QA SIRI 1

UATLRITAYINWINEGBOINFATRRASIENREIERSS F| O2R/2021

QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

Features of a QA/QI study
&

Problem Identification

Dr Divya Nair
CHQR, IHSR

9 FEBRUARY | 3 – 4 PM

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

IN CASE YOU MISSED IT….

uality Webinar 1/2021

Quality in Healthcare
&

the QA/QI Cycle

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

Quality perceived differently
by different people

Patients Healthcare providers Policy makers

• Pleasant staff & • Technically sound • Efficient
• Outcome of treatment • Cost-effectiveness
environment • Professionally ethical • Meets the needs of
• Responsiveness
• Reliable society
• Competence
• Timeliness

DimTeRAnINsINiGoOnFsTRAoINfEQRSuFOaRlity

QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

STEEEP

Safe Timely Effective

Efficient Equitable Patient-Centred

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

Structure, Process, Outcome Approach

Structure Process Outcome

•Personnel Provider of Care Clinical Outcome
•Organisation •Mortality / Survival
•Facilities (Technical Care)
•Problem Recognition Functional Outcome
•Physical Function
Recipient of Care
Integrative/Evaluative
(Interpersonal Care) • Financial Hardship
• Utilisation • Patient Satisfaction
• Patient Experience
(Adapted from Donabedian, 2003)

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

What is ABNA ?

ABNA (Achievable Benefit Not Achieved) = the difference between Optimum level
and Actual level of achievement.

120

The ideal level of care

100 Ideal (with unlimited resources)

80 Optimum Optimal Achievable level.

60 ABNA (Targeted level within means)

Actual
40 QA/QI aims at narrowing

or eliminating the gap

20

0

Model for ImprovementT–RAMINoINsGtOF TRAINETRhS eFOMR alaysian Problem
commoQnUAQLITIYaApSpSrUoRaANcChE/QUALITY IMPROVEMENSTo(QlvAi/QnIg) (PCARyTc1le)

I. What are we trying to
accomplish? (AIM)

II. How will we know that a change
is an improvement?
(MEASURES)

III. What changes can we make
that will result in improvement?
(STRATEGIES)

UALITY WEBINAR SERIES | 2/2021

Is This A QA/QI Study?

Features of a QA/QI Study
&

Problem Identification

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

Features of a QA/QI Study

Intention Desired outcome Design
To improve what Aim to achieve a known
we are currently Interventional in
desired outcome nature, cyclical
doing
Scope of intervention changes of
Scope of data intervention,
Local / Formulate intervention characteristically
more holistically, involving continuous
organisations the whole system and as
many factors as possible Ethical approval
Team members Highly debated.
Usually consists of Statistical rigour Recommended to
Simple statistics, just register and go through
people who own ethics committee
the process enough data especially if it involves

patients

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

Step by step of Problem Identification

When faced with a problem..

Our usual reaction is…

Limited Budget!

We need more Busy!
resources!

The problem may not always be the problem,
the problem may be the attitude about the problem

What is ?

Problems are not stop signs,
they are opportunities

Opportunity for Improvement = (what it should be) – (what it is)

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

Quality problem occurs when quality aspects of a care or services becomes the
centre of the problem. The important aspects of care that are commonly being
given a quality priority are those that:

Causing wastage of Produce problem for
resources patients or staff

Occur frequently – high Place patients at risk by not
volume, high risk or providing care correctly, not
problem prone, affects large providing care when
number of patients. indicated or providing care
that is not indicated

Abundant of problems!

Avoidable errors
Underutilisation of services

Overuse of services
Variation in services

Communication problems
Dissatisfied consumers

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

How to identify problems / opportunities for
improvement

Problem should be Important aspects:
related to your • What is your department?
core business. • What does it do?
• Who does it serve?
(What is your • Where is the service given?
core business?) • When?
• Who else is involved in the

service process?
• Which part of your business

you are not doing well?

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

How to identify problems / opportunities for
improvement

It may have been brought up as issues in
meetings and discussions.

Appear in patient’s complaints

Mentioned by staff.

Problem not yet solved.

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

Examples of Quality Problem

Inappropriate management of asthma in Clinic X Effectiveness

High proportion of X-Ray films rejected Efficiency

Long-waiting time for endoscopy service causing low Timeliness
rate of gastrointestinal cancer detection

High incidence of inpatient fall in geriatric wards Safety

Low incidence of mother-baby skin-to-skin contact
among premature babies in special nursery care (SCN) Patient-centred

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

Client goes to emergency department (ETD) Crowded waiting area dissatisfaction

Client waits to be seen by ETD doctor Long waiting time to be seen by ETD doctor

Client awaits blood results and X-Ray Improper blood samples, samples or forms not
labelled correctly, delayed blood results
Client awaits to be seen by referred team
Delay in referred team to see patient, referring
Client goes to pharmacy team needs investigation results before
decision
OR
Long waiting time to collect medications,
Client require admission prescribing error, prescriptions filled wrongly

Client stranded in ETD as no bed in ward,
delayed sending to ward

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

Examples of Problems Not Suitable for QA/QI Study

Poor restriction of visitors outside the This is a managerial
visiting hour period problem

High mortality rate in diabetic ketoacidosis This is a problem of
scientific interest
Poor feedback from hospital departments
regarding responses to patient complaints This is a managerial
problem

Frequent failure of laboratory equipment Scope too small,
looks at 1 factor

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

How A Study Which Is Not Suitable Be Made Suitable As A
QA/QI Study

Poor feedback from hospital departments regarding This is a managerial
responses to patient complaints problem

Low percentage of patient complaints resolved Suitable

Frequent failure of laboratory equipment Scope too small, looks
High lab turn-around time for urgent tests at 1 factor

Suitable, can include
multiple factors

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

References:

TRAINING OF TRAINERS FOR
QUALITY ASSURANCE/QUALITY IMPROVEMENT (QA/QI) (PART 1)

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