QUALITY CONTROL

Ita Yuanita
Quality ?
• The degree to which health services for individuals and
populations increase the likelihood of desired health
outcomes and are consistent with current and
professional knowledge” (IOM, 2001, p. 232)

• Quality: The totality of features and characteristic of

product or service that bear on its ability to satisfy or
implied needs. American Society for quality control, 1989)
Quality Improvement (QI)
• Vision : “All people should always experience the safest,
highest quality, best value health care across all set-
tings” (The Joint Commission, 2010)
• Terms are total quality management (TQM), Six Sigma,
and Continuous Quality Improvement (CQI), are used to
describe quality improvement.
• QI may be accomplished through a variety of approaches
and models such as the Focus, Analyze, Develop, and
Execute Model (FADE)
(http://patientsafetyed.duhs.duke.edu/module_a/
methods/fade.html) or the Plan Do Study Act cycle
(PDSA)
Six Aims for Improving Quality in
Health Care (IOM, 2001, p. 39).
• Health care should be:
• 1. Safe
• 2. Effective
• 3. Patient-centered
• 4. Timely
• 5. Efficient
• 6. Equitable
QI at the Organizational and Unit
Levels
• Strategic Planning
• Review vision, mission, goals
• SWOT analysis is done—a review of the
organization’s Strengths, Weaknesses,
Opportunities, and Threats.
QI at the Organizational and Unit
Levels
Structured Care Methodologies
•Guidelines. Guidelines first appeared in the 1980s as
statements to assist health-care providers and patients in
making appropriate health-care decisions.
•Protocols. Protocols are specific, formal documents that
outline how a procedure or intervention should be
conducted.
•Algorithms. Algorithms are systematic procedures that
follow a logical progression based on additional information
or patient responses to treatment.
• Standards of care. Standards of care are often
discipline-related and help to operationalize patient care
processes and provide a baseline for quality care.
• Critical (or clinical) pathways. A critical pathway
outlines the expected course of treatment for patients who
have similar
• diagnoses.
Aspects of Health Care to Evaluate
• Structure Structure refers to the setting in
which the care is given and to the
resources (human, financial, and material)
that are available.
• Facilities. Comfort, convenience of layout, accessibility
of support services, and safety
• Equipment. Adequate supplies, state-of-the- art
equipment, and staff ability to use equipment
• Staff. Credentials, experience, absenteeism, turnover
rate, staff-patient ratios
• Finances. Salaries, adequacy, sources
• Process refers to the activities carried out by the
health-care providers and all the decisions made
while a patient is interacting with the organization
(Irvine, 1998).
• Setting an appointment
• Conducting a physical assessment
• Ordering a radiograph and magnetic resonance
imaging scan
• Administering a blood transfusion
• Completing a home environment assessment
• Outcome is the result of all the health-care pro- viders’
activities.
• The National Database for Nursing Quality Indica- tors (NDNQI) is
continuously updated (www .nursingworld.org).
NURSING SENSITIVE INDICATOR
• Patient satisfaction
• Decubitus
• Patient fall
• Iv line Infection
• Medication error
• Staff satisfaction
CQI’S PROCESS
1. identifying areas of concern (indicators),

2. continuously collecting data on these indicators,

3. analyzing and evaluating the data,

4. implementing needed changes.

Hospital’s quality
• Human resource : performance appraisals
• Quality service :
• LOS(Length of Stay)
• The average hospitalization stay of inpatient discharge

Rumus

Jumlah lama dirawat

Jumlah pasien keluar (hidup+mati)
• BOR (Bed Occupancy Ratio)
• The ratio of patient service days of inpatient bed count days in a period
under consideration (huffman, 1994)
• prosentase pemakaian tempat tidur pada satuan waktu tertentu.
Indikator ini memberikan gambaran tinggi rendahnya tingkat
pemanfaatan tempat tidur rumah sakit. Nilai parameter BOR yang ideal
adalah antara 60-85% (Depkes RI, 2005)

Rumus :
Jumlah hari perawatan rumah sakit
(Jumlah tempat tidur X Jumlah hari dalam satu periode)) X 100%
• BTO (Bed Turn Over = Angka perputaran tempat tidur)
: the net effect of changed in occupancy rate and length of
stay.
• frekuensi pemakaian tempat tidur pada satu periode, berapa kali
tempat tidur dipakai dalam satu satuan waktu tertentu. Idealnya
dalam satu tahun, satu tempat tidur rata-rata dipakai 40-50 kali
(DepKes, 2005)
• Rumus
Jumlah pasien keluar (hidup + mati)
Jumlah tempat tidur
• TOI (Turn Over Interval = Tenggang perputaran)
• rata-rata hari dimana tempat tidur tidak ditempati dari telah diisi ke
saat terisi berikutnya. Indikator ini memberikan gambaran tingkat
efisiensi penggunaan tempat tidur. Idealnya tempat tidur kosong
tidak terisi pada kisaran 1-3 hari.

Rumus

((Jumlah tempat tidur X Periode) – Hari perawatan)

Jumlah pasien keluar (hidup + mati)
• NDR (Net Death Rate)
• NDR menurut Depkes RI (2005) adalah angka kematian 48 jam
setelah dirawat untuk tiap-tiap 1000 penderita keluar. Indikator ini
memberikan gambaran mutu pelayanan di rumah sakit.

Rumus :

(Jumlah pasien mati > 48 jam

Jumlah pasien keluar (hidup + mati)) X 1000 permil
Thank you