Centre for Health Management and Research

(CHMR)

Introduction of Quality Management and

Improvement in Healthcare
By : DR. RICHA MISHRA
Assistant Professor IGMPI

For feedback on this lecture please mail on –feedback@igmpi.ac.in

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 Objectives
 To gain an understanding of what quality and
health care quality is

 To highlight the benefits of quality improvement

process and its importance

 To present the key dimensions of quality care

 To introduce the Model for quality improvement

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 What is quality???
 Quality is often used to signify ‘excellence’ of a
product or service ”.

 Quality is doing the right things right from first time.

 The perception of the degree to which the product or

service meets the customer's expectations.

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 Health care quality
 Quality health care is care that is safe,
effective, patient-centered, timely, efficient and
equitable.

 Patient safety is an important aspect of health care

quality

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Historically, the focus in developing countries was on the
quantity rather than quality of health services .

􀂄 Now, there are ample evidence that show that quality

of care (or the lack of it) must be at the center of every
discussion about better health.

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 Historical Development of Quality

 Florence Nightingale serves as a nurse during the

Crimean war. She was the first to identify a positive
correlation between the introduction of adequate nursing
care to wounded soldiers and the lower mortality rate
among them. She attributed a positive outcome to quality
of care.

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 What does health care quality mean ?
Quality means different things to
different people
To the PATIENT:
 Get well – feel better – recover

 Skilled and helpful staff

 Effective health outcomes

 Welcoming atmosphere

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What is health care quality mean?(Cont.)
 To the STAFF:

 Up to date and working equipment

 Continuing Standards of care

 education and training

 Effective team work

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 What is health care quality mean?(Cont.)
 To the HOSPITAL MANAGEMENT

 Positive health outcomes for patients

 Continuous quality development at all levels of

the organization

 Providing education and training for staff

 Stable and trained work force.

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What is health care quality mean?(Cont.)
To the GOVERNMENT & POLICY MAKERS:

 Effective health care system

 Improved quality of life for people

 Research-based continuous quality

development
 Monitoring of results/achievements and
taking actions to improve outcomes

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 We need quality effects and
improvement in the environment
through all the

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 Competition among
Healthcare providers

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Don’t be like an Ostrich….

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Key Dimensions of Quality Care
 Accessibility.
 Appropriateness.
 Continuity.
 Effectiveness.
 Efficacy.
 Efficiency.
 Patient respect and care.
 Safety.
 Timeliness.

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 Accessibility
 "The ease with which users can obtain the care that
they need when they need it"

Appropriateness of Care
• “The degree to which the correct care (the care that
is relevant to the patient’s/users medical needs) is
provided, given the current state of knowledge".

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 Continuity of care

 Continuity of care is an approach to ensure that the patient-

centered care team is cooperatively involved in ongoing
healthcare management toward a shared goal of high-quality
medical care.

 "The degree to which the care needed by patients/users is

coordinated among practitioners, organizations and over
time".

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 Effectiveness of Care

 "The degree to which the care given to patients is

provided correctly (i.e. without error), given the
current state of knowledge".

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 Efficacy of Care

 The optimum utilization of resources to produce the desired

outcomes

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 Patient Perspective Issues
 The degree to which those providing care and services
do so with sensitivity for the individuals’ needs,
expectations and differences.

 This may also include the provision of equitable care to

all patients.

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 Safety of the Care
Environment

 "The degree to which the environment is free from risk

(hazard or danger) for both users and providers."

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 Timeliness of Care

 "The degree to which care is provided to patients/users

when it is needed i.e., at the most beneficial or necessary
time."

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 QUALITY
IMPROVEMENT MODEL

 According to the model, information about quality of

care can be drawn from three categories: “structure,”
“process,” and “outcomes."

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 Structure, Process, and Outcome
Structure

leads to

Process

leads to

Outcome
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 Structure, Process, and Outcome
Structure: is the arrangement of parts of a care system
or elements that facilitate care; the care environment;
evidence of the organization's ability to provide care
to patients, e.g.:
 Resources
 Equipment
 Numbers of staff
 Qualifications/credentials of staff
 Work space

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 Structure, Process, and Outcome
Process: refers to the procedures, methods,
means, or sequence of steps for providing or
delivering care and producing outcomes. In
other words, processes are activities that act
on an "input" from a "supplier" to produce an
"output" for a "customer" e.g.
- Clinical Processes
- Care Delivery Processes
- Administrative and Management
Processes

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Structure, Process, and Outcome
Outcome: refers to the results of care, adverse
or beneficial e.g.
Clinical:
- Short-term results of specific treatments and
procedures
- Complications - Adverse events - Mortality
Functional:
- Long-term health status
Perceived:
- Patient/family satisfaction

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 , Centre for Health Management and Research
(CHMR) ,IGMPI

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