QUALITY IMPROVEMENT IN

HEALTH CARE SERVICE DELIVERY

DURING 29TH ANNUAL

KENYA THEATRE NURSES
SCIENTIFIC CONFERENCE
AT KISUMU

QUALITY IMPROVEMENT OF HEALTH CARE SERVICES

DEFINITION:
Is the making of a service better than before.
Objectives:
Broad Objective
Assess main factors that hinder quality
improvement in the health care delivery.

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Specific Objectives
Assess how best quality can be improved.
How to aim at improving the quality of
health care services.
Identification of opportunities for
improvement.
Hindrances to attaining standards to
improve quality.
Assess improvement in quality of service.

Importance of quality improvement.

FACTORS THAT AFFECT QUALITY AND ITS

IMPROVEMENT

Infrastructure/buildings in which care is provided.

Do not meet the required standards \specifications i.e.
ventilation, spacing to patient ratio.
State of repair i.e. lack maintenance of regular face lifts.
Arrangement and /or absence of all the required duty
stations for proper and easy patient flow.

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Waste management in the

surrounding.
Social amenities .
Security.

Medical equipment and logistical

supplies for use in provision of quality
and timely service.
Lack of modern diagnostic equipment (laboratory, radiology and
imaging ),irregular servicing of these equipment and irregular
supply of related consumables leading to clinical diagnosis and
hence:
Pharmacy
Poly pharmacy (Misuse and Stock outs)
Under use (Expiries and overstocks)
Admissions
Unnecessary admission
Delayed admission
Denied admission

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Discharge
Delayed discharge
Untimely discharge
Referrals
Delayed referral
Unnecessary referral
Mis directed referral

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Lack of most operating theatre (surgical,
anaesthesia) ICU and ward equipment.
Most equipment is improvised or completely
missing
Are not the correct/ right specification
Are too few to meet the patient numbers
Maintenance and servicing of the
available equipment is not done
regularly and/ or not done at all.

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Poor Medical supplies
management
Poor supply of essential/basic
medications and other logistical
consumables.
supply of unspecified/not requested
for items by the end user.
Failure of supply of
specified/requested items by the end
user.

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Corruption involved at all levels i.e.
from tender awards, procurement
until delivery of the items.

Human resource/personnel

Absolute numbers not there.

Health worker to patient ratio
categories.
Lack of Training (CPD/CME, in-service
, up grading).
Poor licensing, promotion,
appointment, recruitment and
retirement methods.

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Brain drain.
Lack of Competent, Skilled,
Knowledgeable and experienced
staff.
Geographical/rural/urban distribution
ratios.
Absentism and unavailability at the
work station.
Lack of Courtesy and poor public
relations/customer care.

Process of patient care and

management

Diagnostic accuracy.
Length of stay in the hospital.
Re hospitalization.
Noso- comial infections.
Mis adventures.
Evidence based practice.
(scientifically proven)

How to aim at improving the quality of

service

Setting up of standards of care in all

departments.
Identifying problems at all levels.
Documentation and assignment of
responsibilities.
Elimination of errors in the system
especially those taken for granted.
Implementation of guidelines to prevent
reoccurrences of mistakes.

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Paying special attention to unwanted
outcomes.
Guarantying presence of personnel
at all times when on duty.
Need to take collective responsibility
instead of blaming one
another/pointing fingers.

Identification of opportunities for

improvement

Regular brain storming and

management meetings.
Morbidity and mortality meetings.
Event identification, measurement
and ultimately there documentation.
Analysis of processes leading to most
occurring problems.
Proper communication and
coordination.

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If change leads to improvement then its
implemented.
Changing of duty roles and continuous duty
relief.
Compulsory attendance to inservice
updates/CME CPD.
Displinary actions in case of grave avoidable
errors.
Reassessing the status of work after an
appropriate period/given time frame to
determine whether improvement really occurred

Hindrances to attaining standards to

improve quality
Costs involved in the input before there is
change.
Not having well qualified and adequate
personnel who know what to do.
Poor conduct and discipline of personnel.
Lack of disciplinary actions for those with
poor professional conduct.
Absence of established guidelines and SOPs.
Failure of some personnel to attend
meetings and inservice updates/CME CPD.

How to assess improvement in quality

It is very difficult to measure a change in
quality of an out come in a service, but
there are other collateral variables that are
good indicators and therefore offer adequate
information:
Satisfaction from the recipient of the
service.
Satisfaction from the service provider with
the out come.
Decrease in the rate of adverse outcomes.

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Increase in quality of outcome from the service.
Improved performance by comparison.
Focus on the chronology of mishaps and there
identification.
The use of statistical analysis with other data
sources.
Retrospective record review.
Setting up of standards that must be met.
Self reporting by the service provider of health
care.

Importance of quality improvement

Enhances the value of services provided

and therefore its out come.
Measures the value of an item/service in
a relative form.
Its a concept whose attention to,
improves patient safety and satisfaction.
It is a continuous process guided by
requirements and programmes of the
health delivery system.

Conclusion

A health unit/Hospital that has adopted

a
system of assessing, improving the
input of
functions and methods of care on a
regular basis
will definitely show quality
improvement.
Finally quality improvement should be

References
Donaldson SM,1999, measuring quality in health care,
Washington, National Academic Press.
Evan RJ, 2005, total quality management organization
and strategy, Ohio. South western publishers.
URL
WWW.progressivepractices.com/articles/system- thinki
ng
pdf accessed 02/05/10.
CURE Children's Hospital of Uganda policy manual inservice update 2010

THANK YOU FOR LISTENING

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