Implementing Quality

Improvement Program

I Nyoman Sutarsa
Email: sutarsa_71@yahoo.com
0878 6038 0028
 Quality Concepts
Service Collaboration Service Provisions
1. Equity
Learning & Innovation 2. Accessibility
1. Creating and using 3. Comprehensive
knowledge 4. Appropriate
2. Quality improvement 5. Client Centred
processes 6. Coordination
3. Workforce 7. Client Safety
development

Management & Innovation Outcomes

1. Leadership and 1. Effective
governance 2. Client experience
2. Infrastructural capacity
3. Business and financial
management
We surveyed a nationally representative sample
of board chairs of 1,000 U.S. hospitals to
understand their expertise, perspectives, and
activities in clinical quality. We found that fewer
than half of the boards rated quality of care as
one of their two top priorities, and only a minority
reported receiving training in quality. The large
differences in board activities between high-
performing and low-performing hospitals we
found suggest that governing boards may be an
important target for intervention for policymakers
hoping to improve care in U.S. hospitals.

(Ashish and Arnold M. Epstein, 2009)

Implementing Quality
Improvement Program
Quality Assurance
Program

Clinical Governance
Implementing Quality Improvement: QAP

1. Define quality
QAP problems based on
standards
1.Process
2. Choose and implement
2.Continuous solutions based on the
3.Systematic current capacity
4.Objective 3. Evaluate results
5.Integrated 4. Develop planning for
quality improvements
 Prior the process…..
Assessment of
Quality in Healthcare
1. Structures (personnel,
facilities, organisation etc)
2. Process (service provision,
monitoring evaluation etc)
3. Outcomes (cure, morbidity,
mortality etc)
1. Staff (skill, certification, etc)
2. Organisation (regulation,
policies etc)
3. System (data collection
system, reporting etc)
4. Clients (satisfaction,
continuity of care etc)
Planning for Quality
Improvement
1. Plan the process
2. Plan the resource required
3. Plan the data collection
strategies
4. Plan the strategies to involve
all staff/stakeholders
5. Plan the timeline
Source of Data:
1. Survey
2. Medical record review
3. Hospital record
4. Pharmacy data
5. Morbidity/mortality
6. Expenditure/cost
 Quality Improvement Process
Generic Steps: P-D-C-A
1. Plan
2. Do Systematic Process:
1. Problem Identification
3. Check
2. Choosing and
4. Act Implementing
Intervention
3. Evaluate the results
4. Planning for quality
improvements
Step 1. Problem Identification

What is problem?
Problem Identification
1. Select or review a particular topic
2. Developing standards
3. Observe practice
4. Benchmark practice with standards
5. Identify underlying problems
 Fish Bone Diagram
INPUTS (6M) PROCESS

Medical
Non-Medical
procedures
procedures
POACE

Quality
Problem(s)
Organisation
Leadership
Management

INPUTS (6M)
Problem identification also needs to Intervention
elaborate the underlying problems (Input,
Process, Environment)
Step 2. Choose and Implement Intervention

Analysis Strategy Implementation

1. Stakeholder 1. Quality 1. Implemen-

involvement goals tation
2. Situational 2. Choosing process
analysis intervention 2. Monitoring
3. Confirmatio for quality processes
n of health
goals

Continuing process and systematic

Choosing Intervention for Quality

Mapping the domains

Linking the domains
1. Leadership (pivotal) 
strong commitment and and decision making
support processes
2. Information (fundamental
domain)  information
system vs. resource?
3. Patient and population
engagement  they are the Deciding the
end users of HC (financing,
partners etc) intervention
4. Regulation and standards
5. Organisational capacity
6. Models of care
 Step 3. Evaluate the Results

Evaluating
• What? • Change?
• How? • How? • Accept?
• Good?
• Not work?
Data Collection Feedback

What is working and what is not!

 Step 4. Planning for QI
Recommendation for quality improvement
strategies

Recommendation will be really specific

and potentially effective when a
combination of methods or
interventions on several levels is
conducted to address specific barriers
to change (quality problems)
Implementing Quality
Improvement Program
Quality Assurance
Program

Clinical Governance
 Clinical 1
Leadership and
engagement

3 2
Clinical Leadership and Engagement

Engagement with job vs.

Engagement with organisation?

Engagement with organisation is the

stronger predictor of positive attitudes
and organisational outcomes
High job-related engagement ≠ organisational engagement
 Clinical Supervision
“a working alliance between practitioners in which they aim to
enhance clinical practice, fulfil the goals of the employing
organisation and the profession and meet ethical, clinical and best
practice standards of the organisation and profession while
providing personal support and encouragement in relation to the
professional practice (Kavanagh et al., 2002)

Functions of Clinical Supervision

1. Quality control (safe ethical practice)
2. Maintaining and facilitating supervisee’s
competence and capability
3. Helping supervisees to work effectively (developing
professional identity, enhancing self awareness,
resilience and personal coping)
 Clinical Supervision
“a working alliance between practitioners in which they aim to
enhance clinical practice, fulfil the goals of the employing
organisation and the profession and meet ethical, clinical and best
practice standards of the organisation and profession while
providing personal support and encouragement in relation to the
professional practice (Kavanagh et al., 2002)

Objectives of Clinical Supervision

1. To provide staff with a confidential safe and supportive
environment to critically reflect on professional practice
2. To improve quality patient services by improving practice,
improvement
encouraging reflection on attitudes
3. Improving self awareness and taking responsibilities of
clinicians
4. Essential for quality
 Clinical Supervision
“a working alliance between practitioners in which they aim to
enhance clinical practice, fulfil the goals of the employing
organisation and the profession and meet ethical, clinical and best
practice standards of the organisation and profession while
providing personal support and encouragement in relation to the
professional practice (Kavanagh et al., 2002)

Model of Clinical Supervision: CLEAR Model

1. Contract
2. Listen
3. Explore
4. Action
5. Review
 Risk Management in CG

Risk:
Event/Change in circumstance leading to
an Impact
ex. Incorrect priority on waiting list causing client injury

Risk factor:
The possible causes
Risk Management
LIKELIHOOD CONSEQUENCE (the impact of such a risk)
(possibility of
occurring)
Insignificant Minor Moderate Major Extreme

Almost certain High High High Extreme Extreme

Likely Medium Medium High High Extreme

Possible Medium Medium High High High

Unlikely Low Low Medium Medium High

Rare Low Low Low Medium Medium

Quality  Expectation vs.
Performance