QUALITY ASSURANCE

MED ICAL MAN AGEMEN T D IV IS ION

FACULT Y OF MED ICIN E, UN IV ERS ITAS IN D ON ES IA
OUTLINE
1. DEFINITION OF QUALITY ASSURANCE (QA)
2. SYSTEM MODEL
3. ACTIVITY OF QA
4. STEPS OF QA
5. CONCLUSION
DEFINITION OF QUALITY
“Product meets customer needs leading to customer
satisfaction”

- Joseph Juran -
DEFINITION OF QUALITY
“Conformance to requirements, not as ‘goodness’
or ‘elegance’ “

- Philip Crosby -
DEFINITION OF QUALITY ASSURANCE

Quality assurance is a judgement concerning the process

of care based on the extent to which that care contributes
to valued outcomes

- Donabedian-
DEFINISI QUALITY ASSURANCE

“ All those planned and systematic actions necessary to

provide adequate confidence that a product and service
will satisfy given requirement for quality.”
- International Standard Organization (ISO) -
 DEFINITION OF QUALITY ASSURANCE

“Suatu program berlanjut yang disusun secara objektif dan

sistematis dalam memantau dan menilai mutu dan kewajaran
pelayanan, menggunakan berbagai peluang yang tersedia untuk
meningkatkan pelayanan yang diselenggarakan serta
menyelesaikan berbagai masalah yang ditemukan”

- Joint Commission on Acreditation of Hospitals, 1988 -

 DEFINITION OF QUALITY ASSURANCE

Suatu upaya yang berkesinambungan, sistematis, objektif dan

terpadu dalam menetapkan masalah dan penyebab masalah
mutu pelayanan berdasarkan standar yang telah ditetapkan dan
melaksanakan cara penyelesaian masalah sesuai dengan
kemampuan yang tersedia, serta menilai hasil yang dicapai dan
menyusun saran tindak lanjut untuk lebih meningkatkan mutu
pelayanan.
 QUALITY IMPROVEMENT
Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?

Act Plan

Study Do

Source: Langley et al, The Improvement Guide: A Practical Approach to Enhancing Organizational Performance,
Jossey Bass, 2nd Edition, 2009, p.10
 QUALITY ASSURANCE VS QUALITY
IMPROVEMENT

Act Plan

Study Do

A P

TA S D
DA
D S
PA
Figure 1 Criterion-based audit cycle. Step 1, establish A
standards of best practice; Step 2, measure the current S P
practice; Step 3, compare the current practice with stan- D
dards of best practice; Step 4, make and implement
recommendations to fill the gaps between current prac-
Kongnyuy EJ, Broek Nvd. Criteria for clinical audit of women
A P
tice and best practice; Step 5, re-evaluate the recom-
friendly care and providers' perception in Malawi. BMC
mendations implemented and, where necessary, refine S D
Pregnancy and Childbirth 2008, 8:28
practice.
 FACTORS AFFECTING QUALITY:

According to Moenir (2002):

­ Awareness of staff, especially they who are involved in the

direct service

­ Regulation, as basis of health service

­ Organization, as a tool and also system to manage the service

­ Skills of the staff

­ Facilities
 8 DIMENSION OF SERVICE QUALITY
1. Technical competence
2. Access to service
3. Effectiveness
4. Efficiency
5. Continuity
6. Safety
7. Interpersonal relations
8. Amenities
QUALITY ASPECTS

1. Clinical
2. Efficiency
3. Patient’s safety
4. Patient’s satisfaction
 A. Indikator Klinis: B. Indikator aspek efisiensi dan
efektifitas
1) salah diagnosa;
1. Masalah pemakaian obat
2) infeksi pasca tindakan;
2. Masalah teknis dengan alat medis.
3) kematian karena salah obat;
3. Masalah dengan sumber daya manusia
4) reaksi obat;
4. Prosedur administrasi yang rumit.

C. Indikator aspek D. Indikator aspek kepuasan pasien

keselamatan pasien: 1. Jumlah keluhan dari pasien atau
1) pasien terjatuh dari tempat keluarga.
pemeriksaan; 2. Hasil survei tentang derajat kepuasan
2) pasien terjatuh dikamar pasien.
mandi, toilet, dsb; 3. Kritik dalam kolom surat pembaca koran.
3) pasien diberi obat yang 4. Pengaduan mal praktek.
salah; 5. Laporan dari staf medik dan perawatan
4) infeksi nosokamial;
FACTORS AFFECTING HEALTH SERVICES

1. New knowledge and technology

2. Community value
3. Legal aspect and ethics
4. Economy
5. Politics
QUALITY CAN BE ACHIEVED WITH REGARDS TO THE
FOLLOWING:
1. Focusing to customers
2. Obsession to quality
3. Scientific approach
4. Long term commitment
5. Team work
6. Continuous system improvement
7. Education and training
 GOOD HEALTH SERVICE

1. Available and accessible

2. Accurate (based on the needs)
3. Efficient (resources)
4. Standardized (profession standards and ethics)
5. Reasonable and safe
6. Satisfying for patients
 MODEL OF QUALITY SYSTEM
LINGKUNGAN
Internal & Eksternal

MUTU MUTU MUTU MUTU MUTU

Input Proses Output Outcome Impact

-Dampak jangka -Dampak jangka

-Jumlah, besarnya -Relevan tidaknya -Hasil segera panjang.
input. proses bagi setelah proses pendek.
pelanggan. -Mutu kepuasan -Keuntungan.
-Kewajaran- -Produk barang &
kewajaran mutu. -Fleksibel dan jasa. pelanggan. -Pelanggan tetap.
efektifitas.
-Mutu proses itu
sendiri.

Gambar. Model Sistem Mutu (Wijono, 1999)

QA ACTIVITIES

qLicensing
qCertification
qStandardization
qAccreditation
qQuality Assessment
qProblem Solving Cycle
OBJECTIVES OF QA
üTo improve the service quality and patient’s satisfaction
üTo prioritize health services that requires continuous
quality improvement
üTo produce solutions for problems required
fundamental/basic management
üTo develop a success organization through quality
service improvement
PROBLEM SOLVING CYCLE
Analisis
Situasi Identifikasi
Evaluasi Masalah

Prioritas
Masalah
Pelaksanaan
Problem
Solving Penyebab
Cycle Masalah
Prioritas
Alternatif
Pemecahan Prioritas
Masalah Penyebab
Alternatif Masalah
Pemecahan
Masalah
STEPS OF QA
1. Problem identification
2. Setting priority of the problem
3. Identifying the root of cause
4. Identifying alternatives of problem solutions
5. Setting priority of solutions
6. Planning and conducting intervention
7. Doing evaluation of the intervention
8. Doing analysis
METHODS TO PRIORITIZE

Scoring and non-scoring technique

q Nominal Group Technique (NGT)

q Multivoting
q Hanlon technique
q Decision matrix
q Pareto chart
METHODS FOR IDENTIFYING THE ROOT
OF CAUSE
METHODS TO SET PRIORITY OF SOLUTIONS

There are variations of methods

q Nominal Group Technique (NGT),

Multivoting, Decision Matrix, Pareto
Chart
q Not Hanlon technique!
DOING INTERVENTION

5W1H methods
q WHY à why it has to be done?
q WHAT à what has to be done?
q WHERE à where will it be done?
q WHEN à when will it be done?
q WHO à who is going to do the intervention?
q HOW à How to do the intervention?
EVALUATION & ANALYSIS

q Evaluating intervention results

q Analysis to compare pre and post-intervention à any

improvement?
CONCLUSION

Quality assurance is a method to improve the service

quality through a systematic approach based on problem
solving cycle.
THANK YOU