Quality Assurance

Agus Widjaja , dr., MHA

What is Quality ?
Definition of Quality
Do the right thing, right ,the first time
proper performance (according to standard)
of interventions that are known to be safe,
that are affordablr to the society in question,
and have the ability to produce an impact on
mortality, morbidity, disability, and
malnutrition

What is Quality ?
Quality be defined as a continuous
effort by all members of an
organization to meet the need and
expectation of the customer.
For health purposes , this definition
might be modified to substitute
patient and other customers for
the word customer

Important Concepts
QA has the potential to
improve health care program
without requiring additional
supplies, logistical support, or
financial and human
resources

Important Concepts

Bad services are expensive services

Is it true? Discuss it.
The iceberg phenomenon of bad
service
cost
s

cost
s

iceberg

Re do

Longer
LOSevent
adverse

fined

Quality and dimension of

quality
The quality of technical care consist in the
application of medical science and
technology in a way that maximizes its
benefits to health without correspondingly
increasing its risks.
The degree of quality is, therefore, the
extent to which the care provided is
expected to achieve the most favorable
balance of risks and benefits.

Quality Management
in Health Service
Relationship among QM, Strategic

Msanagement and Change Managements

Understanding the development of Qconcept from ZD to QC, QA and CQI/QI/TQM
Focus on idea that Health care has three
major cornerstones:
Quality
Access, and
Cost

Quality in Health Care

Quality is achieved when accessible
services are provided in an efficient,
cost-effective, and acceptable
manner.
A quality service is customer
oriented
Emphasis in health care :
from Structure standard, to
Process standard, and
Outcome standard

Dimensions of Quality
(delapan dimensi mutu pelayanan)
1.Technical
competence
2.Access to
services
3.Effectiveness
4.Interpersonal
relations
5.Efficiency
6.Continuity
7.Safety

12.
Customer

1.Technical competence
(Kompetensi Teknis)
Pengertian Kompeten
Terkait dg ketrampilan, kemampuan
dan penampilan
Bagaimana pemberi pelayanan
kesehatan mengikuti standar
pelayanan :
Kebutuhan
Ketepatan
Kebenaran
Konsistensi

2.Access to services
(akses terhadap Pelayanan)

Tidak ada halangan apapun

untuk mendapatkan
pelayanan
Halangan biaya/ekonomi
Halangan sosial/budaya
Halangan geografis

3.Effectiveness
(Kesangkilan)

Mutu pelayana terkait erat

dengan kesangkilan, petunjuk
klinis yang ada.
SOP
Akreditasi ?

4.Interpersonal relations
(Hubungan antar individu)
Bagaimana interaksi :
Antara pemberi pelayanan dan
penerima pelayanan
Antar sesama tenaga kesehatan
Intern organisasi
Stakeholders/pemangku kebijakan

5.Efficiency
(Kemangkusan)

Merupakan dimensi penting dalam

pelayanan kesehatan
Menghargai sumber daya
Merupakan pemikiran keliru jika
menganggap peningkatan mutu
memerlukan tambahan sumberdaya,
melainkan dapat memilih intervensi
yang paling mangkus cost effective

6.Continuity
(kesinambungan pelayanan)

Pelanggan mendapat pelayanan

yang dibutuhkan
Sistem rujukan:
Rujukan diagnostik
Rujukan penanganan/terapi
Rujukan pembiayaan (!)

Pasien mempunyai akses pelayanan

kesehatan apa yang diperlukan.

7.Safety
(Keselamatan Keamanan)

Pelayanan harus aman dari risiko

cedera, infeksi, efek samping
dan bahaya lainnya.
Safety juga bagi pemberi
pelayanan.
Contoh :
Hospital safety
Perhatikan
Patient: UU
safety
Praktik Kedokteran, UU Rumah Sakit, UU
dll
Kesehatan,
Pengendalian
infeksi nosokomial

8.Amenities
(Kenyamanan)
Terkait dengan semua dimensi
mutu
Penting untuk meningkatkan
kepercayaan/keyakinan terhadap
pelayanan yang diberikan

Definition of Quality
Assurance
Quality Assurance includes only those
activities that periodically or
continuously review the condition under
which care is provided, monitor the care
itself, track the outcomes of care.
Using QA , deficiencies may be noted,
and their causes identified and
corrected, resulting in improvements, in
health and well being
Adopted from

Dr. Avedis Donabedian

Four Principles of QA
Focus on clients
Focus on systems and processes
Focus on data as a basic for decision
making
Focus on a team approach to problem
solving and quality improvement

Planning for QA
Review activities and/or the
scope of care of the
organization
Decide where to begin
What kind of QA activities will
be undertaken
Who is responsible

Critetia for Determining Where to

Begin
High Volume:
Activities that affect many people

High Risk :
Activities that address complex or serious
health problems that result in death or
serious harm

Problem Prone:
Activities that frequently experience
problems because they are complicated
or vary in how they are performed

What is Standard?
A statement of expectation that
defines:
minimum levels of acceptable
performance
excellent level of performance, or
the rang of acceptable
performance

Standard answer the question,

Characteristic of a
Good Standars
Valid
Reliable
Flexible
Applicable
Clear

Effective Communication
of Standard
Clearly explain the standards
Give needed guidance on how to
apply standards
Assure that there is effective plan
for implementation
Use incentive

LIMA KONSEP MUTU

yang sangat penting bagi manajer
1. Mutu seagai keistimewaan produk
2. Mutu berarti bebas dari kekurangan atau
kecacatan (defisiensi)
3. Mutu adalah produk yang sesuai dengan
kebutuhan, kegunaan, dan standar teknis
4. Mutu adalah satu bendel produk(Bundle of
Product).
5. Mutu adalah persoalan perilaku
(pengetahuan, kesadaran, sikap, dan
tindakan).
(modifikasi J M
Juran)

Pedoman Praktis dalam

Menjaga Mutu
Triple A
1. Avoid wasting resources
2. Avoid wasting time
3. Avoid doing unnecessary
thing

Bagaimana pandangan pelanggan/pasien terhadap mutu pelayanan?

Dengan meningkatnya tingkat pendidikan, ekonomi, dan kebutuhan masyarakat, dimensi
mutu juga terus berkembang.
Dimensi mutu paling penting saat ini adalah kepuasan pelanggan (customer
satisfaction)