GROUP MEMBERS

1. A. MUSFIRA SEU/IS/09/MG/093

2. AH. MULAFARA SEU/IS/09/MG/094

3. AF. NUSKIYA SEU/IS/09/MG/095

4. AF. SIFNA SEU/IS/09/MG/096

 CONTANTS

 What is service quality?

 Dimension of service quality.

 How to improve the health service quality to achieve the competitive

advantage.

 The important to focus on quality in health service.

 Six dimensions of quality that want to improve in health service.

 The process of implementing quality of health service.

 How to improve the quality of health service?

 Health information technology (hit)

 References
Improving quality is one important way to maintain a

competitive position in today’s market. Explain with

an example of service organization.

 What is service quality?
Service quality is a comparison of expectations with performance. A
business with high service quality will meet customer needs whilst
remaining economically competitive. Improved service quality may increase
economic competitiveness.

This aim may be achieved by understanding and improving operational

processes; identifying problems quickly and systematically; establishing
valid and reliable service performance measures and measuring customer
satisfaction and other performance outcomes.

Dimensions of service quality

Competence is the possession of the required skills and knowledge to

perform the service. For example, there may be competence in the
knowledge and skill of contact personnel, knowledge and skill of operational
support personnel and research capabilities of the organization.

Courtesy is the consideration for the customer's property and a clean and
neat appearance of contact personnel, manifesting as politeness, respect,
and friendliness.

Credibilityis the factors such as trustworthiness, belief and honesty. It

involves having the customer's best interests at prime position. It may be
influenced by company name, company reputation and the personal
characteristics of the contact personnel.

Security is the customer feeling free from danger, risk or doubt including
physical safety, financial security and confidentiality.
 How to improve the health service quality to achieve the
competitive advantage

Introduction

Public Health as a domain is a massive complex mixture of professionals and

organizations that work together to achieve the mission of ensuring the
nation’s health. The mission can only be achieved when the population
based information is made available at the fingertips of healthcare
professionals, administrators, managers, governmental, non-governmental
agencies and other contributing to improve the health of the community.

The important to focus on quality in health service

A wealth of knowledge and experience in enhancing the quality of health

care has accumulated globally over many decades. In spite of this wealth of
experience, the problem frequently faced by policy-makers at country level
in both high- and low-middle-income countries is to know which quality
strategies – complemented by and integrated with existent strategic
initiatives – would have the greatest impact on the outcomes delivered by
their health systems. This guide promotes a focus on quality in health
systems, and provides decision makers and planners with an opportunity to
make informed strategic choices to advance quality improvement.
 Six dimensions of quality that want to improve in health
service

Effective : delivering health care that is adherent to an evidence base and

results in improved health outcomes for individuals and communities,
based on need

Efficient : delivering health care in a manner which maximizes resource

use and avoids waste

Accessible : delivering health care that is timely, geographically

reasonable, and provided in a setting where skills and resources are
appropriate to medical need

acceptable/patient-centered : delivering health care which takes into

account the preferences and aspirations of individual service users and
the cultures of their communities

equitable : delivering health care which does not vary in quality because of
personal characteristics such as gender, race, ethnicity, geographical
location, or socioeconomic status

safe: delivering health care which minimizes risks and harm to service
users.
 The process of implementing quality of health service

1. Stakeholder involvement:

Quality improvement is about change. For this reason, an important early

step in the decision-making process is to determine who are the key
stakeholders and how they will be involved.

A key method of involvement could be the formation of a board or steering

group drawn from the stakeholder groups, which would remain involved in
all stages of the process, including implementation and the review of
progress. The board or steering group could provide the main focus for
accountability and preparing advice to decision-makers, as well as wider
communication with all interested parties. Clear terms of reference would
be essential.

2. Situational analysis:

Situational analysis is a mapping process which allows a clear baseline to be

established before any new interventions are considered or existing ones
adapted. While the main focus of the situational analysis is on the health
system, it also needs to make connections between health and other
sectors and issues which will impact on the performance of the health
system.
The situational analysis will need to cover many areas, which might include
the following.
 Current structures and systems within the ministry of health relating to
quality improvement.

 Current policies in health and across sectors (e.g. where there are
national policies for quality which apply to all sectors, including health).

 Current health goals and priorities.

 Current quality interventions. How is the system acting now in the

various domains of quality improvement? What effect is there on
information, leadership, engagement with patients and the population,
the use of regulation and standards, developing organizational
capacity, and models of care? What impact are those current activities
having on the quality of health care and outcomes?

3. Confirmation of health goals:

The third element in the process of analysis is to confirm the wider health
goals of the health system. This activity is included as a separate element
because:

 it will be critical for any new interventions in quality improvement to

be seen by stakeholders as aligned with and serving the broader health
goals of the system
  the situational analysis may cause some health goals to be called into
question by policy-makers and other stakeholders

 without clear and agreed health goals, the focus and purpose of any
new quality intervention is questionable

4. Development of quality goals:

The choice of quality goals will be driven by the agreed health goals, and will
relate to the different dimensions of quality. The questioning process in
relation to the health goal will be to ask the following.

 What are the deficiencies in effectiveness?

 What are the deficiencies in efficiency?
 What are the deficiencies in accessibility?
 What are the deficiencies in acceptability?
 What are the deficiencies in equity?

In answering these questions, the evidence gathered in the situational

analysis should be invaluable. In particular, the situational analysis should
inform judgments about the significance of general evidence for a particular
health issue. For example, there may be a general perception that access to
health care is reasonable. There may also be evidence that delays in access
to health care are affecting outcomes for particular populations.
5. Choosing interventions for quality:

This element moves attention from the “what” to the “how”. It calls for
judgments to be made about interventions, and agreement to be reached
about the process of implementation.

6. Implementation process:

The success of the interventions will then depend on maintaining a clear

focus on implementation, sustaining interest and commitment, and having
the capacity to make tactical decisions to modify activities in response to
feedback. All of this is critical for sustainability, as many quality-
improvement initiatives encounter declining results because they lack
sustained focus on implementation.

Having a programmed board or steering group with appropriate

stakeholder representation and terms of reference could be an effective
way of sustaining a focus on and interest in the implementation of the
quality improvement strategy.

The core responsibilities of such a board might include:

 keeping under review progress on implementation, adherence to

timetables, and achievement of targets and goals;
 redirecting resources;
 providing an account of progress to interested parties;
  modifying timetables and milestones;
 preparing the health system for scaling up where a phased approach is
 planned;
 Keeping new evidence under review and modifying plans to take
account of that evidence.

7. Monitoring progress:

The final element is to maintain a focus on the delivery of the improved

outcomes and benefits being sought. This focus is important because:

 if results are not those that were expected, it will be important to

make early decisions about how the strategy and its selected
interventions might be modified to achieve better results any
investment of effort and resources in quality improvement can only be
justified in terms of improved outcomes – giving proper account to
stakeholders for that investment can only be done with information
about changing outcomes

 Maintaining the motivation and commitment of stakeholders in the

change process will be helped by being able to point both to progress
and achievements, and to the delivery of the quality goals to which
they have subscribed.
 How to improve the quality of health service

1. Improve the existing preventive health programs and in addition

develop more comprehensive coordinated and focused programs that
would:

(a)   Reduce the burden of disease in the community;

(b)  Enable early detection of preventable disease/ health problems

and their complications;

(c)   Focus on promoting positive health behavior;

2. Improve the existing medical facilities and develop additional services to

meet a wider range and level of medical needs including rehabilitation and
continuing care, both institutional and community base.

3. Health care will make more accessible to the community on an equitable

basis with provision for meeting specific health needs.

4. Improve the quality of health care to a level acceptable to both the

community and service providers.

5. Health services activities and patient care will respect the dignity of the
individual at all times.

6. The Government will remain committed to providing basic health care

free of cost to the individual at the point of delivery, in State sector
institutions.
7. The Government will ensure the right of men and women to be informed
and to have access to safe, effective, affordable and acceptable methods of
family planning of their choice.

8. Health care will be made more efficient and cost effective.

9. Develop and implement a National Drug Policy for the rational use and
distribution of drugs.

10. Promote the involvement of the community in health care.

11.Allocate resources between provinces/ districts based on their health

needs and national priorities.

12. The Health Ministry will strengthen integrated approaches with other
Governmental and Non-Governmental agencies to facilitate greater
coordination for better health care.

13. The Government will facilitate the development and regulation of the
private health care sector and promote better coordination with this
sector.

14. Encourage health systems research and its application.

15. Human Resource Development will be supported and strengthened in

keeping with contemporary needs.

16. Services and programs will be introduced to meet the emerging health
needs of the elderly and those affected by physical disabilities, mental
health disorders, as well as the health problems of displaced populations.
17. Development of indigenous systems of medicines and homeopathy will
be encouraged.

18. The Government is committed to allocate additional funds from

Governmental sources and through alternative mechanisms of funding,
towards meeting priority health needs especially in the areas of health
promotion and prevention.

Further suggestions to improve the quality of health service

 Create a non-punitive culture Hospitals need to support quality

improvement in a non-punitive environment.

 Promote teamwork Hospitals need to make teamwork a all part of

their organization to Develop small quality action teams and promote
stronger physician-nurse relationships.

 Start with national measures Start with the kinds of measures that are
being collected nationally. Heart attack, heart failure and pneumonia
are some of the conditions with a good sample size that rural hospitals
can start analysing


 Individualize the measures it is important for hospitals to personalize
quality measurement beyond what’s required at the national level.

 Utilize the right data Hospitals often collect a ton of information, send
or store it somewhere--then don’t use it as part of decision-making
processes. Hospitals not only should evaluate what they are currently
collecting, but they also must do a better job of collecting crucial
information, then actually using that information for critical decisions.

 Collect and report information regularly Improving quality means

measuring, analyzing and reporting information. “We need to
institutionalize this, and part of that process is developing regularity for
it. Public reporting initiatives are crucial, as well.

 Invest in information systems rural hospitals need to invest in

statistical analysis tools and management information systems that
support quality improvement.

 Establish networks one of the best strategies for small rural hospitals--
especially critical access hospitals--is to join forces with other small
facilities rather than taking on quality initiatives by themselves. These
networks enable small rural facilities to share their experiences and
pool resources to facilitate quality improvement activities
  Ask the experts Small rural facilities should take advantage of the
assistance available to them. Numerous organizations, including state
hospital associations, the state offices of rural health, and quality
improvement organizations, can offer expertise along with educational
and analysis tools to assist rural hospitals with quality improvement
initiatives.

Health information technology (HIT)

It provides the umbrella framework to describe the comprehensive

management of health information and its secure exchange between
consumers, providers, government and quality entities, and insurers. Its role
in public health is unmatchable because it plays a vital role in early
detection of infectious disease outbreaks around the country, improved
tracking of chronic disease management, monitoring healthcare programs
and coverage, evaluation of health care utilization, and in making
transparent and evidence-based decisions for health system interventions.

In addition, HIT also reduces the paper work by eliminating the needs of
paper based record and improve the administrative efficiency. It improves
the healthcare by decreasing medical errors with an assurance that all the
healthcare providers have accurate and timely information. Health
information technology in general is increasingly viewed as the most
promising tool for improving the overall quality, safety and efficiency of the
health delivery system.

Health Information Technology has the potential to make a major

contribution in improving access and quality of healthcare services while
containing costs. HIT contribution in public health is countless in terms of
providing elective, emergency, and long-term clinical care; educating
community; improving nutrition and hygiene; and providing more sanitary
living conditions. These in turn ultimately involve massive social and
economic changes, as many health challenges go well beyond the health
sector.
 REFERENCES

 http://www.ncbi.nlm.nih.gov/pubmed/20088632

 http://www.who.int/management/quality/assurance/QualityCare_B.Def.pdf

 http://www.health.gov.lk/HealthPolicy.htm

 Andrew Greasly (2008), operations management- first edition

 Roger G. Schroeder (2000) operations management contemporary concepts