Quality Management in Healthcare

Joko Mulyanto Departement of Public Health & Community Medicine Jenderal Soedirman School of Medicine

OUTLINE
Background and Significance Definition of Quality Concept of Quality Management Total Quality Management Application of Quality Management in Healthcare Accreditation and Standardization

Background
US, at least 44,000 people die per year, as a result of medical errors. Bigger number than other cause of death such as motor vehicle accident, breast cancer, and AIDS. Economic cost about US $ 17 29 billions. Indonesia ? No data.

Quality Defined..

In General An ability of a product or service to fulfill the expectations set to it by the customers. In healthcare settings The degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge. (IOM,1990)

Quality Defined .. (cont)

Health services Wide array of health services, many types and multiple settings of care. Individual and population. Both individual organization & entire system. Not a particular part of population, irrespective cultural heritage, sociodemographic characteristics, etc. Increase likelihood Not identical to good outcome, unknown aspect of health, provide more benefit than harm

Quality Defined .. (cont

Desired outcome The link between the care that is provided and its effect on health, taking into account patients values and preferences. Current professional knowledge Knowledge-based, use the knowledge appropriately

Domains of Quality
Safe Effective Patient-centered Timely Efficient Equitable

Measuring the Quality

Structure Tools, resources, and facilities. Process Performance. Outcome Biomedical, quality of life (functional), satisfaction.

Quality Problems in Healthcare

Overuse Underuse Misuse

Quality Management
Quality Assurance Quality Improvement Total Quality

Quality Assurance
Eliminating defects. Bad apples concept. Performance threshold.

Quality Assurance (contd)

Quality Improvement
Learning process Share the best practices Not only improve the performance, reduce the variation More consistent improvement.

Quality Improvement (cont)

Total Quality
Often used interchangeably with QI / CQI TQ is strategic concept TQ has three principles, which are: - costumer focus - continuous improvement - teamwork QI is one of the principles that support TQ strategy.

Total Quality Management

Organization wide Process focused Output measurement Customer driven

TQM Model
Are we doing the right things ? Are we doing the things right? How can we be certain we do the right things right the first time, every time?

TQM Approaches
W. Edwards Deming Demings 14 points for quality Joseph M. Juran Jurans Quality Trilogy Philip B. Crosby Crosbys 14 steps of QI

Process Improvement
FOCUS-PDCA Find a process to improve Organize a team that know the process Clarify current knowledge of the process Understand sources of variation Select the process improvement Plan Do Check Action CYCLE

TQM Tools

Application in Healthcare Settings

Waiting time in outpatient department. Clinical Practice Guideline

AKREDITASI

A self-assessment and external peer assessment process used by health care organizations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve Pengakuan yang diberikan kepada institusi kesehatan yang telah menerapkan standar pelayanan yang ditetapkan.

STANDARISASI
Standar: Konsensus mengenai bagaimana sesuatu hal harus dilakukan, batas minimal yang harus dicapai, berdasarkan best practices. Standarisasi : Proses untuk menyusun dan menerapkan standar pada kegiatan organisasi.

AKREDITASI Vs STANDARISASI
Standarisasi merupakan proses internal institusi, sedang akreditasi umumnya adalah external review process oleh badan independen Akreditasi bersifat voluntary dan by request.

AKREDITASI RS DI INDONESIA
Dilakukan oleh KARS Kementerian RS. Dilakukan secara bertahap.

TAHAPAN AKREDITASI
Tahap I Tahap II Tahap III

: 5 pelayanan : 12 pelayanan : 16 pelayanan

STATUS AKREDITASI
Istimewa (5 tahun) Penuh (3 tahun) Bersyarat (1 tahun) Tidak terakreditasi

THANK YOU
djokomoeljanto2007