Mutu pelayanan kesehatan quality Assurance

Shirley I.M

What is quality (Roemer & Montoya Aguilar, WHO 1988)

Proper performance of intervention that are known to be safe, that are affordable to the society, and that have ability to produce an impact on
Mortality Morbidity Disability Malnutrition

Quality in health care

Care that meets or exceeds expectations

There are 2 aspects of quality

Technical Patients satisfaction

The quality of health care delivery may be evaluated by structure, process and outcome indicators

Quality assurance
An attempt to protect and enhance quality It concerned with patient care that is high in professional quality and satisfying the patients Quality holds the promise of being able to:
Deliver the most appropriate and up-to-date medicare Reduce the chance of unsuitable treatment and care, and an inappropriate variation in the care between doctors Encourage accountability between providers, consumers and founders of health care Save unnecessary costs by reducing waste, duplication and increasing efficiency

Continuing improvement
The steps:
Its leader must hold to a shared vision of a health care system that is undergoing continuous improvement Substantial investment in managerial capital, time and expertise will be required for quality improvement Respect must be established for health-care worker involved in complex task in a complex system Those served and those serving must carefully maintain an open dialogue

 Modern technical, theoretically grounded tools must be applied to health-care setting Health-care regulations must be more sensitive to the cost and ineffectiveness of relying on inspection to improved quality Professionals must take part in specifying preferred methods of care that exceed minimalist standards Individual physicians must actively participate in the effort for continuous improvement

QA CYCLE
Implementation of continuing improvement is done through quality assurance cycle. QA cycle is made up of 4 steps
1. 2. 3. 4. Select or review the topic Observe practice Compare practice with explicit standards Implement change

1. Select or review the topic

QA process begins with setting standards for the topic under review Guide for setting standard :
Keep the standard simple Limit the number of standard Include only essential items Include items proved effective Exclude dangerous and ineffective items Exclude excessive and unnecessary items Allow the best adoption of provider and patient resources Be sure the content is up to date

2. Observe practice Data is collected from the practice Collecting data consist of:
Selection the indicators Selection the collection method (validity, reliability, feasibility, and acceptability. Data analysis It should look at essential aspects of care Data to be collected must be valid, reliable

Dimentions of Quality
Technical competence Access to services Effectiveness Interpersonal relations Efficiency Continuity Safety amenities

Quality assurance process

Planning for QA Developing guidelines and setting standards Communicating standards and specifications Monitoring quality Identifying problems and selecting opportunities for improvement

Defining the problem operationally Choosing a team Analysing and studying the problem to identify the root causes Developing solutions and actions for improvement Implementing and evaluating quality improvement efforts