teams and leadership Reinforces the work of the team Builds senior leadership support Prepares the organization for spread

>> Choice of method; >> Information given to clients; >> Technical competence; >> Client/provider interaction; >> Mechanism to promote continuation of services; >> Appropriateness and acceptability of services; >> Access.

Number of contraceptive methods available at a specific Service Delivery Points Percentage of counseling sessions with new acceptors in which provider discusses all methods Percentage of client visits during which provider demonstrates skill at clinical procedures, including asepsis Percentage of clients reporting sufficient time with provider Percentage of clients informed of timing and sources for resupply/revisit Percentage of clients who perceive that hours/days are convenient

 Work as a complete team Dont try to accomplish too much in one cycle Tackle a basic process before the complex ones Keep process changes simple and easy to implement .