Professional Documents
Culture Documents
QualityAssuranceProgram Benchbook PDF
QualityAssuranceProgram Benchbook PDF
All rights reserved. No part of this book may be reproduced or used in any form or by any
means, electronic or mechanical, including photocopying, recording, scanning or by any
information storage or retrieval system, without permission in writing from the publisher.
Glossary............................................................................................................... 43
Preface
Philippine Health Insurance Corporation
ii
The provision of quality health care has always been in the agenda of
the Philippine Health Insurance Corporation.
iii
For starters, the writing of this Benchbook needed financial allies: the
AusAID, through the Philippines-Australia Governance Facility, and the
Deutsche Gesellschaft für Technische Zusammernarbeit (GTZ) GmbH.
These two foreign agencies provided the financial lifeline for the
initial writing of the draft and its final editing to make the Benchbook
publication ready. For their administrative support at the start of
the project, Ms. Christine McMahon and Mr. Carlos Mendoza, of the
Philippines-Australia Governance facility deserve our thanks. So do Dr.
Claude Bodart, health program manager; Dr. Matthew Jowett, advisor;
and Mr. Manolito Novales, senior technical coordinator, of the GTZ for
similar assistance in the completion of the Benchbook.
Mr. Karl Karol and Ms. Brenda Ballantyne of the Australian Health
Insurance Commission facilitated the participation of two of their
consultants, Dr. Denis Smith and Dr. Jose Acuin. These two doctors,
joined by Prof. Don Hindle, a PhilHealth consultant, assisted in the
creation of the PhilHealth Quality Standards, the conceptualization
of quality improvement in the context of the Philippine health
system. They also led the brainstorming for a new quality assurance
framework for PhilHealth. Dr. Acuin concretized everything in black
and white by producing the original manuscript. Dr. Hindle wrote
the PhilHealth drafts for the clinical pathways for Outpatient Cataract
Surgery and Low Risk Maternity Care featured in Part III of the
Benchbook.
iv
Arnold Aquino executed the cover design and most of the layouting.
His wife, Bituin Acebron-Aquino, assisted in the layout work and
proofreading.
Thanks are also in order for the entire QARPDG staff, for their assistance
in all forms.
May this Benchbook serve its purpose of improving the way health
care is delivered to every Filipino.
➠ Information Management
➠ Improving Performance
BENCHBOOK
2
Quality Standards
Philippine Health Insurance Corporation
One or more criteria flesh out the standard. ese criteria lay
down specific actions that need to be done to meet the standard.
ese actions, determined by the organizations themselves, should
reflect contemporary best practice principles, be achievable, easily
understood and measurable.
5
55
Human Resource
Management
2
A copy of the “World Medical Association Declaration on the Rights of the Patient” adopted by
the 34th World Medical Assembly in Lisbon in 1981 and amended during the same organization’s
47th General Assembly in Bali in 1995 can be found in Part IV (Appendix).
3
Informed consent is defined in the glossary. Johns Hopkins University professors Debra Roter
and Judith Hall’s work (1993) on the patient-doctor communication process, links it with issues
regarding informed consent. Also see the University of Washington School of Medicine’s website
discussion on bioethics.
BENCHBOOK
Criteria
• Policies and programs to educate patients and
families on how to take a more pro-active role
in health care decision making are documented,
monitored and evaluated for their effectiveness.
• Patients and their families are involved in making
care decisions with ethical issues4, such as
withholding resuscitation, foregoing life-sustaining
treatment, end of life care, etc.
Criteria
• Hospital staff is aware of and follows policies
and procedures in addressing patients’ needs for
confidentiality, privacy, security, counseling and
communication.
• e hospital systematically determines, monitors
and improves the extent to which patients’ needs
for confidentiality, privacy, security, counseling and
communication are addressed.
4
Examples of ethical issues may include, but are not limited to, insisting on giving blood transfusion to
a Jehovah’s witness patient who refuses transfusion but will most likely save his life in a critical case.
Quality Standards
Philippine Health Insurance Corporation
Criteria
• Policies and procedures for routinely determining
and improving the level of patient satisfaction with
all relevant aspects of care are documented and
monitored.
• Policies and procedures for addressing and resolving
patients’ complaints are documented and monitored.
Criteria
• e organization identifies relevant codes of
professional conduct and other statutory standards
and informs its personnel about these codes and
standards.
• e organization identifies and monitors personnel
compliance with the code of ethics relevant to their
respective disciplines.
• Procedures for resolving ethical issues related to
professional practice or to conflicts of interest are
based on the relevant code of ethics and other
professional and legal standards.
Criteria
• Procedures for resolving ethical issues that arise in
the course of providing care are monitored for their
effectiveness.
BENCHBOOK
STANDARDS
• feedback to patients
2.1 Access
Criteria
• Information detailing the clinical services offered
and hours of their availability is strategically5
distributed and prominently posted.
• Clinical services are appropriate to patients’ needs
and the former’s availability is consistent with the
organization’s service capability and role in the
community.
• e community is aware of clinical services offered
and times of availability.
Criteria
• Entrances and exits are clearly and prominently
marked, free of any obstruction and readily
accessible.
• Directional signs are prominently posted to help
locate service areas within the organization.
• Alternative passageways for patients with special
needs (e.g., ramps) are available, clearly and
prominently marked and free of any obstruction.
• Major service areas have nearby waiting facilities
that are clean, well-lit, adequately ventilated and
equipped with appropriate fixtures and furniture.
5
The following example distinguishes prominent from strategic: if a clinic is located far from the
main street, then the signage should be located at the street corner nearest the clinic. Otherwise
it would not be seen. That is strategic. Making the signage big enough to be seen from a block
away is prominent.
BENCHBOOK
10
2.2 Entry
Criteria
• Patient waiting times are routinely monitored,
evaluated and improved based on standards and
procedures developed by the organization. Depending
on their needs, patients are seen within the planned
waiting period.
• Patients are informed of the cause of any delay in the
delivery of services.
• Patients are satisfied with the actual waiting time.
Criteria
• e staff follows policies and procedures in
determining and prioritizing patients’ clinical needs
and in identifying clinical services that will best
address them.
• e staff follows policies and procedures in
determining admissibility of patients or the need for
referral to other organizations.
• Patients are correctly and efficiently assigned to the
clinical services appropriate to their needs.
Quality Standards
Philippine Health Insurance Corporation
11
Criteria
• All patients are correctly identified by their patient
charts.
• e patient charts contain identifiers unique to each
patient.
• Patient charts are appropriately and systematically
indexed to facilitate retrieval and storage and to
avoid duplication or loss.
Criteria
• Prior to admission, patients and/or their families
are appropriately informed by authorized qualified
personnel of their disease, condition or disability,
its severity, likely prognosis, benefits, and possible
adverse effects of various treatment options, and the
likely costs of treatment.
• Patients and/or their families demonstrate
knowledge of their disease, condition or disability,
its severity, likely prognosis, benefits, and possible
adverse effects of various treatment options, and the
likely costs of treatment.
Criteria
• Patients and/or their families are informed of the
expected (barring any complications) approximate
6
To uniquely identify a patient may mean making the patient number a lifetime number.
7
The organization itself determines the limits of who are authorized personnel in any given situation.
8
Doctors are not the only providers of care within the organization; hence health professional is
preferred to encompass a wider spectrum of health care providers.
BENCHBOOK
12
2.3 Assessment
13
Criteria
• During the course of management, qualified
personnel re-assess the patients’ physical and
psychological conditions according to the patient’s
needs.
• Re-assessment is done whenever the patients’
condition take an unexpected turn.
• Re-assessment results in a review of the patients’
management.
• Qualified personnel give patients for surgery pre-
operative physical and pre-anesthetic assessment.
• e status of post-operative patients is assessed
upon admission into, during confinement and upon
discharge from the recovery area.
Criteria
• Legible written records of the initial and ongoing
assessments are accomplished for each patient and
kept in the patient chart.11
• Medical records are stored in an area that is safe and
accessible to all members of the health care team,
and whenever appropriate, to external providers.12
11
Results of re-assessment may be documented as problem-oriented progress notes in SOAP
(subjective complaints/objective findings / assessment / plan) form for each patient and
kept in the medical record.
12
The term external providers includes, but is not limited to, other health care providers to
whom the patient is referred for continuity of care.
BENCHBOOK
14
Criteria
• Policies and procedures for the standard
performance, monitoring and quality control of
diagnostic examinations are documented and
monitored.
• Policies and procedures for accessing and referring
patients to approved external providers when
diagnostic services are not available within the
provider organization are documented and
monitored.
Criteria
• Policies and procedures identify patients with
special needs and the specific types of assessment
appropriate to their needs.13
13
Patients with special needs include infants, school-age children, adolescents, the elderly and the
disabled, victims of alleged or suspected sexual abuse or violence, patients with emotional or
behavioral disorders, patients with drug dependencies or alcoholism.
Quality Standards
Philippine Health Insurance Corporation
15
14
Clinical pathways derived from clinical practice guidelines and other types of clinical evidence
should be developed or implemented for the top 10 cases of admissions and / or consultations.
For more information, refer to Part III.
15
Problem oriented notes may take other forms aside from SOAP, such as SOAPIE, etc.
BENCHBOOK
16
GOAL Care is delivered to ensure the best possible outcomes for the
patient.
Criteria
• In the management of clinical pathway-covered
conditions, the order and timing of treatments follow
the pathway.
• Orders for treatments are implemented within time
intervals established by the organization.
• Referrals to other specialties are made according to
established pathways or guidelines.
• Results of referrals are communicated to relevant
members of the health care team and are considered
in the management.
Criteria
• Patients receive explanations on the nature of a test or
treatment, the need for it prior to administration, its
likely effects and side effects, and what patients can
do to cope with them.
• Patients’ wish to decline tests or treatments is respected.
Criteria
• Policies and procedures that determine the extent of
duplicate assessments and treatments performed by
trainees respect patients’ rights, and are documented
and monitored.
Quality Standards
Philippine Health Insurance Corporation
17
Criteria
• .e organization documents and implements
policies and procedures, and provides resources
to promote interactive, appropriate and relevant
educational programs for patients.
• Patients are aware of their roles and responsibilities
in their health care.
Criteria
• Drugs are administered in a timely, safe, appropriate
and controlled manner.16
• e provider organization documents and follows
policies and procedures and allocates resources
for the training, supervision and evaluation of
professionals who administer drugs.17
• Only qualified personnel order, prescribe, prepare,
dispense and administer drugs.
• Regular review of prescription orders is undertaken
by appropriately trained staff to ensure safe and
appropriate use of drugs.18
• Prescriptions or orders are verified and patients are
identified before medications are administered.
• Telephone orders are countersigned by the ordering
physicians not later than standards set by the
organization and based on statutory requirements.
• Discontinued or recalled drugs are retrieved and
safely disposed of according to established policies
and procedures.
16
The processes of administering drugs should be documented in flowcharts. See Part III (Flow
Chart) for more information.
17
The Generics Act, National Drug Policy and the PhilHealth “Positive” List of Reimbursable
Drugs are examples of these government policies.
18
This is to ensure that prescriptions are written correctly (e.g., in generic form), and that
precautions for drug-drug and drug-food interactions have been adequately addressed.
BENCHBOOK
18
Criteria
• Treatment procedures are performed in a timely, safe,
appropriate and controlled manner.19
• e provider organization documents and reviews
policies and procedures and allocates resources for the
training, supervision and evaluation of professionals
who perform procedures.
• Only qualified personnel order, plan, perform and
assist in performing procedures.
• Orders are verified, and patients are identified before
treatment procedures are performed.20
• Treatment procedures are legibly and accurately
documented in the patient chart by qualified
personnel.21
• Medical devices and equipment are used, maintained,
stored and disposed based on technical specifications.
• Medical devices and equipment are selected and
procured based on the organization’s case mix, staff
expertise, service capability and according to policies
and procedures that are consistent with scientific
evidence and government policies.
19
The processes of performing the most common treatment procedures should be documented
in flowcharts. See Part III (Flow Chart) for more information.
20
Armbanding may be one method for identifying patients for surgery. The actual operative site
may be marked indelibly beforehand.
21
Treatment records should document who did what to whom, when and for what indication.
An appropriately adequate description of the procedure and operative findings should be
included in the records.
Quality Standards
Philippine Health Insurance Corporation
19
22
There are many clinical tools that can be used to evaluate care, including medical audit,
utilization review, sentinel event monitoring and incident reporting. For more information on
how to conduct these routine assessments of care, refer to Part III.
BENCHBOOK
20
2.7 Discharge
GOAL Care is coordinated between the organization and other health care
providers in the community to ensure that the needs of the patient
are continuously met.
STANDARDS 2.7.1 e discharge plan is part of the patient’s care plan and
is documented in the patient chart.
23
Examples of other relevant community health services include, but are not limited to, rural health
units (RHU), Botika sa Barangay, etc.
Introduction
Philippine Health Insurance Corporation
21
2 Patient Care
ENTRY STANDARDS
ASSESSMENT STANDARDS
GOAL:
CARE PLANNING STANDARDS
The health care team develops in
• relevant to patients’ needs partnership with the patients a
• evidence-based care plan coordinated plan of care with goals.
• clear and accessible information
on care
BENCHBOOK
22
IMPLEMENTATION OF CARE
STANDARDS
• patient education
• standardized drug
administration
• standardized treatment
procedures
• discharge plan
GOAL:
• continuing management plan Care is coordinated between the
• patient access to community
organization and other health care
health services providers in the community to ensure
that the needs of the patient are
• patient understanding of continuously met.
discharge plan
Introduction
Philippine Health Insurance Corporation
23
24
The organization’s management team may consist of the hospital director or chief of
hospital or chief health officer together with the administrative officer and / or service
heads.
BENCHBOOK
24
Criteria
• e organization develops its mission, vision and
corporate goals based on agreed-upon values.
• e organization’s by-laws, policies and procedures
support care delivery and are consistent with its
goals, statutory requirements, accepted standards
and its community and regional responsibilities.
• Policies and procedures, aside from being complied
with, are reviewed and revised as necessary.
• e organization communicates its policies and
procedures to all levels of the workforce.25
25
Total quality management begins with commitment and tangible support from the
organization’s top leadership. Refer to the ”What is Quality of Care” section in Part 1 for a
discussion on its importance to the organization’s survival and on how it can be assessed and
improved. Also refer to Part III for step-by-step instructions on how to establish a total quality
management program.
Quality Standards
Philippine Health Insurance Corporation
25
3 Leadership and
Management
GOAL:
The organization is effectively and
THE MANAGEMENT TEAM STANDARDS
efficiently governed and managed
according to its values and goals
• leadership to ensure that care produces
the desire health outcomes, and
• effective working relationships is responsive to patients’ and
community needs.
• committee meetings
• management performance
assessment
26
Criteria
• Staff numbers and skill mix are based on actual
clinical needs.27
26
Those who are consulted include technical as well as medical consultants, such as engineers,
waste disposal experts, accountants, etc.
27
The hospital may document and analyze information, like daily patient loads, utilization rates of
services, turnaround times, to determine staff size and mix.
Quality Standards
Philippine Health Insurance Corporation
27
Criteria
• e organization defines, disseminates and ensures
compliance with policies and procedures governing
personnel recruitment, selection and appointments.
• e recruitment and selection process is open and
transparent, is consistent with legal and ethical
requirements, and allows a fair and unbiased
evaluation of the qualifications and competencies of
all applicants.
• Relevant staff members participate in the
development and implementation of personnel
recruitment, selection and appointment.
• Selection and appointment and evidence of staff
compliance with selection or appointment standards
are documented
• Relevant licenses are routinely monitored for renewal.
• Evidence of continuing staff education and training is
routinely monitored and assessed.
28
Staff in this context refers to employees, contractors and other service providers.
BENCHBOOK
28
Criteria
• Written job descriptions are given to and discussed
with all newly-appointed staff members.
4.2.3 Staff members are accountable for the care and services
they give and for the discharge of their delineated
responsibilities.29
Criteria
• e organization ensures that staff accountabilities
and responsibilities are consistent with their
qualifications, training, experience, registration and
licensure.
Criteria
• All doctors, nurses and midwives providing clinical
care have current licenses and documented evidence
of appropriate training and experience.
• All administrative, business and technical services
staff have current licenses and documented evidence
of appropriate training and experience.
29
Logbooks of procedures document the identities of the staff member who did the procedures. All
entries in the patient chart are legibly signed by the originators—those who wrote the entry in the
patient chart—and dated.
Quality Standards
Philippine Health Insurance Corporation
29
Criteria
• e organization assesses the educational needs of
management and staff and identifies and/or provides
resources to meet those needs.
• Policies and procedures for orientation of new
management and staff are documented and
monitored.
• e organization evaluates the effectiveness of
training and development programs to ensure that
they meet organizational, community and individual
needs.
Criteria
• New personnel—including trainees, volunteers, new
graduates and external contractors—are adequately
supervised by qualified staff.
• e staff are provided with a documented
job description outlining accountabilities and
responsibilities.
BENCHBOOK
30
4 Human Resource
Management GOAL:
The organization provides
the right number and mix of
HUMAN RESOURCES PLANNING competent staff to meet the
STANDARDS needs of its internal and external
customers and to achieve its goals.
• HR needs assessment
• workload monitoring
STAFF RECRUITMENT,
SELECTION, APPOINTMENT AND GOAL:
RESPONSIBILITIES STANDARDS Recruitment, selection and
appointment of staff comply with
• procedures
statutory requirements and are
• job descriptions consistent with the organization’s
human resource policies.
• staff accountabilities
• supervision
Introduction
Philippine Health Insurance Corporation
31
5. Information Management
GOAL Collection and aggregation of data are done for patient care,
management of services, education and research.
Criteria
• e organization defines the relevant aspects of its
operations from which data will be collected.
• e organization defines data sets, data generation,
collection and aggregation methods and the qualified
staff who are involved in each stage.
• e organization defines policies and procedures to
monitor and improve the accuracy, completeness and
reliability of relevant qualitative and quantitative data
relating to its operations.
• e organization provides resources and opportunities
to enable management and staff to use data in their
decision and policymaking activities.
• Policies and procedures on record storage, retention
and disposal are documented and monitored.
Criteria
• e organization collects and submits reports required
by the Department of Health and PhilHealth.
BENCHBOOK
32
Criteria
• Care providers document management details in the
patient chart. All entries are promptly accomplished,
accurate, legible, dated and duly signed by the care
providers whose designations are clearly indicated.30
Criteria
• Data from the patient charts are routinely
collected, aggregated and reported for use in quality
improvement activities, for administrative purposes
and for mandatory reporting to the Department of
Health and PhilHealth.
GOAL Integrity, safety, access and security of records are maintained and
statutory requirements are met.
30
Documentation in patient charts should be sufficiently detailed to enable any member of the
health care team to understand care plans and care provision. Clinical pathways are excellent
means to achieve this.
31
Data from patient charts are used in peer review, medical audits, variance analysis, quality
circle meetings, etc.
Introduction
Philippine Health Insurance Corporation
33
STANDARDS
Criteria
• When patients are admitted or are seen for ambulatory
or emergency care, patient charts documenting any
previous care can be quickly retrieved for review,
updating and concurrent use.
• e organization has policies and procedures, and
devotes resources, including infrastructure, to protect
records and patient charts against loss, destruction,
tampering and unauthorized access or use. Only
authorized individuals make entries in the patient chart.
5 Information Management
GOAL:
Collection and aggregation
DATA COLLECTION, AGGREGATION AND
USE STANDARDS
of data are done for patient
care, management of services,
• timely and efficient data education and research.
collection
• standardized information
34
GOAL Patients, staff and other individuals within the organization are
provided a safe, functional and effective environment of care.
Criteria
• e organizational environment complies with
structural standards and safety codes as prescribed
by law.32
• ere are management plans which address safety,
security, disposal and control of hazardous materials
and biological wastes, emergency and disaster
preparedness, fire safety, radiation safety and utility
systems.
• ere are management plans for the safe and
efficient use of medical equipment according to
specifications.
Criteria
• Policies and procedures that address safety, security,
control of hazardous materials and biological wastes,
emergency and disaster preparedness, fire safety,
radiation safety and utility systems are documented
and implemented.
32
The organization maintains current licenses and permits that ensure safe and effective
operations. Such permits include, but are not limited to, occupancy, electrical, plumbing,
radiation safety, fire safety, occupational safety, food storage and handling and waste disposal.
Introduction
Philippine Health Insurance Corporation
35
Criteria
• e effectiveness of safety procedures and devices are
routinely tested, monitored and improved.33
• An incident reporting system identifies potential
harms, evaluates causal and contributing factors for
the necessary corrective and preventive action.
33
Staff compliance with safety procedures, performance in emergency and fire drills, handling
and operation of medical devices are regularly assessed and monitored. Findings of routine
checks of equipment and facilities are documented and appropriately reported.
BENCHBOOK
36
34
System wide refers to the different processes making up the entire system.
Introduction
Philippine Health Insurance Corporation
37
Criteria
• e organization undertakes case finding and
identification of nosocomial infections.
• e organization takes steps to prevent and control
outbreaks of nosocomial infections.
Criteria
• ere are programs for prevention and treatment of
needlestick injuries, and policies and procedures for
the safe disposal of used needles are documented and
monitored.
• ere are programs for the prevention of transmission
of airborne infections, and risks from patients with
signs and symptoms suggestive of tuberculosis or
other communicable diseases are managed according
to established protocols.
38
Criteria
• Appropriate equipment and supplies that support
the organization’s role and level of service are
provided. Consideration is given to at least:
➠ the intended use
➠ cost benefits
➠ infection control
➠ safety
➠ waste creation and disposal
➠ storage
39
GOAL:
EQUIPMENT & SUPPLIES STANDARDS
The provision of equipment
• planning and acquisition of and supplies supports the
equipment and supplies
organization’s role.
• specialized equipment operated
by qualified staff
• safe reuse guidelines
GOAL:
ENERGY & WASTE MANAGEMENT
STANDARDS The organization demonstrates its
• standardized waste handling and commitment to environmental issues
disposal program by considering and implementing
• implementation of a waste disposal strategies to achieve environmental
program sustainability.
BENCHBOOK
40
7. Improving Performance
Criteria
• ere are resources available for developing or
adopting clinical practice guidelines.
• Clinical practice guidelines for the top 10 causes of
admissions and / or consultations and PhilHealth-
adopted guidelines are disseminated and monitored.
7.4 All service units and staff are responsible for, and
demonstrate involvement in, performance improvement
that results in better services for internal and external
clients.
35
Important processes of care include invasive and non-invasive surgical procedures, medication use, and
hospital admissions. Important outcomes include patient and staff satisfaction, lengths of stay, staff
views, and autopsy results.
Quality Standards
Philippine Health Insurance Corporation
41
7
GOAL:
Improving Performance
The organization continuously
and systematically improves its
STANDARDS
performance by invariably doing
the right thing the right way the
• organization-wide approach
first time and by meeting the
• collaboration in new processes needs of its internal and external
of care clients.
• management responsibility
• evaluation of quality
improvement program
• confidentiality of data
BENCHBOOK
42
Glossary
Philippine Health Insurance Corporation
43
Glossary
BENCHBOOK
44
Glossary
Philippine Health Insurance Corporation
45
Glossary
• Accreditation, initial
accreditation given to a health care provider applying for
the first time.
• Accreditation, renewal
accreditation given to a health care provider after the
expiration of a previous accreditation.
• Accreditation, provisional
accreditation granted to a health care provider applying
for renewal while compliance to standards/ requirements
set by the Corporation are being completed for a period
determined by the same.
• Accreditation, reinstatement
restoration of accreditation following a suspension of an
accreditation after compliance with the requirements,
conditions and corrections imposed by the Corporation.
• Re-accreditation
accreditation given to a health care provider following the
expiration or denial of a previous accreditation or
following a change of ownership or upgrading of
capability of institutional health care providers or
acquisition of specialty capabilities and skills by
professional health care providers.
Adverse events injury caused by medical management (and not necessarily the
disease process) that either caused death, prolonged
hospitalization or produced a disability at the time of discharge.
BENCHBOOK
46
Affinity diagram used to creatively generate a large number of ideas/issues and then
organize and summarize natural groupings among them to
understand the essence of a problem and its breakthrough solutions.
• Comparative method
standards are derived from comparison with other
performance rates of compliance to common performance
measures.
• Prescriptive method
standards are derived from medical literature and expert
opinions on what should be achieved.
Case mix the type and number of patient groups an organization serves.
Case payment payment based on the condition itself, and not on the specific
medical or surgical intervention used.
47
Check sheet used to systematically record and compile data from historical
sources, or observations as they happen, so that patterns and
trends can be clearly detected and shown.
Control chart line graph used to monitor, control and improve performance
over time by studying process variations and their causes.
Credentialing and privileging a process that matches the work that a practitioner wishes to
perform in a hospital with his or her demonstrated competence
and professional skill.
Criteria statements that lay down specific actions that need to be done to
meet a standard.
48
Environment of care surroundings or conditions under which the process of health care
provision occurs.
Evidence-based medicine the use of current best evidence in making medical decisions.
Expanded incident monitoring routine process of identification, processing, analysis and reporting of
deviations from expected or standard practice to prevent recurrence.
Force field analysis analysis tool used to identify the forces and factors in place that
support or work against the solution of an issue or problem so that
the positives can be reinforced and/or the negatives eliminated.
49
50
Health education any and all information that help patients make informed choices
about personal health, available health services, healthy lifestyles,
disease prevention and early detection of illness.
51
Matrix diagram diagram used to systematically identify, analyze and rate the
presence and strength of relationships between two sets of
information.
• Clinical audit
patient-focused audit process involving doctors, nurses and
other clinicians who comprise the clinical care team.
• Nursing audit
patient-focused audit process of nursing care.
Medical intervention any action of a health care professional aimed at providing life
saving action, relief of pain, prevention or mitigation of disability
using pharmacological, surgical or diagnostic modalities.
Medical review criteria Medical review criteria are statements used to assess specific
health care decisions, services and outcomes.
Meta-analysis the statistical synthesis of the results of several studies testing the
same relationship into a single outcome measure, thus increasing
the strength of the conclusion.
National Health Insurance the compulsory health insurance program of the government as
Program (NHIP) established in the National Health Insurance Act of 1995 (RA
7875) which shall provide universal health insurance coverage
and ensure affordable, acceptable, available and accessible health
care services for all citizens of the Philippines.
BENCHBOOK
52
Nominal group technique team brainstorming method used to quickly come to a consensus
on the relative importance of issues, problems or solutions by
combining individual rankings.
Outcome the effect of care on the health status of patients and populations
seen in less impairment of functions, less pain and suffering,
and/or less illness.
Outcomes assessment process of monitoring and review of end results of the health
service rendered by providers both from the standpoint of effects
on health and/or member satisfaction.
Outcome-based standard measure of the quality of care rendered based on the end-result of
health care provision, including the presence or absence of death,
disability, pain, dissatisfaction, or cure.
Pareto chart data analysis tool which combines analysis of the frequency of a
problem and analysis of its causes by identifying the most
influential cause or causes, also called the “vital few,” thereby
separating them from the “trivial many.”
Pathway review assessment or evaluation of the flow of care provision for a specific
condition.
53
Performance measure a standard used to assess the level of function of a task, activity or
program.
Philippine Health Insurance the corporation mandated by law to administer the National
Corporation (PHIC) Health Insurance Program
Philippine National Drug Formulary the essential drugs list for the Philippines prepared by the
National Drug Committee of the Department of Health in
consultation with experts and specialists from organized
professional medical societies, academe and the pharmaceutical
industry and which is updated every year.
Plan-Do-Check-Act cycle a systematic method for identifying areas for improvement, pilot
testing solutions, evaluating results, and institutionalizing long-
term solutions
Prescription drug a drug approved by the Bureau of Food and Drug and which can
only be dispensed through a prescription order from a duly
licensed physician.
Primary care the basic or general medical care sought by the patient for
treatment of the simpler and more common illnesses.
Problem-oriented progress notes records regarding the developments in a patient’s condition based
on the most recent assessment of difficulties encountered.
BENCHBOOK
54
Process denotes what is actually done to and for the patient in giving and
receiving care. It includes the patient’s activities in seeking care and
carrying it out, as well as the physician’s activities in making a
diagnosis and recommending or implementing treatment.
Process Decision Program Chart used for contingency planning after the identification of a possible
solution to a certain problem, wherein possible problems are
identified for each step of the proposed solution and reasonable
steps are listed as countermeasures.
Quality assurance a formal set of activities to review and ensure the quality of services
provided. It includes quality assessment and corrective actions to
remedy any deficiency identified in the quality of direct patient,
administrative and support services.
Quality health care optimum attainable outcome as a result of health care provision.
Radar chart data analysis tool which illustrates in one graph the size of the gaps
between a number of current organizational performance levels and
ideal performance levels.
Randomized control trial (RCT) an experimental study in which participants have equal
opportunity to be assigned to a treatment or control group.
55
Scatterplot diagram data analysis tool which shows whether or not two sets of
observations or data are related in a linear fashion.
“Swiss cheese” model a theory proposed by human factors engineering pioneer James
Reason, which states that errors happen in any organization
because there are “holes” in the system and when they “align”—
happening at a certain sequence or combination—they form a
trajectory which opens up opportunities for errors to happen.
56
Treatment procedure any method used to remove the symptoms and cause of a disease.
Tree diagram graphic tool used to organize tasks into increasing levels of detailed
actions that must or could be done to achieve stated goals.
Variance analysis data interpretation tool used to document and identify the most
common causes of deviation from routine care.
Warranties the guarantee that a health care provider applying for accreditation
agrees to abide by the provisions of the National Health Insurance
Law (RA 7875), its Implementing Rules and Regulations and all
PhilHealth Administrative Orders during its participation in the
National Health Insurance Program.