Introduction to Healthcare Quality Management-

Examples from Hospitals in Taiwan

Nai-Wen Kuo, Ph.D., M.P.H.

Professor and Director
School of Health Care Administration
Taipei Medical University

A. Definition of Health Care Quality

1. A consumer’s quality expectation will be confirmed when the service performs as expected,
positively confirmed when expectations are exceeded, and negatively confirmed when
expectations fail to be met.
2. Quality is a process of meeting the needs and expectations of patients and health service
staff (WHO 2000)
3. Quality is the degree to which care services influence the probability of optimal patient
outcomes (American Medical Association, 1991)

B. Dimension of Health Care Quality

1. Technical Quality: the quality of the delivery of care (competence and outcome)
2. Functional Quality: how a patient receives a service (environments, attitude, and methods
in delivering care)

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 C. Evaluation of Health Care Quality
Donabedian’s Model in Evaluating Healthcare Quality: Structure—Process--Outcome
Structure
◎Equipment available
◎Staffing (numbers,
qualifications, expertise)
◎Training programs
◎Teaching affiliation
Technical ◎Size, volume, ownership
◎Governing board
◎New technology’s impact on
roles and role relationships
◎Building design, signage
◎Presence of chaplains, patient
advocates, social workers,
translators, ethics committees
◎Cleanliness
Interperso ◎Presence of conveniences
nal ◎Ease of access, parking
◎Appearance of staff
Amenities
Process
◎Accuracy of diagnosis
◎Appropriateness of treatment
◎Treatment skillfully applied
◎Treatment plans, sequencing
◎Practice guidelines
◎Collegiality
◎Nature of communication
◎Honest, forthright treatment of
patients and families
◎Sensitivity and compassion in
delivery of care
◎Efficiency in patient flow
◎Short waiting periods
2
Outcome
◎Morbidity, mortality
◎Increments or decrements in
health or functional status
◎Palliation
◎Frequency, distribution of
adverse incidents
◎Malpractice
◎Donations (time, bequests)
◎Patient satisfaction
◎Emotional, spiritual peace
◎Family satisfaction
◎Referrals
◎Compliance
◎Returns for future care
◎Malpractice
◎Donations (time, bequests)
◎Patient satisfaction
◎Family satisfaction
◎Referrals
◎Donations (time, bequests)
D. Activities of Healthcare Quality Improvement in Taiwanese Hospitals
1. Total Quality Management
Do the right things right
To build a culture of respect
Respect for your customer, respect for your supplier-customer cnetered
Continuous improvement
Just in time manufacturing

2. Quality Control Circles

3. Clinical Pathway

4. Healthcare Quality Indicator

(1) Taiwan Quality Indicator Project (TQIP)
(2) Taiwan Healthcare Indicator Series (THIS)

5. Patient Safety

E. Conclusion

1. Safety,
2. Effectiveness,
3. Patient-centered,
4. Timeliness,
5. Efficiency, and
6. Equity

Eight dimensions of patient-centered care:

1. Fast access to reliable health advice
2. Effective treatment delivered by trusted professionals
3. Clear, comprehensible information and support for self-care
4. Involvement in decisions and respect for patient preferences
5. Attention to physical and environmental needs
6. Emotional support, empathy and respect
7. Involvement of, and support for, family and patients
8. Continuity of care and smooth transitions.

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Duck Hunting Doctors Joke

Five doctors went duck hunting one day. Included in the group were a general practitioner, a
pediatrician, a psychiatrist, a surgeon and a pathologist. After a time, a bird came winging
overhead. The first to react was the general practitioner who raised his shotgun, but then
hesitated.

"I'm not quite sure it's a duck," he said, "I think that I will have to get a second opinion." And
of course by that time, the bird was long gone.

Another bird appeared in the sky soon thereafter. This time, the pediatrician drew a bead on it.
He too, however, was unsure if it was really a duck in his sights and besides, it might have
babies. "I'll have to do some more investigations," he muttered, as the creature made good its
escape.

Next to spy a bird flying was the sharp-eyed psychiatrist. Shotgun shouldered, he was more
certain of his intended prey's identity. "Now, I know it's a duck, but does it know it's a duck?"
The fortunate bird disappeared while the fellow wrestled with this dilemma.

Finally, a fourth fowl sped past and this time the surgeon's weapon pointed skywards and he
fired without hesitation. BOOM!! The surgeon lowered his smoking gun and turned
nonchalantly to the pathologist beside him: "Go see if that was a duck, will you?"