Quality Management in Healthcare Services

Unit 5

Unit 5

Quality Control in Healthcare Services

Structure:
5.1 Introduction
Objectives
5.2 Introduction to Quality Control
5.3 Quality Control in Healthcare
Methods to evaluate quality of healthcare
Need for quality control in healthcare
5.4 Indicators of Quality Control in Healthcare
Ten elements for creating solid healthcare indicators
Quality inspection
Roles of different accrediting organisations
5.5 Advantages of Quality Control
5.6 Disadvantages of Quality Control
5.7 Summary
5.8 Glossary
5.9 Terminal Questions
5.10 Answers
5.11 Case-Let

5.1 Introduction
The previous unit dealt with seven quality and management tools. We have
also dealt with statistical and design tools as well as the benefits of quality
tools and techniques in healthcare. This unit focuses on quality control in
healthcare. It also describes the indicators of quality control in healthcare. It
assesses the advantages and disadvantages of quality control in healthcare
that are of vital importance in quality management.
Objectives:
After studying this unit, you should be able to:
define quality control
discuss quality control in healthcare
describe the indicators of quality control in healthcare
assess the advantages and disadvantages of quality control in
healthcare

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5.2 Introduction to Quality Control

Quality control is a procedure or set of procedures used to ensure that a
manufactured product or performed service adheres to a defined set of
quality criteria or meets the requirements of the client or customer.
Quality control in healthcare focuses on the process of producing the
service with the intent of eliminating problems that might result in risk of
injury to patients.
Quality control ensures the maintenance of proper standards, especially in
terms of inspecting the product or service to meet customer expectation and
satisfaction. For example, a defective part of biomedical equipment must be
replaced or repaired to meet the quality standards of performance. It is also
important to ensure that the defects are not repeated again in the product or
service. Quality control in healthcare involves the activities from the care
provider to determine the patients requirements and satisfaction on
services.
Self Assessment Questions
1. Quality control is a set of _______ used to ensure that a product or a
service meets the standard criteria and requirements of a customer.
2. Quality control maintains the proper standards in manufactured
products or services to meet customer expectation. (True/False)
3. The _______ of a healthcare involves the activities from the care
provider to determine the patient requirements and satisfaction on
services.

5.3 Quality Control in Healthcare

Efforts to examine the quality in healthcare are not in progress for two
reasons:
Healthcare organisations feel that the tools to examine performance are
not available.
Healthcare organisations remain unconvinced about the problems that
exist in examining performance. So multiple approaches are made to
examine the quality of healthcare and new methods have been sought
to obtain good results in the health status of patients.

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The World Health Organisation (WHO) has identified the four components of
quality in healthcare:
Professional performance (technical quality).
Use of resources (efficiency).
Risk management (risk of injury or illness) associated with the service
provided to patients in healthcare.
Patient satisfaction with the service provided.
5.3.1 Methods to evaluate quality of healthcare
A healthcare organisation evaluates quality to ensure patient satisfaction. It
is important for an organisation to consider the following before evaluating
the quality of healthcare:
A pre-determined purpose.
A clear beginning and end.
Data Collection and analysis of information that leads to a decision.
A form of comparison (for example to standards).
A purpose for making more informed decisions and/or assessing if goals
are met.
Generally, it is the peers (including organisations and professionals), private
professional authors/consultants, purchasers/insurance companies, patients
and government agencies that evaluate the quality of a healthcare in terms
of equipments, staffing levels, budgets, drugs, facilities, service utilisation,
efficiency, technical quality, risk, safety and patient satisfaction. The
methods used to evaluate quality of healthcare must be:
Valid and reliable
Easy to understand
Inexpensive
Resistant to manipulate
Related to better health outcomes
Quality evaluation from the perspective of patients and professionals
Super-speciality healthcare organisations involve multiple professionals,
disciplines and institutions. Each professional plays a specific role assigned
to him/her. Patients who visit this healthcare are able to provide feedback on
the complete range of service. This patient perspective feedback is used as
a source for evaluating the quality of healthcare.
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Patients expect a quality service in terms of diagnosis, care and treatment

from clinical professionals. The patients expectations and experiences are
important to professionals for evaluating the quality of healthcare. They look
for how much their services match and meet the expectations and
experiences of patients and try to avoid quality gap in delivering the services
to patients. Patients expectations can be identified by different methods like
patients survey and feedback.
The following are the methods to evaluate the quality of healthcare:
Self-assessment method - It is a comprehensive, systematic, and
regular review of an organisations activities and results. An
organisations staff or management follow this method to ensure that the
services have met the agreed quality standards. Figure 5.1 shows the
sample of self-assessment sheet of a hospital. Self-assessment method
helps an assessor to identify the areas of good or weak process and
services of a healthcare organisation. For example, the method is used
for evaluating technical quality of a healthcare to check and ensure
proper functioning of the following:
o Building structure
o Ventilation systems
o Physical factors
o Noise environment
o Radiation (medical and natural)
o Perceived indoor air quality
o Location of the patient and the spaces needed in the building
o Safety
o Waste management
o Quality of cleaning
o Water and sewage systems
o Verification of the criteria

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Figure 5.1 depicts the sample of a self-assessment sheet.

Figure 5.1: The Sample of a Self-Assessment Sheet

Method of accreditation It is usually the non-governmental

organisations that use this method to evaluate and recognise the quality
of healthcare from the perspective of organisational management. It also
involves professional, patient and staff perspectives. Peers of
professionals trained in evaluating techniques evaluate the structures
and processes of healthcare quality services. This results in
improvement of services in regulatory and market share. For example,
peers evaluate an organisations arrangements to assure the quality of
its products or services against a set of agreed standards. Joint
Commission International (JCI), the National Accreditation Board for
Hospitals and Healthcare Providers (NABH) and Accreditation
Commission for Healthcare (ACHC) are some of the accreditation
organisations of healthcare services.

Method of certification - An authorised body (government or nongovernmental organisation) uses this method to evaluate and recognise
an individual, a programme or an organisation meeting pre-determined
requirements and criteria. Professional quality authors use this method
from the organisation perspective to evaluate the quality and
performance (practice) of healthcare to check the adherence to predefined quality standards. These results in quality improvement and

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increase in market share. International Organisation for Standardisation

(ISO) is an example of a certifying organisation that issues certificates
and guides health professionals, providers, researchers, agencies and
policy makers to achieve excellence in healthcare delivery and to
improve quality of care.

Method of licensing - A government authority uses this method to grant

permission for an individual practitioner, a piece of equipment or a
healthcare organisation to operate or engage in an occupation or
profession. Licensing regulations are generally established to ensure
that an organisation or individual meets quality standards to protect
health and safety of patients. Individual licensure is usually granted after
some form of examination or proof of education and may be renewed
periodically through payment of a fee and/or proof of continuing
education or professional competence. Organisational licensure is
granted following an on-site inspection determining the organisations
ability to meet minimum health and safety standards. Maintenance of
licensure is an on-going requirement for the healthcare operation to
continue to operate and care for patients. Government auditors and
peers use this method from the governmental, professional, and
organisational perspective to evaluate qualifications, structures and
processes of a healthcare and staff.

The main difference between accreditation, certification and licensing is:

Accreditation is a procedure by which an authoritative body like JCAHO
formally recognises that a healthcare organisation is competent to carry out
specific tasks. Certification is a procedure by which a third-party like ISO
gives a written assurance that the healthcare services conform to specific
requirements. Licensing is a procedure through which licensing bodies or
agencies that grants an individual to practise in a healthcare profession and
use the title of a healthcare practitioner.

Method of supervision - Technical or managerial persons, who have

the knowledge to address an issue, use this method to follow-up and
support the right kind of service delivery. The supervisor provides
reliable advice to solve problems and give feedback to improve the
quality of service. The supervisor also gathers and verifies information
about the delivered services. Supervision is used from the professional

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and organisational perspective to evaluate clinical staff, managers and

peers performance, knowledge, skills and attitude. This results in
improvement of competency or performances of managers, staff and
peers of a healthcare organisation.
Figure 5.2 outline the methods to evaluate quality of healthcare.

Figure 5.2: The Five Methods to Evaluate Quality of Healthcare

5.3.2 Need for quality control in healthcare

It is important for a healthcare management to establish quality levels for the
consistent provision of services. The success of a healthcare depends upon
patient satisfaction. Lack of quality control can have consequences on the
health and safety of patients and affects the operation of the healthcare
making a difference in the healthcares financial success.
A healthcare organisation needs quality control to deliver, evaluate, maintain
and improve high quality services. Quality control is an important component
of a healthcare management. Quality control measures the extent to which
an organisation and individuals achieve and maintain desired outcomes. It
also helps in tracking patient-sensitive process and outcome issues on
routine basis. It measures and tracks outcomes of groups of comparable
patients using epidemiological techniques, it provides feedback on the
delivered services of healthcare and utilises the data to manage the
process, evaluate effectiveness, and facilitate further planning and
improvements.
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Quality control, for example, measures the actual performance of a

healthcare to evaluate the technical quality and services, and thus
establishes standards to improve the service and solve the problems.
Self Assessment Questions
4. A healthcare organisation evaluates the quality to ensure the
__________.
5. A Self-assessment method is not a comprehensive method for
reviewing an organisations activities and results. (True/False)
6. An authorised body uses _________ method to evaluate and recognise
an individual, a programme or an organisation meeting pre-determined
requirements and criteria.
7. Licensing method is used to grant permission for an individual
practitioner, a piece of equipment or a healthcare to operate or engage
in an occupation or profession. (True/False)

Activity: 1
Consider that you are the head of the quality team of a hospital. Identify
the methods that are necessary to evaluate the quality of services and
performances of the medical and non-medical staff of the hospital.
(Hint: Refer to section 5.3.1 Methods to evaluate quality of control
section.)

5.4 Indicators of Quality Control in Healthcare

Indicators of quality control are the norms, standards, and other qualitative
and quantitative measures used in determining the quality of healthcare.
Quality control indicators are used to determine and monitor the quality of a
healthcare organisations performance. Indicators are measurable and
relates to the outcome of patient care or staff performance. The following
are three categories of quality control indicators.
Administrative quality control indicators A healthcare management
must identify and solve problems. A healthcare organisations policies,
procedures, and other management actions regulate the administrative
activities to assure safe and efficient staff performance. Quality control
checks must be performed regularly to determine the quality of
workmanship and service to the patients. For example, a healthcare
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management must always administer the clinical staff performance in

treating malaria patients and also must check the quality performance of
the staff.

Patient satisfaction quality control indicators Patient satisfaction is

important for the success of a healthcare organisation. Indicators of
quality control help in measuring the quality of services delivered to
patients based on patients feedback, complaints and experiences with
clinical and non-clinical staff. For example, patient satisfaction quality
control indicators related to patient care and complaints help a
healthcare staff to deliver the service well, to handle the equipments well
and to improve the quality of services to patients.

Technical quality control indicators A healthcare organisation

requires staff involvement in problem-solving and in contributing to
technical quality services. They must be given opportunities and
incentives for solving problems and for making systematic decisions.
Empowerment enables everyone in the organisation to take personal
responsibility in their performance and service. A few examples of
technical quality are maintenance of water and sewage system,
ventilator system and well handling of biomedical equipments. For
example, technical quality indicators related to technical performance of
the staff helps a lab technician to perform his/her lab activities well and
also to solve the problems. The following are the principles to empower
the staff to contribute towards technical quality:
A person doing the technical job must know how to do it.
The clinical or non-clinical staff must fix the problem at the lowest
capable level in the organisation.
A healthcare organisation must encourage its staff to meet and
exceed the expectations of the patients requirements.

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Figure 5.3 shows the three categories of quality control indicators.

Figure 5.3: The Three Categories of Quality Control Indicators

5.4.1 Ten elements for creating solid healthcare indicators

Indicators in a healthcare service monitors and evaluate performance and
quality of services delivered to patients. An indicator of a quality control
helps in quality improvement and also supports the change in the structure
and process of a healthcare service. So, it is very essential to build solid
indicators. The ten elements for creating solid healthcare indicators are:
Type of data A healthcare must select the patient-satisfaction data
that provides whole information on services provided to patients as the
type of data to measure and evaluate quality. The patient data must be a
continuous data and the accurate way to measure this data is using a
percentage (%). Understanding and selecting data type is the most
important step in creating a healthy indicator. For example, the number
of out-patient flow to the hospital.

Indicator name A useful indicator name must be selected to avoid a

statement of judgement. For example, the patient must not wait for a
long time. The indicator name must include the unit of measure and
must be descriptive in its measurement. The indicator name must
convey a clear meaning to a reader. For example, percentage of outpatient flow to the hospital and average minutes wait in ultrasound
scanning room.

Purpose A selected indicator must explain its purpose for collecting

information of patient satisfaction. It is important to document the
purpose of the indicator as a monitoring device or as a standard created
to be used within the healthcare. For example, a hospital must state the
purpose of data collection to the outpatients.

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Owner The information of owner and his/her description about an

indicator is collected continuously and accurately in a healthcare.
Generally, it is a person in leadership will be the key point for answering
questions about the indicators performance. The ownership must be
documented so that the owners of indicators take the responsibility of
answering questions and learning from data. More than one person for
each indicator creates confusion about responsibility. For example, the
chairperson of a healthcare management is responsible for
management level indicators related to financial and revenue aspects of
healthcare service.

Level Indicators are of three levels: big dots, drivers and project.
o Big dots level act as the crude measures of an organisations
mission. For example, the percentage of mortality in a hospital.
o Driver level is any mid-level indicator that supports the big dot. For
example, the percentage of typhoid mortality in a hospital.
Indicators at the big dot and driver level are large for making
improvement efforts.
o Project level indicator is used to make improvement efforts and to
support the higher-level driver indicator. For example,
administering antibiotics to reduce the percentage of typhoid
mortality in a hospital. Defining the level of an indicator helps the
creator and the reader to understand its role in a healthcare
organisations mission.

Kind An indicator is present in three kinds of measures. They are:

o Process A process measures the aspect of a step or a
procedure within a process. For example, a patient suffering from
malaria undergoes a number of lab tests in a hospital.
o Outcome An outcome measures the overall progress and gives
the end result. For example, Doctors diagnose malaria through the
results of lab tests.
o Balance Balance measures, monitors and provides guard
against sub-optimisation. For example, the average length of
admission of a patient suffering from malaria in a hospital helps to
monitor and guard the health-status of patient.

Operational definition Any form of documenting an indicator is the

operational definition. According to Lloyd, an operational definition is a

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description, in quantifiable terms, of what to measure and the specific

steps needed to measure it consistently. It removes anxiety form those
who are not sure of what it is and helps to collect data. An effective
operational definition is established when more people are able to
observe the same phenomenon, and obtain the same results. For
example, a healthcare must document its treatment procedures for each
illness or disease which helps its clinical staff to follow the same
procedures and to derive the same results.

Where the data reside It is necessary to document the exact location

of data. When a data is extracted from information systems, one must
know to run a screen, or module, or report title. This step supports the
consistency of measurement and reduces anxiety in data collectors. For
example, a healthcare front office staff must store the information of
patients depending on the type of treatment or illness.

Persons responsible for collecting and entering data When an

indicator is the output of a report or a document, it is important to decide
the person to run a report and to enter the data into the database. For
example, a front office staff of a hospital must collect and enter the
information of each patient in terms of his/her age, address and the
contact number in the Hospital Information System (HIS).

When to stop It is important to decide the time or period for stopping

the collection of an indicator. Generally, healthcare persons in
leadership are hesitant to stop collecting indicator. So it is necessary to
agree on when to stop collecting an indicator as it creates an ambiguity
at the end. For example, a healthcare must define a standard time for
the patients to visit the hospital, so that the front office staffs, who are
asked to collect the data of outpatients, can decide and stop the
collection of outpatients data at the end of the day.

Before collecting data, one must take the time to clearly understand what is
being measured and hence avoid rework and frustration. These are the
main elements which help in creating solid healthcare indicators.
5.4.2 Quality inspection
The term inspection means the measurement of quality of service provided
in a healthcare organisation. An inspection determines proper quality of care
and service in an organisation. In quality control of healthcare, the role of
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inspection is to verify and validate the performance and service data. The
healthcare service and performance must be inspected to ensure that they
meet the requirements and expectations of the patients. It is a good
business practice to control the problems that occur in the quality services.
The aim of most healthcare organisations is:
To provide patients the highest quality healthcare in a cost-effective
manner.
To function within the stated guidelines of regulatory agencies,
accrediting bodies, and government specifications.
A quality inspection helps to identify the needs of a healthcare organisation
and to maintain the physical condition of the facility. The purpose of quality
inspection in a healthcare is to improve the performances and services
provided by its staff to the patients. The objective of quality inspection in a
healthcare is to:
Provide services to patients in a cost-effective manner.
Ensure and maintain the patient care.
Improve the quality of patient care practices and professional
performance using reliable and valid data.
Ensure the performance of tasks of all clinical, non-clinical, technical and
administrative staff.
Provide hygiene and safe environment for patients, staff and visitors.
Quality inspection is an integral part of the provision and management of
services. When there is an administrative or a technical crisis in a
healthcare organisation and the evaluation method is delayed, it is in this
situation the quality inspection is undertaken in a healthcare organisation. It
is also important to decide who must inspect the quality control of a
healthcare organisation. Generally, it is a person, who is technically
qualified, from the organisation itself or from outside, who is responsible for
the inspection. An outside person is suitable for inspection as he/she is
likely to be more objective and can give fair measures and results. But an
inside person who inspects his/her own healthcare are more likely to be
biased as they are familiar with the internal problems and realities.
Quality inspection in a healthcare organisation is made through recording
and reporting procedures of clinical and non-clinical staff, through analysis
of the patient surveys and through staff surveys. It enables the management
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to make a quick response to problems and meet the satisfaction level of

patients.
5.4.3 Roles of different accrediting organisations
According to the Joint Commission of the Accreditation of Healthcare
Organisations (JCAHO) Accreditation is a process in which an entity,
separate and distinct from the healthcare organisation, usually nongovernmental, assesses the healthcare organisation to determine if it meets
a set of standard requirements designed to improve quality of care.
Accreditation helps to ensure the quality of a healthcare organisation in
terms of standards, competency and ethics. Accreditation standards are
optimal and achievable. Accreditation provides an organisation a
commitment to improve the quality of patient care and services, ensure a
safe environment and work to reduce risks to patients and staff.
Accreditation is seen as an effective quality evaluation and management
tool. It is given as a certification to healthcare organisations or practitioners
to confirm that they have passed the accreditation process successfully.
Accreditation promotes the following services:
Certification from a recognisable accreditation organisation.
Availability of trained physicians and care teams.
Affiliations with reputable healthcare organisations, facilities and
teaching hospitals.
Provision of clinical information technologies.
The accreditation of a healthcare organisation provides a sense of security
to patients and their rights are respected and protected in these accredited
healthcare organisations. The following are the different accrediting
organisations that play an important role in the improvement of quality of
services for patients in a healthcare organisation.
JCI Accreditation
Joint Commission International (JCI) is an accrediting organisation based in
the United States (US) and is a part of the Joint Commission on the
Accreditation of Healthcare Organisations (JCAHO). It assesses a
healthcare facility to make sure it meets basic standards and requirements
involved in providing the quality of healthcare. It certifies all hospitals in the
US and other international hospitals located outside the US. JCI is the most
accepted healthcare benchmark and supports quality services of healthcare
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organisations. JCI has derived its standards and qualifications in terms of

structure, outcome and process for medical facilities. It works closely with
hospitals, patients, clinical staff, non-clinical staff, insurance companies,
government agencies, legal experts and medical consultants to provide
standards, rules and process for the consistent and reliable services to
patients.
The standards of JCI help a healthcare to support and improvement in
patient care and safety. It reduces risks, adverse effects and consistently
improves methods and procedures of a healthcare. Healthcare
organisations undergo the certification of JCI on a periodic basis. The
guidelines of JCI approve quality service not only in healthcare, but also in
laboratories, rehabilitation centres and assisted living environments. JCI
accredited healthcare organisations offer peace of mind and satisfaction to
patients.
NABH accreditation
The National Accreditation Board for Hospitals and Healthcare Providers
(NABH) is an essential board of Quality Council of India. NABH establishes
and operates accreditation programmes for healthcare organisations. The
board is structured to meet the requirements and needs of patients.
International Society for Quality in Health Care (ISQua) accredited the
second edition of NABH standards for hospitals which were released in
November 2007. NABH standards are accepted as a global benchmark. The
hospitals with NABH accreditation have international recognition.
NABH supports the stakeholders, industry, consumers and Government in
functioning. NABH standards focus on quality improvement and ensure the
safety and quality of healthcare in hospitals. The NABH accreditation
standards are of two groups:
The group related to patient care. For example, assessment, medication
management and education.
The group related to organisational structures. For example, leadership,
facility management, information management and human resources.
The NABH accreditation helps a healthcare organisation to get good
benefits from the accreditation in the following ways:
Ensures high quality of service and patient safety.
Focuses on the protection of rights of patients and medical ethics.
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Enables a hospital for continuous improvement and commitment to

quality service.
Improves the performance of clinical and non-clinical staff.
Builds confidence among patients and helps in achieving quality
healthcare services.
Activity: 2
Consider that you are working in the inspection team of a hospital that
checks the quality of services. Identify the role of inspection in the quality
control of services to ensure patient satisfaction.
(Hint: Refer to section 5.4.3 Roles of different accrediting organisations
section.)

Self Assessment Questions

8. Quality control _____________ are used to determine and monitor the
quality of a healthcare performance.
9. The accurate way to measure the patient data is using a percentage.
(True/False)
10. The role of inspection in quality control is to ______ and _______ the
staff performance and service data.
11. Accreditation helps to ensure the quality of a healthcare in terms of
standards, _______ and _______.

5.5 Advantages of Quality Control

Quality control must assess and evaluate a structure, a process or an
outcome of a healthcare. The quality control helps a healthcare organisation
for the continuous improvement and ensures the safety and requirements of
the patients. The advantages of quality control are:
Ensures provision of services to meet or exceed patients requirements.
Provides feedback for quality improvements. So the patients can know
more about the services and the professionals of a healthcare
organisation.
Provides the information on the structure, process and outcomes of the
service provided to patients.
Provides quick solutions to patient questions or concerns and helps a
healthcare organisation to provide cost-effective services to patients.
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Measures the samples of collected data in larger numbers and helps the
quality management to solve the problems quickly and permanently. It
records the data in terms of percentage (%).
Monitors the process of clinical/non-clinical staff providing service and
their outcome. It also helps in tracking patient-sensitive process and
outcome issues on routine basis.
Eliminates the risk of injury or illness associated with the service
provided in healthcare. It also makes a healthcare organisation more
flexible for changes.
Provides the market support for a healthcare organisation and helps to
grow and sustain the business.

5.6 Disadvantages of Quality Control

Quality control has some disadvantages in evaluating the quality services
and performances of a healthcare. They are:
Requires more man power/operations to maintain quality and more time
to undertake an assessment on any patient related data.
Fails in getting full data of a patient from the electronic record (database
system). For example, the information of a patient, who experiences a
bad condition with a clinical staff, is not entered in the electronic record
as it is and also there are chances for a clinical staff deleting or
eliminating the data of bad condition experienced. So, it is in this
situation a quality control is unable to give fair results.
Lacks transparency the performance of a healthcare organisation and
leads to the lack of quality services.
Needs greater co-ordination of men resources, accountability and
transparency among different staff departments to asses the quality of
services delivered in a healthcare organisation.
Creates a sense of dependency for a healthcare organisation in
providing services and measuring quality. Sometimes an organisation
strictly follows the procedures of treatment to meet the quality standards
without responding to the patients concerns or needs.
Risk of exposing patients confidential data while measuring patient
satisfaction data for evaluating the quality of services and performances
of a healthcare organisation.

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Self Assessment Questions

12. Quality control helps a healthcare organisation to ensure the safety and
requirements of the patients. (True/False)
13. Quality control is not capable of providing quick solutions to patient
questions or concerns. (True/False)
14. Quality control requires more _________ to maintain quality and more
________ to undertake an assessment on any patient related data.
15. Quality control exposes the patients ________ while surveying on a
larger number of data.

5.7 Summary
Quality control in healthcare services can be summarised as follows:
Quality control is a procedure or set of procedures used to ensure that a
manufactured product or performed service adheres to a defined set of
quality criteria or meets the requirements of the client or customer.
Quality control of a healthcare involves the activities from the healthcare
provider to determine the patient requirements and satisfaction on
services.
A healthcare organisation evaluates the quality to ensure the patient
satisfaction.
The methods used to evaluate the quality of a healthcare must be valid,
reliable and inexpensive, and must be related to better health outcomes
of a patient.
Self assessment method, accreditation, certification, licensing and
supervision are the main methods to evaluate the quality of a
healthcare.
Quality control indicators are used to determine and monitor the quality
of a healthcare performance.
Indicators are measurable and relates to the outcome of patient care or
staff performance.
There are ten elements for creating solid healthcare indicators. The term
inspection means the measurement of the quality of service provided in
a healthcare.
An inspection determines the proper quantity of care and service in a
healthcare.

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Accreditation helps to ensure the quality of a healthcare in terms of

standards, competency and ethics.
Accreditation is seen as an effective quality evaluation and management
tool. It is given as a certification to healthcare organisations or
practitioners to confirm that they have passed the accreditation process
successfully.
JCI Accreditation and NABH accreditation are some of the recognised
accrediting organisations.
Quality control ensures provision of services to meet or exceed patients
requirements. It also helps in tracking patient-sensitive process and
outcome issues on routine basis.
Quality control requires more man power/operations to maintain quality
and more time to undertake an assessment on any patient related data.
It has the risk of exposing patients confidential data while measuring
patient satisfaction data.

5.8 Glossary
Super-speciality:

It is a term used for hospitals with many qualified

professionals and facilities related to health care.

Physical factors:

It is a term used in healthcare for materials and

infrastructure.

Radiation:

It means the process of emitting rays of heat or light

used in a healthcare, especially in treating cancer
patients or to take the x-ray of a patient.

Epidemiology:

It is a branch of medical science which deals with

the study of transmission and control of disease.

Regulatory agencies:

It is a term used for the authoritative organisations

which dictate the rules and regulations for a
healthcare organisation.

5.9 Terminal Questions

1.
2.
3.
4.
5.

Define quality control.

Discuss the methods to evaluate quality of healthcare.
Elaborate the elements needed to create solid healthcare indicators.
Explain the role of different accrediting organisations.
Discuss the advantages of quality control in healthcare.

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Quality Management in Healthcare Services

Unit 5

5.10 Answers
Self
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Assessment Questions
Procedures
True
Quality control
Patient satisfaction
False
Certification
True
Indicators
True
Verify and validate
Competency and ethics
True
False
Man power/operations and time
Confidential data

Terminal Questions
1. Quality control is a procedure or set of procedures used to ensure that
a manufactured product or performed service adheres to a defined set
of quality criteria or meets the requirements of the client or customer.
Refer to section 5.2 for the same.
2. There are five methods for evaluating the quality of healthcare. Refer to
section 5.3.1 for the same.
3. There are ten elements to create quality control indicators. Refer to
section 5.4.1 for the same.
4. JCI and NABH organisation are the different accrediting organisations.
Refer to section 5.4.3 for the same.
5. Quality control monitors and ensures the safety and satisfaction of
patients. Refer to section 5.5 for the same.

Sikkim Manipal University

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Quality Management in Healthcare Services

Unit 5

5.11 Case-Let
The Recognition of Standards and Patient Safety
The New Hope Hospital was promoted in 1998 with a capacity of over
200 beds. Over the years, the hospital has become familiar in catering to
more than ten super-specialties like cardiology, neurology, nephrology,
internal medicine, urology and gynaecology. Apart from catering to these
super-specialties, the hospital has opened a nursing education centre
and a meditation centre.
The hospital believes that quality of healthcare delivery is achievable
through an honest, sincere and ethical healthcare practice. The support
system of the hospital has trained quality control staff, who coordinate
with various staffs, departments and patients or relatives of the patients to
ensure high level of satisfaction. Clinical coordinators, a part of the
support system, monitor and check the process and performance of the
clinical/non-clinical staff to ensure the quality standards and patients
safety. The hospital has achieved international accreditation and quality
standards. The management of the hospital has improved its technical
quality and has gained technological advancement through procurement
of quality and speedy diagnostic and surgery facilities. The hospital
quality team inspects the use of these equipments and other staff
performance to ensure the high quality service. The hospital has a quality
team which controls the activities and guides the staff to perform the
services as per the quality standards.
The hospitals objective is to provide cost-effective services to patients. It
also aims to increase the patient-inflow. So the hospital organises
seminars and meetings about the hospital structure, process of treatment
and outcome within the available resources for the public to increase the
visibility of the hospital. The hospital proposes to provide high quality
services and also offers meditation programme to improve patients
mental and physical growth. The hospital has established a kind of
transparency in terms of pricing and process of service and has created
an image in the market.
Discussion Questions
1. What is the belief of the hospital? (Hint: Refer to section 5.3 Quality
control in healthcare.)
2. What is the aim and objective of the hospital? (Hint: Refer to section
5.3 Quality control in healthcare.)
Source: http://www.eximbankindia.com/ht/chapter%204.pdf
Sikkim Manipal University

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Quality Management in Healthcare Services

Unit 5

Reference
Wolper, F. L. (2004), Health care administration, Fourth edition, Canada,
Jones and Bartlett Publishing.
E-Reference
http://www.shsu.edu/~mgt_ves/mgt481/lesson1/lesson1.htm
http://www.nejm.org/doi/pdf/10.1056/NEJM199009133231129
http://www.placidway.com/article/55/Understanding_JCI_Credentials
http://www.4cpl.com/NABH-National-Accreditation-Board-for-HospitalsHealthcare-certification-consultants-standards.html

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