QUALITY as a concept in

HEALTHCARE
Priyanka Roy Chowdhury
 What is Quality?

 Quality means satisfying customer on CONTINOUS

BASIS

 Quality Means value for money

 "Fitness for use" (Joseph M. Juran). Fitness is

defined by the customer.

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 Introduction:
 What is Quality?

The meaning for the term quality has developed over

time. Various interpretations are given below:

 "Degree to which a set of inherent characteristic

fulfills requirements" as in ISO 9000
 "Conformance to requirements" (Philip B. Crosby in
the 1980s).

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  The American National Standards Institute (ANSI)
and the American Society for Quality (ASQ)
defined quality as;
o The totality of features and characteristics of a product or
service that bears on its ability to satisfy customer’s
stated and implied needs.
o a product or service free of deficiencies

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 Perspectives of Quality
 Varied perspective among different Stakeholders

 Client:
 Relief from the ailment
 Service & Treatment with compassion
 Provider:
 Offering state of the art-- technical care
 Outcome comparable to known standards
 Protection from legal systems
 Program Manager:
 Will quality improvement make difference to the utilization?
 If yes, does the investment justify the return ?
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  Quality in healthcare means providing the right
services in the right way from the first time and
every time for every patient regardless to his/her
ability to pay 24hours/7days a week/ 365
days/year
Brown 2001

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What is Quality
 The Institute of Medicine defines quality as:

"The degree to which health care services for

individuals and populations increase the
probability of desired health outcomes and are
consistent with current professional knowledge of
best practice."

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Product Vs. Relationship

 Products are tangible – they are physical, you can touch, see, feel and
smell them. Services are intangible. Often part of the challenge of
marketing services is creating tangible elements that connect the
consumer to the service brand.

 Need vs. Relationship. Products tend to fill a need or want for the
customer. Marketing services is more often about building relationships
and trust. When you buy a car, you are using the the car and continue to
see it and use it. When you leave your doctor’s office, you might not have
anything to take away from the transaction.

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Products vs Services

 One vs. Many. Physical products usually come in many formulations.

Clothes come in different styles, colors, sizes. Dog food comes in different
ingredient combinations. Services typically do not offer multiple
formulations. As a doctor’s visit is a doctor’s visit, whether you are going
for tennis elbow or diabetes. (You might choose different service
providers, but the basic elements will be the same.)
 Comparing Quality. It is much harder for consumers to evaluate the
quality of the service received than the quality of a product purchase. If
you buy an anti-dandruff shampoo and you have less dandruff, it works.
Quality of service is not tangible and difficult to be perceived and also it is
perceived in different ways.

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 It is much easier to return a product than a service, because a service
is consumed as it is offered. It can be done, but it is usually much harder
for the consumer.
 Every day that a service is offered and not consumed is lost forever.
If I don’t sell my hotel room tonight, I cannot ever sell it – it is gone
forever. Products on the other hand have a longer life. If I put a box of
cookies on the shelf and don’t sell it today, I can still sell it for some period
of time beyond today.

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Dimensions of Quality
 Dimensions of Quality
Institute of Medicine – 2001- “Crossing the Quality Chasm”

 Safety
 Effectiveness
 Equity
 Efficiency
 Timeliness
 Patent Centeredness

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 Introduction

 Why Quality?
 Ensure safety and minimize risk
 Cost of non quality- Duplication of
work, wastage , re-do s etc.
 Reduce cost of health care
 Advancement in technology
 Litigations & Consumer Protection Act

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Concept of a Customer- Customer Focus

 Hard Needs & Soft Needs

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 A customer is the most important visitor in our premises.
 He is not dependant on us.
 We are dependant on him.
 He is not an interruption on our work.
 He is the purpose of it.
 He is not an outsider on our business.
 He is a part of it.
 We are not doing him a favor by serving him.
 He is doing us a favor by giving us an opportunity to do so.
` - Mahatma Gandhi

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External Customers
 Patients/families

 Purchasers:-
– Insurance companies and health plans.
– Employers.
 Government agencies. Regulators and accrediting agencies.
 Vendors/suppliers (goods and services, including registries).
 Educational institutions.
 Attorneys.
 Community businesses, agencies, and residents

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Internal Customers
 Admitting/reception/front
office staff
 Administrative services staff.
 Ancillary staff.
 Technicians.
 Care coordination/social
services staff.
 Communications staff.
 Human resource staff.
 Facility management staff
 Finance staff.
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 Medical/clinical record staff.
 Nurses, aides, medical
assistants.
 Performance
improvement/quality
management/review staff.
 Pharmacists.
 Physicians, med. directors,
other independent
practitioners.
 Support service staff.
 Volunteer staff.
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 QI:  QA:
 Performance  Plan for maintaining the
Improvement. quality requirement.
 Continuous improvement  Preventive aspect
 Ongoing activities.  One time activity .
However modifications
may be done.

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 QA:  QC
 Assurance is provided by  Quality Control is known as QC and
organization management, it focuses on identifying a defect. QC
means giving a positive declaration ensures that the approaches,
on a product which obtains techniques, methods and processes
confidence for the outcome. are designed in the project are
following correctly.
 QC activities monitor and verify
 It gives a security that the product
that the project deliverables meet
will work without any glitches as the defined quality standards.
per the expectations or requests.
 Quality Control is a reactive process
.. It recognizes the defects. Quality
Control has to complete after
Quality Assurance.
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Concept of Cost of Quality ( COQ)

 - rather non quality

 any cost that would not have been expended if
quality were perfect contributes to the cost of quality.
 Every time work is redone, the cost of quality
increases.
 When quality costs are high, it is a sign of
ineffectiveness.

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Prevention Costs

 The costs of all activities specifically designed to prevent poor

quality in products or services.

 Examples are the costs of:

» New product review
» Quality planning
» Supplier capability surveys
» Process capability evaluations
» Quality improvement team meetings
» Quality improvement projects
» Quality education and training

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Appraisal Costs

 The costs associated with measuring, evaluating or auditing

products or services to assure conformance to quality
standards and performance requirements.

These include the costs of:

– Incoming and source inspection/test of purchased material
– In-process and final inspection/test
– Product, process or service audits
– Calibration of measuring and test equipment
– Associated supplies and materials

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Failure Costs
 The costs resulting from products or services not conforming to
requirements or customer/user needs.

 Failure costs are divided into internal and external failure categories.
 Internal Failure Costs
 Failure costs occurring prior to delivery or shipment of the product, or
the furnishing of a service, to the customer.
 Examples are the costs of:
 Scrap
 Rework
 Re-inspection
 Re-testing
 Material review

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External Failure Costs

 Failure costs occurring after delivery or shipment of the product — and

during or after furnishing of a service — to the customer.

Examples are the costs of:

– Processing customer complaints
– Customer returns
– Warranty claims
– Product recalls

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Total Quality Costs:

 The sum of the above costs. This represents the difference between the
actual cost of a product or service and what the reduced cost would be if
there were no possibility of substandard service, failure of products or
defects in their manufacture.

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 The Ultimate goal is to manage quality, but you
cannot manage it until you have a way to measure it
and you cannot measure it until you can monitor it.

- Florence Nightingale

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Dashboard

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 DONOBEDIAN’s FRAME WORK OF
QUALITY
Structure
leads to

Process

leads to

Outcome

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 Structure Process Outcome

 Infrastructure, equipment Work Flow Clinical/Technical Outcome

 Technology Processes Non-Technical Outcome
 Manpower Procedures Ethics
 Governance & Mgmt Protocols
Regulatory Compliance
Documentation
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3
 Example: Antenatal care
Inputs Process Outcome

Separate room for Registration Normal delivery-mother &

examination Child healthy
Waiting room/sitting History taking Complications during
space pregnancy
Staff Physical Examination Referral to higher level
Equipment- weighing Obstetric Examination- Risk Death of the mother/child
machine, BP Instrument, assessment
stethoscope etc.
Facilities for Urine Immunization with TT, Iron
examination, Hb supplementation
Registers/records Urine examination, Hb
Estimation

Stock of medicines and Provider Client interaction-

nutritional supplements Information, counseling

Bathroom, electricity , Follow up & Treating

water
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complications
 Indicators are statistical measures of performance of functions, systems
or processes overtime.

 Examples:

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Thank You