PAHS 423

PRINCIPLES OF HEALTHCARE
QUALITY ASSURANCE
STUDY GUIDE
Session 6 – Healthcare Quality Assurance
Lecturer: Nana Nimo Appiah-Agyekum (PhD), UGBS
Contact Information: nnappiah-agyekum@ug.edu.gh

College of Education
School of Continuing and Distance Education
2014/2015 – 2016/2017
 Session Overview
Now that we know what healthcare quality is and how it
evolved, we will now focus Quality Assurance (QA). As an
essential component of healthcare delivery in Ghana, GHS
places a lot of emphasis on assuring the quality of services
and care provided.
At the end of the session, the student will be able to
• Explain the evolution of quality assurance
• Describe what QA means and how it enhances
healthcare
• Explain the operational principles and issues affecting QA
Slide 2
 Session Outline
The key topics to be covered in the session are as follows:
• Topic One : Defining healthcare quality assurance
• Topic Two : The rise of healthcare quality assurance
• Topic Three : Emphasizing quality assurance in healthcare

Slide 3
 Reading List
• Brown, L. D., Franco, L. M., Rafeh, N., & Hatzell, T. (1992). Quality
assurance of health care in developing countries. Quality assurance
project. http://pdf.usaid.gov/pdf_docs/PNABQ044.pdf
• Donaldson, M. S., Corrigan, J. M., & Kohn, L. T. (Eds.). (2000). To err is
human: building a safer health system (Vol. 6). National Academies
Press. https://www.ncbi.nlm.nih.gov/books/NBK221671/

Slide 4
Topic One

DEFINING QUALITY ASSURANCE

Slide 5
 What is healthcare QA?
• “The process of measuring quality, analyzing the
deficiencies discovered, and taking action to improve
performance followed by measuring quality again to
determine whether improvement has been achieved. It
is a systematic, cyclic activity using standards of
measurement” (Palmer, 1983).
• “a systematic approach for conveying the importance
of excellence to individuals and teams. It provides the
health team with tools that gauge current performance
levels and facilitate continuous improvement” (Brown,
Franco, Rafeh & Hatzell, 1992). Slide 6
 Other definitions?
• “a planned systematic approach for continuously
assessing, monitoring and improving the quality of
healthcare within available resources to meet
expectations of both providers and users” (GHS, 2005)
• “all the arrangements and activities that are meant to
safeguard, maintain, and promote the quality of care”
(Donabedian, 1980).
• “A set of activities that are carried out to set standards
and to monitor and improve performance so that the
care provided is as effective and as safe as possible”
(Brown et al, 1992) Slide 7
 Central issues in definitions
All the definitions provided assert that QA is
• a process: not an event
• a systematic ongoing activity
• a program: focuses on the attainment of intended
goals
• oriented toward improving performance
• Focused on using data (either implicitly or
explicitly)
• Often presented as cyclical steps
Slide 8
Topic Two

THE RISE OF HEALTHCARE QUALITY

ASSURANCE
Slide 9
 Roots of Quality assurance
• Ancient history – ‘eye for an eye’ philosophy, ref:
biblical times, pharaoh’s physicians in Egypt
• Florence Nightingale (circa 1855) – assessed and
improved quality of care in Army hospitals during
the Crimean war. Improved unsanitary conditions,
quality of care and reduced the length of stay and
death count by two-thirds.
• Ernest Amory Codman (circa 1912) – ‘end result
assessment’ of hospital care that resulted in a QA
process and causes of failuresSlide 10
 Further developments in QA
• American College of Surgeons (1918 –
 moved from Codman's exacting end-result
evaluation of a hospital's care to general standards
instead.
 Began voluntary accreditation program based on a
one-page set of minimum standards
• Paul A Lembcke (1950) –
emphasized the need for explicit and objective
measures of quality.
developed medical auditing by scientific methods.
Slide 11
 Modern day developments in QA (I)
• IOM’s report ‘To err is human: building a safer
health system’ in 1999.
It placed medical errors (either human or
systematic) among the top 10 causes of deaths
and pushed for implementing protocols, projects,
and legislation to address the errors.
Encouraged the use of specific outcome measures
as quality indicators for provided care.

Slide 12
 Modern day developments in QA (II)
• IOM’s report ‘Crossing the quality chasm’ of 2001
suggested that the necessary changes based on
the previous report should be translated into six
dimensions of health care:
Safety
Effectiveness
patient-centeredness
Timeliness
Efficiency
Equity
Slide 13
Topic Three

EMPHASIZING QUALITY
ASSURANCE IN HEALTHCARE
Slide 14
 Reasons for the growing emphasis quality
assurance in healthcare
• Pressure from pressure groups, civil society and the
general public on politicians, healthcare facilities,
professionals and regulators for better quality care.
• Knowledge that improvements in quality must come by
improving the efficiency and effectiveness of current
resources especially considering limited public funds
• The need for cost recovery, vis-à-vis the knowledge that
it will be difficult to charge for services without
improving quality
• The applicability of successful quality management
approaches by other sectors to the healthcare sector
 Tenets of Quality assurance
Quality Assurance
• is oriented toward meeting the needs and
expectations of the patient and the
community.
• focuses on systems and processes.
• uses data to analyze service delivery processes.
• encourages a team approach to problem
solving and quality improvement
Slide 16
Other key features of Quality assurance
• QA can be extremely broad and can include all
program management activities.
• QA can include everything from applied research to
comprehensive management assessments and
interventions.
• In practice, the scope of QA depends on the needs
and capacities of the health service organization.
• QA may be developed as a limited activity that is
integrated into the existing management system.
• QA may also be developed comprehensively as a
component of a general management improvement
effort or a total quality management system.
 Sample Question
• How would you define quality assurance in your own
words?
• What will be the key elements of your definition and
why?

Slide 18
 References
• Brown, L. D., Franco, L. M., Rafeh, N., & Hatzell, T. (1992). Quality
assurance of health care in developing countries. Quality assurance
project.
• Donaldson, M. S., Corrigan, J. M., & Kohn, L. T. (Eds.). (2000). To err is
human: building a safer health system (Vol. 6). National Academies
Press.
• IOM (2001) ‘Crossing the quality chasm: a new health system for the
21st century’, Committee on Quality of Health Care in America. xx.
Washington, D.C.: National Academy Press; 2001. p. 337.
• Palmer, R. H. (1983). Ambulatory health care evaluation: principles
and practice. American Hospital Association. Chicago. p. 139
• Donabedian, A. (1980). Explorations in quality assessment and
monitoring: the definition of quality and approaches to its
assessment. Ann Arbor, MI:Health Administration
Slide 19
Press. pp. 5-6