Quality Assurance

This review of experience in accreditation and external quality assessment systems was produced at the request of the UK Department for International Development in India. The purpose of this review is to describe where External Quality Assessment fits in the broader set of levers that exist for engaging with health care providers and organisations in developing countries in order to improve quality and affordability of care. This information is partially based on theory, but primarily presents lessons learned and experience with accreditation and other assessment methods in both OECD and developing countries.

This report will review the critical elements of quality assessment in Section 1. In the second section it will review the National Health Insurance Fund Act requirements for accreditation and the current means of registering and evaluating health providers. What is needed in accreditation, the options for Tanzania, and the potential problems there may be with accreditation. The final section provides practical guidance for implementing a short-term and longterm strategy for accreditation of NHIF providers and more broadly for all Tanzanian providers. Appendix A provides a practical tool: An Accreditation Survey Instrument for Hospitals.

The task of improving quality is a demanding job. It requires focusing on clients, using data, working collaboratively with other team members, and maintaining an overarching view of the health system in which we work. Benchmarking is a process for finding, adapting, and applying best practices. [adapted from author]

Family Medicine training and assessment is becoming more formalized and developed in South Africa. Assessment of competency in relation to clinical skills can involve observation in the clinical setting, but is more usually assessed in an examination. Summative assessment of family physician’s clinical skills now usually includes an Objective Structured Clinical Examination (OSCE). Standardisation of the OSCE is required to define the pass mark above which a candidate performs at the level expected of a family physician. [from abstract]

A central part of the World Federation for Medical Education strategy is to give priority to specification of international standards and guidelines for medical education, comprising both institutions and their educational programmes. Adoption of international standards will constitute a new framework for medical schools to measure themselves. Furthermore, internationally accepted standards could be used as a basis for national and regional recognition and accreditation of medical schools’ educational programs. [from introduction]

Credentialing of health care providers, facilities and educational institutions is an integral component in building and sustaining robust human resources for health (HRH) systems. The credentialing mechanisms—licensure/registration, certification and accreditation-are among the most frequently used quality assurance tools in health care and serve as valuable instruments in the broader function of health care regulation. This technical brief examines the characteristics and potential advantages of these mechanisms and common challenges faced in implementing them in lowresource settings. [Author's description]

It is envisaged that these common competencies will support the role of nurses within the region, provide direction for recognition of qualifications and for multi-country licensure programs and guidance for those countries that have not yet developed their specific competencies for nurses. This document details background information, the competency development process, the proposed WPSEAR Common Competencies, suggestions for their application and a glossary of terms. [author's description]

This report provides inforation on the potential establishment of regulatory bodies for allied health professionals in the ECSA region. It introduces the concept of regulation and the traditional methods of regulation, discusses the contextual issues, outlines five possible regulatory models, provides some draft model legislative provisions to regulate AHPs, and describes how to establish and implement a regional body. [adapted from author]

The standards provide a new framework against which individual doctors and the medical profession can assess themselves in a voluntary self-evaluation and self-improvement process. The standards should form the basis for continuted professional development (CPD) providers in designing CPD activities. Depending on local needs and traditions, the standards can also be used by national or regional agencies engaged in monitoring, recognition, and accreditation of CPD. [from introduction]

Credentialing is a means of assuring quality and protecting the public by confirming that individuals, programmes, institutions or products meet agreed standards. Credentialing is becoming increasingly important as health systems strive to address issues of public safety and quality services. [author's description]

This presentation was part of the 2006 Global Health Mini-University. This session highlights the need for greater investments in quality improvement in the private health sector. It also provides an overview of promising approaches and offers a detailed discussion of emerging accreditation models and other recognition systems for the private sector. [publisher's description]
To view this presentation, you must have either Microsoft PowerPoint or download the free PowerPoint Viewer.

This study explores the details of the process leading to the equivalence determination of qualifications and degrees for the education and training of the health professions in Thailand. [from abstract]

Applying the lessons of the quality movement in industry and medicine, programs have created approaches that suit reproductive health care in developing countries. While still in the early stages, these efforts suggest some important principles: clients come first; quality design, quality control, quality improvement—the three sides of the "quality triangle" are equally important, strengthen systems and processes, everyone contributes, every program can improve quality. [adapted from author]

This study reviews the healthcare literature that examines the effect of financial incentives on the behaviour of healthcare organisations and individuals with respect to the quality of care they deliver to consumers. Its purpose is to provide guidance to policy-makers in government and decision-makers in the private sector in their efforts to improve quality of care through payment reforms. [adapted from summary]

The main objective of the Ministry of Health (MOH) certification program, which will be called the Health Worker Certification System (HWCS), is to achieve a standard level of quality provided by all health workers. To achieve this level of quality it is critical that the skills of each health worker by certified through a competency-based test. This system of testing will require that all training of health workers in the future be focused on combining knowledge acquisition with hands-on competency based skills, rather than just didactic training. Refresher training and recertification will also be required in order to ensure a basic level of quality.

Costa Rica has taken the search for improvement of quality health care seriously, and has initiated several activities in that area. The Quality Assurance Project... has provided technical assistance to introduce continuous quality improvement methodology in seven hospitals and clinics in the South Central Health Region. This intervention was expected to result in concrete improvements for specific problems in each of these health facilities, and to serve as a model to be duplicated in health facilities elsewhere in the country. [author's description]

This presentation is from the VII Regional Meeting of the Observatories for Human Resources for Health. It discusses the quality assurance standards for HRH in Belize, outlines the country's plans for expanding this program and indicators for success.
To view this presentation, you must have either Microsoft PowerPoint or download the free PowerPoint Viewer.

QAP implemented the first randomized control trial to measure the impact of accreditation in a developing country setting and reports its findings in this Operations Research Results report. The central issue to the report addresses the extent to which accreditation, known to favorably impact measurable indicators relating to the quality of care, actually improves patient outcomes. While exploring this issue, the report also sheds light on the importance of careful planning and communication in implementing complex research and would serve as a guide to others in undertaking similar efforts. [

Research on the Integrated Management of Childhood Illness (IMCI) shows that it is a scientifically sound way to treat sick children, but ways to ensure that it is implemented properly are lacking. This 1997-98 study examined and compared three implementation approaches: structured feedback of performance data, structured feedback of performance data where quality improvement (QI) teams were in place, and the formal World Health Organization training in districts with QI teams. The report details the impact of each intervention, noting that sustaining performance is problematical under any intervention. The cost of IIMCI training was four times that of performance feedback. [publisher's description]

This paper describes strategies for improving the performance of health care workers. Many factors interact to affect the quality of health care. The structure of the health care system, educational opportunities for health practitioners, the administrative system, the pace of change, economic conditions and the technology available may influence the ability of the existing workforce to acquire new skills and implement them in practice. Thus, a comprehensive strategy is needed if the quality of the overall system is to improve, including the development of indicators to measure progress. [author's description]

This presentation was part of the ECSA 38th Regional Health Ministers' Conference. It discusses the purpose of regulation , the responsibilities of self-regulation, implementing a framework for professional regulation, and the challenges involved.
To view this presentation, you must have either Microsoft PowerPoint or download the free PowerPoint Viewer.

This presentation was part of the ECSA 38th Regional Health Ministers' Conference. It discusses the health sector vision, the role of the Department of Standards and Regulatory Services, the Nursing Council of Kenya, strategies to improve quality, the Kenya Quality Model, lessons learned and challenges.
To view this presentation, you must have either Microsoft PowerPoint or download the free PowerPoint Viewer.

In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers' competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. [abstract]

This guidance was developed to help staff of the ACQUIRE Project understand and explain to counterparts and field partners the improvement approaches and tools used by ACQUIRE. ACQUIRE brings together partners with proven, effective approaches to improving provider performance and the quality of services and to mobilizing communities to drive improvements in health care: performance improvement (PI), quality improvement (QI), and participatory learning and action (PLA). These approaches and tools can be used alone or in a complementary manner, depending on the situation and on the program level being addressed.

This report analytically and comparatively reviews international models and experiences in the development and implementation of health care regulations. The study commences with an introduction to the concept of health care regulations, and then describes the most universally common approaches for putting them into practice: licensing, accreditation, and certification. Depending on the country and its economic and political structures, different governmental and voluntary regulations over health services have evolved. Traditionally, in most countries, official licensure of health personnel has been the favored approach.

This monograph provides a brief overview of several aspects of quality assurance, including its cost-effectiveness and its feasibility in less developed countries. The monograph describes the dimensions of quality, the four principles of quality assurance, the QA process, and key activities in the development of a QA program. Activities/tools: QA cycle (since replaced by the QA triangle); analytical tools, including the cause and effect (fishbone) diagram, flowchart, and systems model; statistical and presentation tools, including the run chart, histogram, check sheets, pareto chart, scattergram, and control chart. [publisher's description]

This article provides an historical overview of the three major ways that nursing regulates the profession, its members, and their performance, i.e., licensure, certification, and accreditation. Each type of regulation mechanism is described and differences between them are explained. Current issues related to accreditation of schools of nursing are outlined. [abstract]

This paper focuses on lessons learned about building quality improvement into service delivery programs. Addressed to the program leaders and donor agencies that allocate resources for service delivery programs, the paper offers guidance on the actions that must take place to improve the quality of reproductive health and child survival programs. This guidance is based on the field experiences of members of the Management and Supervision Subcommittee of the MAQ Initiative. [publisher's description]

This document aims to facilitate the development of quality-oriented health sector reforms by providing a clear conceptual framework that can serve as a roadmap for policymakers and senior managers. By taking advantage of opportunities to integrate quality assurance activities into health sector reforms, healthcare leaders can maximize the effectiveness of reform and move toward optimizing health outcomes for the citizens of Latin America and the Caribbean. [author's description]

The methodology for improving quality in healthcare has evolved rapidly over the past decade. This has come about as a result of several factors: the large number of field experiences that have taken place in many countries worldwide and in a variety of different areas and specialities in healthcare delivery; the increasing complexity of healthcare delivery and with that the emerging new needs for efficient and cost-effective care; the increased expectations of our customers; and lastly, the advances in our knowledge on improvement, management, and clinical practice. This monograph represents an update on quality improvement methodology, which incorporates the most recent thinking on how to implement improvement.