CQI in SME
CESAR TRONCO
OIC, Asst. Hospital for Nursing Services
West Visayas State University Medical Center
E. Lopez Street, Jaro, Iloilo City 5000
QUALITY ASSURANCE
OVERVIEW
RATIONALE
1 Quality improvement in health system needs to be organized systematically and
appropriately linked to accreditation and safety
2 Uphold quality literacy at all levels and promote just culture and policy
environment
3
From “quality control and assessment” to the definition of agreed and valid
standards, systematic and reliable measurement of performance, implementing
action for change, repeated measurement and continuous improvement in a cycle
4 Success of quality initiatives lies in producing people and organization work
CQI IN CDI 2023
QUALITY QUALITY
ASSURANCE CONTROL
Assurance: Control:
The act of giving confidence, An evaluation to indicate
the state of being certain or needed corrective responses;
the act of making certain. the act of guiding a process in
which variability is
Quality Assurance: attributable to a constant
The planned and systematic system of chance causes.
activities implemented in a
quality system so that quality Quality Control:
requirements for a product The observation techniques
or service will be fulfilled. and activities used to fulfill
requirements for quality.
Source:
http://asq.org/index.aspx
QUALITY QUALITY
ASSURANCE CONTROL
“ISO 9001 STANDARDS, “ISO 9001 STANDARDS,
CLAUSE 4.4.1” CLAUSE 4.4.2”
The organization shall establish, The organization shall maintain
implement, maintain and documented information to support
continuously improve a quality mgt the operation of its processes; retain
system, including the processes documented information to have
needed & their interaction, in confidence that the processes that are
accordance with the requirements of being carried out as planned
the standard
Source: ISO 9001:2015(en):Quality management systems
WHY QUALITY ASSURANCE IS IMPORTANT?
Poor results can
Affect patient safety and welfare due to:
• Inappropriate action or inaction
• Incorrect treatment resulted from
poor documentation
PURPOSE OF QUALITY ASSURANCE
To meet the rising expectations of Help exercise a regulatory
1 consumers of quality of services 5 function.
Help patients by improving quality Restricting undesirable
2 of care. 6 procedures.
Assess competence of medical
staff, serve as an impetus to keep
3 up to date and prevent future 7 Eliminating medical errors.
mistakes.
Bring to notice of hospital
administrations, about the
4 deficiencies and in correcting the
causative factors.
METHODS OF QUALITY ASSURANCE
A retrospective quality assurance A concurrent quality assurance
measures actual documented evaluates patient care while it is in
outcomes against desirable and progress.
valued outcomes.
Documentation of the caliber of
Data for documentation of actual care being delivered is obtained
outcomes are obtained from the through review of the patient’s
medical records of a specific chart, interview, observations, and
patient population after the examination of the patient.
patients have been discharged.
The advantage of concurrent
review is that it can provide
opportunities for improvement of
patient care while it is in progress.
COMPONENTS OF QUALITY ASSURANCE
Strategic or organizational level
1 dealing with the quality policy, objectives and
management and usually produced as the Quality
Manual
Tactical or functional level
2 dealing with general practices such as training,
facilities, etc
Operational level
3 dealing with the Standard Operating Procedures
(SOP’s) worksheets and other aspects of day to day
operations
MODELS OF QUALITY ASSURANCE
DONABEDIAN AN PDC
A A
DONABEDIAN MODELS/METHODOLOGY
Physical, financial and
organizational resources provided
for healthcare
Activities of a health system or
healthcare personnel in the
provision of care
rhythm
A change in the patient’s
current or future health
that results from medical
interventions
MODELS OF QUALITY ASSURANCE 01
ANA MODELS/METHODOLOGY
MODELS OF QUALITY ASSURANCE 02
PDCA MODELS/METHODOLOGY
MODELS OF QUALITY ASSURANCE 03
APPROACHES OF QUALITY ASSURANCE
GENERAL APPROACH SPECIFIC APPROACH
APPROACHES OF QUALITY ASSURANCE
GENERAL APPROACH SPECIFIC APPROACH
It involves a large governing or
official bodies’ evaluation of a
person or agency to meet
established criteria or
standards at a given time.
APPROACHES OF QUALITY ASSURANCE
APPROACHES OF QUALITY ASSURANCE 01
APPROACHES OF QUALITY ASSURANCE
Process by which the eligibility of
an entity for a particular job or
task is established by determining
if the entity has the specified
qualifications and fulfills the
defined requirement
APPROACHES OF QUALITY ASSURANCE 01
APPROACHES OF QUALITY ASSURANCE
Individual licensure is a contract
between the profession and the
state, in which the profession is
granted control over entry into
and exit from the profession and
over quality of professional
practice
APPROACHES OF QUALITY ASSURANCE 02
APPROACHES OF QUALITY ASSURANCE
Is an independent third-party
recognition than an organization
has the competence and
impartiality to perform specific
technical activities such as
certification, testing and
inspection
APPROACHES OF QUALITY ASSURANCE 03
APPROACHES OF QUALITY ASSURANCE
Is the third-party confirmation via
audit of an organization’s systems
or products such as ISO, JCI and
the like
APPROACHES OF QUALITY ASSURANCE 04
APPROACHES OF QUALITY ASSURANCE
GENERAL APPROACH SPECIFIC APPROACH
APPROACHES OF QUALITY ASSURANCE
GENERAL APPROACH SPECIFIC APPROACH
It involves a large governing or
official bodies’ evaluation of a
person or agency to meet
established criteria or
standards at a given time.
APPROACHES OF QUALITY ASSURANCE
GENERAL APPROACH SPECIFIC APPROACH
APPROACHES OF QUALITY ASSURANCE
01 Peer Review
Standard as a device Client Satisfaction
02 06
for Quality Assurance Survey
Audit as a tool for
03 07 Incident Review
Quality Assurance
04 Utilization Review 08 Quality Control
05 Evaluation Study 09 Quality Rewards
APPROACHES OF QUALITY ASSURANCE 01
AREAS OF QUALITY ASSURANCE
OUTPATIENT DEPARTMENT EMERGENCY MEDICAL SERVICES IN-PATIENT SERVICES
SPECIALTY SERVICES TRAINING
FACTORS AFFECTING QUALITY ASSURANCE
Absence of
01 Lack of Resources 06
Accreditation Law
Lack of Incident
02 Personnel Problems 07
Report
Improper Lack of Management
03 08
Maintenance Information System
Unreasonable patients Absence of Patients
04 09
and attendants Satisfaction Survey
Absence of well
05 10 Lack of medical Records
informed population
TYPES OF QUALITY ASSURANCE
CONTINUOUS
QUALITY
IMPROVEMENT
CESAR TRONCO
CREDENTIALS
CQI PROJECT
AREAS OF QUALITY ASSURANCE
OBJECTIVES
1 Understand the role and benefit of Continuous Quality Improvement (CQI)
2 Use PDCA tools in CQI Project to improve the quality of patient care and
services
3 Apply the process to develop a CQI Project
CQI IN CDI 2023
WHAT IS CQI?
WHAT IS CQI?
QUALITY QUALITY MANAGEMENT SYSTEM QUALITY OF CARE
IMPROVEMENT
Refers to an organizational Refers to a set of interrelated Refers to the degree to which
strategy that formally involves or interacting elements of an health services for individuals
the analysis of process and organization relating to the and populations increase the
outcomes data and the establishment of quality likelihood of desired health
application of systematic process which includes policies, outcomes and are consistent
efforts to improve performance objectives, planning, assurance with current professional
and improvement. knowledge.
CQI POLICY
GENERAL GUIDELINES
CQI shall be planned and identified as a priority of all health facilities
A along with the identified priorities of Universal Health Care of access,
coverage and financial protection.
B All health facilities shall implement a CQI Program at all levels of care
CQI shall be sustained by following a number of steps and principles
applied namely transparency, people centeredness, measurement,
C generation of information and investing on the workforce, all underpinned
by leadership and supportive culture.
A Quality Improvement (QI) TEam/Unit shall be organized and shall
D serve as an advisor body to the head of the health facility.
SPECIFIC GUIDELINES
A CQI Program Structure
B CQI Process
SPECIFIC GUIDELINES
A CQI Program Structure
1. The health facility shall have a unit that will oversee the
implementation of the planned activities of the program. Pending
approval of the Department of Budget and Management (DBM) on the
Proposed Staffing Standard, the unit shall be headed by a healthcare
worker trained in CQI. Support staff with CQI experience shall be
provided by the health facility. The CQI committee as mandated by
Department Circular No. 2018-0131 or the Revised Licensing
Assessment Tools for Hospitals, and Administrative Order No. 2012-
0012 or the Rules and Regulation Governing the new Classification of
Hospitals and other Health facilities in the Philippines, shall work with
the unit to ensure facility-wide implementation. In a local government
setting, a unit shall be designated to oversee the activities in all the
health facilities under its jurisdiction.
SPECIFIC GUIDELINES
A CQI Program Structure
2.Continuous Quality Improvement shall be institutionalized in the
policies, systems and processes of the health facility or in the LGU unit
governing the health care facilities.
3. Adequate and appropriate qualified staff shall be maintained.
Continuous capacity building programs shall be in place in line with the
development plan of the health facility.
4. Training to capacitate all staff on CQI shall be continuously scheduled in
coordination with the Professional Education, Training and Research
Unit (PETRU) or its equivalent.
SPECIFIC GUIDELINES
A CQI Program Structure
5. Conduct Annual Operational Planning shall be reflected in their
respective Work and Financial Plan (WFP) or as the case maybe. Funds
shall be allocated for CQI activities. The provision and maintenance of
quality healthcare services need not be expensive and/or dependent
on the capability of the facility.
6. Implementation of CQI shall be harmonized with ongoing initiatives to
pursue Quality Management System. However, certification or
accreditation from third parties (e.g. PGS, ISO and other international
accreditation bodies) is optional for facilities that do not have existing
requirement for such.
SPECIFIC GUIDELINES
A CQI Program Structure
B CQI Process
SPECIFIC GUIDELINES
B CQI Process
1. The systems and processes ofthe health facilities shall adhere to the elements of
Quality (ANNEX B).
2. Health facilities shall:
A. Implement a computerized integrated health information and management
system;
B. Benchmark with the standards and policies published by the DOH including the
programs such as, but not limited to, Patient Safety, Infection Control, People
Centeredness and the 12 Manuals on the Standard of Operations issued by the
Health Facility Development Bureau.
3. The program shall document CQI activities for future best practice reference, and
report outputs and outcomes as tool for monitoring and evaluation.
ELEMENTS OF CQI PROGRAM
PEOPLE
01 05 EQUITY
CENTEREDNESS
02 EFFECTIVENESS 06 ACCESS
03 SAFETY 07 APPROPRIATENESS
04 EFFICIENCY
ELEMENTS OF CQI PROGRAM
PEOPLE
01 05 EQUITY
CENTEREDNESS
02 EFFECTIVENESS 06 ACCESS
03 SAFETY 07 APPROPRIATENESS
04 EFFICIENCY
PEOPLE CENTEREDNESS
“An approach to care that focuses on what is
valued by the client, individuals, families, and
communities, and sees them as participants as
well as beneficiaries of trusted health systems that
respond to their needs and preferences in holistic
and humane ways” -(WHO, 2016) -
EMPHASIS
ELEMENTS OF CQI PROGRAM 01
ELEMENTS OF CQI PROGRAM
PEOPLE
01 05 EQUITY
CENTEREDNESS
02 EFFECTIVENESS 06 ACCESS
03 SAFETY 07 APPROPRIATENESS
04 EFFICIENCY
EFFECTIVENESS
Delivering health care and products that improve
health outcomes for individuals and communities,
based on need as supported by evidence-based
knowledge.
ELEMENTS OF CQI PROGRAM 02
ELEMENTS OF CQI PROGRAM
PEOPLE
01 05 EQUITY
CENTEREDNESS
02 EFFECTIVENESS 06 ACCESS
03 SAFETY 07 APPROPRIATENESS
04 EFFICIENCY
SAFETY
Delivering health care and product which minimize
risks and harm to service and medical product
users; health care and products that ensure that
the patients and staff do not suffer undue harm
from the treatment itself and from the manner it
was given.
ELEMENTS OF CQI PROGRAM 03
ELEMENTS OF CQI PROGRAM
PEOPLE
01 05 EQUITY
CENTEREDNESS
02 EFFECTIVENESS 06 ACCESS
03 SAFETY 07 APPROPRIATENESS
04 EFFICIENCY
EFFICIENCY
Delivering health care and products in a manner
which maximizes resource use and avoid waste
(technical efficiency); resources are used
appropriately to ensure optimum benefits for
patients and the population (allocative efficiency).
ELEMENTS OF CQI PROGRAM 04
ELEMENTS OF CQI PROGRAM
PEOPLE
01 05 EQUITY
CENTEREDNESS
02 EFFECTIVENESS 06 ACCESS
03 SAFETY 07 APPROPRIATENESS
04 EFFICIENCY
EQUITY
Implies considerations of fairness so that in some
circumstances, individuals will receive more care
than others to reflect differences in their ability to
benefit or in their particular needs.
Regardless of socio-economic status, religion, gender, race,
ethnicity, political inclination, or geographical location.
ELEMENTS OF CQI PROGRAM 05
ELEMENTS OF CQI PROGRAM
PEOPLE
01 05 EQUITY
CENTEREDNESS
02 EFFECTIVENESS 06 ACCESS
03 SAFETY 07 APPROPRIATENESS
04 EFFICIENCY
ACCESS
Ability of the people to obtain health care and
products that are timely, geographically and
financially reasonable, socio-culturally sensitive
and provided in a setting where skills and
resources are appropriate to medical need.
ELEMENTS OF CQI PROGRAM 06
ELEMENTS OF CQI PROGRAM
PEOPLE
01 05 EQUITY
CENTEREDNESS
02 EFFECTIVENESS 06 ACCESS
03 SAFETY 07 APPROPRIATENESS
04 EFFICIENCY
APPROPRIATENESS
Defined as that care is effective (based on valid
evidence); efficient (cost- effectiveness); and
consistent with the ethical principles and
preferences of the relevant individual, community
or society.
ELEMENTS OF CQI PROGRAM 07
APPROPRIATENESS
Appropriateness contains a judgment regarding
care at different decision levels (such as health
care delivery, and research and development) that
summarizes clinical, public health, economic,
social, ethical and legal considerations.
ELEMENTS OF CQI PROGRAM 07
CQI PROCESS
PDCA MODELS/METHODOLOGY
CQI PROCESS
BENEFITS OF PDSA CYCLE
CQI PROCESS
BENEFITS OF PDCA CYCLE
PLAN
PDCA MODELS/METHODOLOGY 07
STEP 1 ORGANIZE THE TEAM
Identify & involve stakeholders
01
(e.g. physicians, nurses,
admin…etc.)
02 Cover all related departments to
the improvement initiative
Select team members who best
03 do or know the process to be
improved
PDCA MODELS/METHODOLOGY
STEP 2 PROBLEM IDENTIFICATION
Find a process that needs
01
improvement
02 Use Brainstorming
PDCA MODELS/METHODOLOGY
STEP 2 PROBLEM IDENTIFICATION
OTHER METHODS/SOURCES OF INFORMATION:
01 Complaints
02 Incident reports
Environment of Care (EOC) round
03
findings
04 Surveys
05 Research Findings
Findings during Executive Rounds
06
PDCA MODELS/METHODOLOGY
STEP 3 PRIORITIZE THE PROBLEM
UTILIZE THE
PRIORITIZATION
MATRIX TOOL
PDCA MODELS/METHODOLOGY
STEP 3 PRIORITIZE THE PROBLEM
PDCA MODELS/METHODOLOGY
STEP 3 PRIORITIZE THE PROBLEM
PDCA MODELS/METHODOLOGY
STEP 3 PRIORITIZE THE PROBLEM
EXAMPLE
PDCA MODELS/METHODOLOGY
STEP 4 SELECT THE HIGHEST SCORE
AFTER THE PRIORITIZATION OF THE
01 PROBLEM USING THE PRIORITIZATION
MATRIX TOOL
Choose the top three problems with the
02
highest score being the priority projects
PDCA MODELS/METHODOLOGY
STEP 5 DESCRIBE AND QUANTIFY THE PROBLEM
PROVIDE A BRIEF AND
CONCISE STATEMENT
ABOUT THE PROBLEM
IDENTIFIES
PDCA MODELS/METHODOLOGY
STEP 6 CLARIFY THE PROBLEM
CHECK THE CURRENT PROCESS:
01 CHECK THE POLICY
02 USe flowchart to describe workflow
(optional)
PDCA MODELS/METHODOLOGY
STEP 6 CLARIFY THE PROBLEM
DO ROOT CAUSE ANALYSIS (RCA)
BRAINSTORMING FISHBONE 5WHYS STRATEGY
METHOD
PDCA MODELS/METHODOLOGY
STEP FORMULATE SOLUTIONS
701 BASED ON RCA
02 Brainstorming
03 Solutions/strategies from other hospital
PDCA MODELS/METHODOLOGY
STEP BEST PRACTICE/BENCHMARK
8
LOOK FOR RELATED LITERATURES
(EVIDENCE-BASED)
Have a benchmark for best practice
PDCA MODELS/METHODOLOGY
STEP ESTABLISH THE GOALS
7 USING S.M.A.R.T CRITERIA TO DEFINE A CLEAR GOAL
S = SPECIFIC
M= MEASURABLE
A = ACHIEVABLE
R = REASONABLE
T = TIME-BOUND
PDCA MODELS/METHODOLOGY
DO
PDCA MODELS/METHODOLOGY
DO
PDCA MODELS/METHODOLOGY
DO
EXAMPL
E
PDCA MODELS/METHODOLOGY
CHECK
PDCA MODELS/METHODOLOGY 07
CQI PROCESS
MEASUREMENT IN PDSA CYCLE
PROFILE
CQI PROCESS
CQI PROCESS
CQI PROCESS
ACT
PDCA MODELS/METHODOLOGY
CASE SCENARI
PLAN
PLAN
PLAN
PLAN
PLAN
PLAN
PLAN
PLAN
PLAN
PLAN
DO
DO
CHECK
CHECK
CHECK
CHECK
CHECK
ACT
CQI PROCESS
PDCA MODELS/METHODOLOGY
THANK YOU
PRESENTATION BY CESAR TRONCO
