LAWRA NTC
MAN 222
Quality Assurance in Health Care
ALEXIS KUURIDONG
2023
Learning Objectives
Components of quality
3 Perspectives on quality in health care and
significance of each
Quality assurance – definition
Steps of the quality assurance cycle
Application of quality assurance at the facility
and district/regional/national levels
What is Quality?
What is Quality?
1) efficacy: the ability of care, at its best, to
improve health; what is possible?
2) effectiveness: the degree to which attainable
health improvements are realized; what is
achieved?
3) efficiency: the ability to obtain the greatest
health improvement at the lowest cost;
4) optimality: the most advantageous balancing
of costs and benefits
What is Quality
5) acceptability: conformity to patient
preferences regarding accessibility, the
patient-practitioner relation, the amenities,
the effects of care, and the cost of care;
6) legitimacy: conformity to social preferences
concerning all of the above; and
7) equity: fairness in the distribution of care
and its effects on health.
3 Perspectives on Quality
1. Patient – individual view;
satisfaction with experience
of receiving care
2. Management – system view;
cost effectiveness,
efficiency, minimization of
iatrogenic illness and errors
3. Professional – view of clinician/nurse;
effectiveness, results of individual
actions, job satisfaction
What does the community need and want?
As the facility As the district As the consultants
requested it ordered it designed it
As the experts As the specialists What the community
created it installed it wanted
What is Quality Assurance?
The set of activities that are carried out to set
standards and to monitor and improve
performance so that the care provided is as
effective and as safe as possible.
Quality assurance is a systems approach.
The process of continual systems
improvement is also referred to as:
Continuous Quality Improvement (CQI)
What is Involved?
Quality Assurance depends on:
1. Adherence to standards, and
2. An ability to monitor and evaluate health
care delivery based on those standards.
3. An ability to make improvements based on
findings utilizing a strong supervisory
system
What Standards are Used?
Evidence based practices; best practices
National and International protocols and
practice guidelines or essential activities
packages
◦ e.g. IMCI case management guidelines, malaria case
management guidelines, TB management case
guidelines, etc.
Monitoring and Evaluating
Often dependent on the accuracy and
completeness of documentation
May be research driven
May be carried out at a facility, district,
regional, or national level
Monitoring & Evaluation
Areas for Monitoring and Evaluation in health
care:
◦ technical competence,
◦ access to service,
◦ effectiveness,
◦ interpersonal relations,
◦ efficacy,
◦ continuity,
◦ safety,
◦ amenities
Data Sources
Patient files
Information system data on OPD attendance
In-patient admission & deaths
Immunization coverage
Surveys (patient satisfaction)
Supervision
Complaints
Critical incidents
Indicators
The yardstick by which you are measuring the
problem; examples:
◦ What percentage of patients were attended
promptly in the A&E?
◦ What percentage of patients understand their
diagnosis?
◦ What percentage of patients understand their
medication regimen?
Factors Negatively Affecting Quality
of Health Care
Financial resources – national/regional
Human resources - nurse/patient ratio
Material resources – availability of
medications and treatments
Structural resources – few hospitals/clinics
in certain areas
Clinician/nurse fatigue
Lack of knowledge/skills
Communication/language
Attitude
Costs of Poor Quality Health Care
Wrong diagnosis Wasted time
Wrong treatment (patient and
Repeated OPD nurse)
Wasted treatment
visits
Prolonged illness Non-compliance
Iatrogenic illness Frustrated
Death patients
Low staff morale
Benefits of High Quality Health Care
Good health Health workers
outcomes understand patients
Patient satisfaction Improved
Value for money information flow
Patients utilize among staff
Good reputation of
services
appropriately/timel facility
y
Satisfied health
workers
