In the name of Allah. Most Gracious, Most Merciful
بســـــم الله الرحمـــــن الرحـــــيم

QMD/ CPD Program
HEALTHCARE QUALITY
BASIC CONCEPTS
Dr. Yasser Sami Amer
MBBCh, MS Pediatrics, MS HC Informatics, CPHQ
Supervisor, R&D, QMD, KSUMC
CPGs Advisor , KSUHs, AUHs
Member, NAHQ, USA
Member, G-I-N Adaptation & Implementation Working Groups

Learning objectives
By the end of this session, participants should be able to know:-
Basic concepts of Health Care Quality
• Healthcare Organizations (CAS)
• Definitions of Healthcare Quality (HCQ)
• Dimensions of HCQ
• Aspects of HCQ
• Resources
• Careers

An Indian tale Six Blind Men and the Elephant
http://www.youtube.com/watch?v=qPlJWk8-b4E

All of them were correct,
and all of them were wrong !

current debates about HC Reform is like a
modern version of the elephant fable!
• Various groups of stakeholders have banded
together to come up with their "solution” to
the problems of current healthcare models.
• Too much is spent, outcomes are not good
enough, and too many people are harmed.
• As solutions are presented, not only are the
stakeholders convinced of their merit, they are
also certain that counterproposals are wrong.

A complex adaptive system is
comprised of a heterogeneous and diverse
network of interacting and independent
agents/elements that learn and adapt over time.
Complex system behaviors are often said to be
emergent and subject to self-organization. In
short, the macro-level behavior of the system is
more than the sum of the micro-level.

C – A – S
Inclusion of
significant
number of
elements
Capacity to
change and to
learn from
experience
Set of
connected or
interdependent
things

HEALTHCARE ORGANIZATIONS (HCO)
are Complex adaptive systems

C – A – S

Nursing
a good example of complex adaptive system

Quality “as dictionary defined”
Noun peculiar and essential character,
superiority of kind, degree or grade
of excellence
Adjective having a high degree of excellence.
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Perfection of One's Work. The Messenger (peace be upon him)
said: "Allah loves that if one does a job he perfects it."
......من الإتقــــان إلى الإحســـان ......

Definitions of Quality in Healthcare o
In practice …………
= doing right things right the first time
= the right care for every person every time
= first NO harm
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Healthcare Quality
The extent to which health services
provided to individuals and patient
populations improve desired health
outcomes. The care should be based on the
strongest clinical evidence and provided in
a technically and culturally competent
manner with good communication and
shared decision making.
IOM 2001

KAIZEN
KAI = change, ZEN = good/ for the better
KAIZEN = continual improvement

Standards are created when experts are able to
understand what the right things are and now
the right things are best achieved
Quality = Compliance with the Standards
17

Quality of care is ………
Accessible
Effective
Safe
Accountable
Fair
18

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Why do we need Quality in Healthcare?
•Increasing costs of healthcare in the presence of
rising demands and limited resources.
•Variation in quality of medical performance and
outcomes in similar health organizations.

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Inspection phase
(1920-1940)
Quality Control phase
(1940-1960)
Quality Assurance phase
(1970-1985)
Total Quality Management (TQM) phase
(Continuous Quality Improvement-CQI)
(1986 and currently)

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Three Aspects of Quality
MEASURABLE
APPRECIATIVE PERCEPTIVE

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Measurable Quality
Can be defined objectively as compliance with,
or adherence to standards.
•Clinically, these standards may take the form of
CPGs or protocols, or they may establish acceptable
expectations for patient and organizational
outcomes.
•Standards serve as guidelines for excellence.
PROVIDERS ASPECT OF CARE

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Appreciative Quality
Is the appraisal of excellence beyond minimal
standards and criteria.
•Requires the judgments of skilled, experienced
practitioners and sensitive, caring persons.
• Peer review bodies rely on the judgments of like
professionals in determining the quality or non-quality
of specific patient-practitioner interactions.
PEER REVIEW/ ACCREDITATION BODIES, EXPERTISE
AND SKILLED PERSON ASPECT OF CARE

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Perceptive Quality
Is the degree of excellence which is perceived
by the recipient or the observer of care rather
than by the provider of care.
Is generally based more on the degree of
caring expressed by physicians, nurses, and
other staff than on the physical environment
and technical competence.
RECEPIENT/ PATIENT ‘customer’
ASPECT OF CARE

ALL THE THREE ASPECTS OF
QUALITY ARE ABSOLUTELY
ESSENTIAL TO OUR CONSIDERATION
OF THE OUTCOME AND ALL
ASSOCIATED PROCESS AND
STRUCTURE OF HEALTHCARE
DELIVERY

Key Dimensions of Quality
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KEY DIMENSIONS OF QUALITY CARE
PERFORMANCE
1. Safe
2. Timely
3. Effective
4. Efficient
5. Equitable
6. Patient-centered
7. Efficacy
8. Appropriateness
9. Availability
10.Continuity
11.Respect and Caring
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Is the intervention/ setting Appropriateness relevant, correct given the need?
Availability/ Is there sufficient access to care? Are there undue restrictions?
accessibility
Is care coherent and connected (considered less expensive)?
Are there gaps or redundancies in care (considered more expensive)?
“coordinated care” or “care coordination” in chronic diseased patients with
mutli-morbidities
Continuity
Does data indicate desired and cost-effective treatment outcomes?
Provide care based on scientific knowledge and EBP
Effectiveness
Does the proposed treatment have the capacity to produce the desired
outcome, as demonstrated in the literature? (is it evidence-based?)
Efficacy
Efficiency Are tests and treatments provided in a manner that conserves resources?
to what extent the patient/designee/family was involved in the decisions
and care provided, and treated with respect and dignity.
Respect & Caring
Safety Does care protect patients, reduce risk, and reduce liability?
Is care/intervention prompt/provided at the most beneficial necessary
time?
Timeliness
Dimensions of Performance
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EFFECTIVENESS
• Definition: Whether a drug or other treatment
works in real life. Effectiveness studies of drugs
look at whether they work when they are used
the way that most people take them.
Effectiveness means that most people who have
the disease would improve if they used the
treatment.
• Example: antidepressant drugs are considered to
be effective for the treatment of depression.
These drugs have been examined in many clinical
trials and other types of research studies (EBP).
AHRQ Glossary of Terms

EFFICACY
• Definition: Whether a drug or other treatment works
under the best possible conditions. In a research
study about efficacy, the study participants are
carefully selected, and the researchers can make sure
the drug is taken properly and stored properly. The
study participants may differ from other people in the
general public who have the disease. A treatment that
has efficacy under the best conditions may not work as
well in a different group of people with the same
disease. AHRQ Glossary of Terms

Efficacy (cont’d)
Example: a recent clinical trial compared people treated
with insulin to people treated with oral medicine for
diabetes. Only people with no other medical problems
were enrolled in the study, and most were under age 65.
The people treated with insulin had better improvement
in their blood glucose than the people treated with oral
medicines.
This study is considered an efficacy study, because only
younger people without any other health problems were
included. Many people who have diabetes are over age
65 and have other problems such as heart disease. It is
not known whether the same results would be found in
these people.

Changing the Healthcare Delivery System
As part of the agenda for change, the IOM’s Committee on
Quality of Health Care in America established aims for the 21st
century healthcare system. The committee proposed six
improvement aims to address key dimensions of healthcare
quality that were performing at far lower levels than they should
be.
They suggested that healthcare at a minimum
should be: STEEEP !
32

Framework for Quality: Six Key Areas of IOM
33
Report
Six key areas of quality of healthcare are needed to
be monitored. Healthcare should be:
(Acronym: STEEEP)
– Safe
– Timely
– Effective
– Efficient
– Equitable
– Patient-centered

The Healthcare Customer

A “customer”is one who receives goods
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or services .
It is a concept utilized in TQM philosophy to identify
the needs, expectations, and preferences of
all who are affected by the healthcare services we
provide.
Customers are our "dependents"; they rely on us
for a service or product.

The Concept of the Customer

Healthcare System

Quality of Care
Standards for Licensure
Addresses the structure
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Quality of Care
Standards for Certification
(e.g.. ISO)
o Focus an capability rather than results
o Thus address structure and Process than
on the outcome.
39

Quality of Care
Standards for Accreditation Addresses
Structure, Process and Outcome of care.
40

Standard
Is defined as an explicit predetermined expectation set by a
competent authority, that describes an organization’s
acceptable performance level.
Standards Should be :
Optimal
Achievable
When met would lead to highest possible quality in
a system
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Resources in HCQ

AHRQuality Indicators

CPGs

www.qualityforum.org/Home.aspx

ISQua http://www.isqua.org/

Janet Brown, BA, BSN, RN, CPHQ, FNAHQ
was active in the healthcare quality field since 1978 as
an administrative director, consultant, and nationally
known educator
http://jbqs.com/about-janet

Careers in HCQ (in USA)
Healthcare Quality Professional
(Academic degrees OR Professional certificates)
• Thomas Jefferson University/ Jefferson School of
Population Health: MS in Healthcare Quality &
Safety
• Northwestern University Feinberg School of
Medicine/ Center for Education in Health Sciences:
Graduate Programs in Healthcare Quality and
Patient Safety (MS, PhD & certificate)
• National Association for Healthcare Quality:
Certified Professional in Healthcare Quality
• ISQua: Fellowship Programme

CPHQ
• Information management
• Performance Improvement
• Strategic leadership and people
management
• Patient safety
• Accreditation and continuous readiness
• Change management

Questions? Tanong? सवाल? ?سوالات

Acknowledgment
Dr. Magdy Gamal Youssef,
MBBCh, MS OBGYN, DTQM, CPHQ
Former Director, Healthcare Quality Directorate, Alexandria University
Hospitals, Alexandria, Egypt

Dr. Yasser Sami Amer
EBCPGs Advisor & Trainer
yasser3amer@yahoo.com
yamer@ksu.edu.sa