Quality Management in Healthcare

1. What are the steps in improving patient quality?

A- The steps in improving Patient quality are as follows:
Step 1- Discover quality features
The first step is to find out quality features, their relative importance to patients and
threshold levels for those who have received the service. It must be made clear that
selection of important quality features should be by the patients themselves and not
from the professional staff or managers of the organisation.
This can be obtained from feedbacks, patient participation groups and suggestions or
comments from patients and their carers.
Consequently special market research methods are used to discover them. These
include:
Focus groups using a representative group of patients
Critical incident interviews and analysis
Flow-process analysis
The validity and accuracy of the method is not the most important consideration. The
choice of the method should be influenced by its cost effectiveness, its credibility and
its likely use by service providers to make continual improvements and to judge the
effect of their changes over time.
Step 2- Set patient quality standards
The next step is to use this research to set standards. The basic principle is to decide
how to measure each selected quality feature. The standard is defined as the level of
performance to be achieved according to this measure. A measure of this feature is the
average time between the clients arriving at the hospital reception and seeing the
doctor.
Step 3- Measure performance
Subjective measurements of the health service can be very difficult. It is easy to
measure waiting times, length of stay in hospital and number of visits prior to
discharge but much more difficult to ascertain how much satisfaction a patient obtains
following treatment that may be technically correct but results in unwanted side
effects.
Another problem with measurements in health care is that in addition to relieving
clinical symptoms and prolonging survival, a primary objective of any health
intervention is the enhancement of quality of life and wellbeing. For those individuals

diagnosed with a chronic condition whose cure is not attainable and therapy may be
prolonged, quality of life is likely to be the essential outcome.
One of the methods by which clinical outcomes can be assessed with a fair degree of
accuracy is Health related quality of Life (HRQoL). This is being increasingly used as
an outcome measure in clinical trial research. It is more specific and appropriate; it
refers to patients appraisals of their current level of functioning and satisfaction with
it compared to what they perceive to be ideal.

2. Explain Quality Management Cycle

A- In quality management cycle a service first selects the most important features of
takes action if performance does not meet standards. The cycle is then repeated with
these standards and takes action if performance does not meet standards.

1) select
quality
features

5) Take
Action

Quality
Managem
ent Cycle

4) Present
& Analyse
performan
ce Data

2)
Formulate
standards

3)
Measure &
Document
Performan
ce

Inputs from service strategy

Many of the quality features that are the start of the cycle come from market
analyses and from quality specifications in purchaser contracts.
Select quality features
Quality features are definitions of those aspects of service that are critical to
each dimension of service quality at a particular time. A service will choose
quality features at first that will be different from those selected later. At the
start, only a few will be picked out so that the full cycle can be established.
Formulate standards
In this part of cycle, standards are formulated for each feature. In doing so, the
service addresses any conflicts between standards and picks out areas where
changes may improve all dimensions of quality at the same time. Formulation
of standards is crucial in quality management.
Measure and document performance
Once the service has standards, it is then possible to measure its relative
performance.
Analyse and present performance
The records are used to analyse and present performance. These are posted or
made available to all staff and can be easily understood.
Action
The point of setting standards and measuring performance is to take action
either congratulatory or corrective.
Reassessment
Once quality performance is stable and standards are being met, the cycle then
returns to the quality features apart. The purpose of this cycle is to ensure that
quality methods are used in the right way and that service has a process for
continuously improving quality.

3. What is accreditation? What are its benefits? How a successful accreditation system
helps hospital? Explain in detail.
A- It is a self assessment and external peer assessment process used by health care
organizations to accurately assess their level of performance in relation to establish
standards and then to implement ways to continuously improve it.
Accreditation is the process of evaluating and recognising excellence for health care
delivery for whole hospitals, integrated service delivery networks and other such
systems as well as professional activities. It is a voluntary process of development and
education through consultation, participation, and professionalization and independent
peer review.
Benefits of accreditation
Greater efficiency
More accountability & responsible governance in hospitals
Overcome quality of care deficiencies in their practices

Prevents negligence
Benefits for patients
Benefits for hospital
Benefits to paying and regulatory bodies

It benefits the hospital as accreditation is an effective tool to standardize the quality

of health care services provided by them. Put simply, accreditation is public
recognition of the achievement of accreditation standards by a health care
organization, demonstrated through an independent external peer assessment of that
organizations level of performance in relation to these standards.
4. Write short notes on:
A) EFQM excellence model

EFQM stands for European Foundation for Quality Management. It is used to

assess an organization against certain criteria. Qualified assessors evaluate a
company and its practices and produce an assessment score. In the assessment
process, a maximum of 1000 points are available. These points are divided equally
between the enablers and the results.
The foundation is in itself an extraordinary example of international collaboration
of like minded organisations dedicated to quality. Started by the executives of a
dozen companies in the eighties, it has become a driving force for competitiveness
on the global scene.
There is a growing wealth of evidence to show that organisations that score well
against the EFQM model deliver outstanding business results. Using the models
criteria as a benchmark will lead to an improved business performance.

B) Types of medical audit

Medical audit method can be classified into four types:

Internal retrospective audit: Simplest and most common, especially in the

United Kingdom. It uses past patient records.
External retrospective audit: It is undertaken by or in co operation with one or
more outside groups.
Concurrent active audit: It is a review of the care of patients still under care.
Such reviews are usually conducted in relation to established procedures of
protocols as in clinical trials.
Criterion based audit: It involves agreeing explicit and measurable criteria of
good practice for selecting cases, and for comparing what is done against them.
By this process, it is possible to compare health care performance between
different units.