Quality Assurance

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]

The purpose of this newly revised manual and accompanying toolbook is to assist health care providers working in emergency obstetric care (EmOC) settings to improve the quality of services within their facility. With whatever resources are at hand, quality improvement (QI) processes can help staff change and improve practices and conditions and, in so doing, have a significant impact on pregnancy outcomes. [publisher’s description]

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, quality improvement, and participatory learning and action.

The Public Private Partnership in Health (PPPH) is an element of Uganda’s Health Sector Strategic Plan II. The private sector includes not-for-profit providers, for-profit providers called private health practitioners (PHPs), and traditional and complementary medicine providers. A representative sample of facilities was selected and surveyed to provide in-depth information on PHP facilities, which could be extrapolated to the national database. The survey collected information from 359 facilities on facility ownership, human resources, staff employment in other facilities, infrastructure and equipment, health services provided including in-depth information on HIV/AIDS services, drug availability, health management information systems, financial management procedures, and registration and organizational affiliation.

The goals of this presentation include introducing the performance improvement (PI) approach, framework and factos influencing performance; how PI works; and the benefits of using PI. [adapted from author]

This case study describes how healthcare providers in Nicaragua worked together to improve the quality of obstetric care at their health centers and posts. They began by measuring the extent to which staff performed according to standards. Once aware of the quality gaps, they formed QI teams and used rapid team problem solving to implement quality improvements so that healthcare providers could perform according to obstetric standards. Continuous monitoring shows their success in meeting the standards and improving health outcomes. [author’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]

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]

The World Federation for Medical Education (WFME) Working Party applied the principles which were developed regarding basic medical education to postgraduate medical education. Attention was focused on the general application of guidelines in quality development of medical education. WFME holds that the set of international standards presented can be used globally as a tool for quality assurance and development of postgraduate medical education. [from introduction]

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]

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 value of accreditation remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. [from abstract]

This user’s guide contains materials needed to design and implement the Quick Investigation of Quality (QIQ) in a given country. QIQ refers to the set of three related data collection instruments designed to monitor 25 indicators of quality of care in clinic-based family planning programs. This volume includes an overview of the QIQ (including objectives, short list of indicators, and methodological and ethical issues), guidelines for sampling and training of field personnel, instruments and guidelines for data collection and summary results from short list of indicators (tabular and graphic forms).

This monograph provides an introductory overview of QA for developing countries. It will be of interest to policy makers, upper-level ministry of health (MOH) officials, and district-level health service managers. Part I describes how quality assessment and improvement have been carried out in less developed countries (LDCs). Part II discusses the feasibility and rationale for applying QA in the developing world. Part III proposes some definitions and dimensions of quality. Part IV reviews the definition and basic tenets of QA.

This monograph presents a conceptual framework to help healthcare systems and organizations analyze, plan, build and sustain efforts to produce quality healthcare. The framework synthesizes more than ten years of QA Project experience assisting in the design and implementation of QA activities and programs in over 25 countries. [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 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]

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 paper aims to provide an overview of the current evidence and opinion of the workforce implications of regulation, competency development and role definition. These three elements are inextricably linked to each other and are fundamental to the practice of nursing in today’s environment. [from introduction]

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]

Health systems in industrialized countries are having success with new approaches for evaluating and improving care delivered by clinicians in ambulatory care settings. Described herein is a program which awards recognition to individual physicians or physician groups who deliver high-quality, cost-effective care. [from author’s description]

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]

This study aimed to establish the occupational profiles of each grade of nurse in Indonesia, identify their training and development needs and ascertain whether any differences existed between nurses working in different regions or within hospital or community settings. [from abstract]

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.

Credentialing of health care providers, facilities and educational institutions is an integral component in building and sustaining robust HRH systems. This technical brief examines the characteristics and potential advantages of credentialing mechanisms and common challenges faced in implementing them in low-resource settings. [from author]

Zambia’s recently developed hospital accreditation program is a major component of ongoing health sector reforms that have taken place in the country during the last decade. Although Zambia previously had several processes in place for evaluating hospital performance, comprehensive performance standards had not been developed and quality measurement was not standardized.

This report examines whether Zambia’s hospital accreditation program improved health outcomes and other indicators. Performed after an accreditation program had been launched in about 40 hospitals, the evaluation examined eight indicators of healthcare quality at hospitals that had and had not been exposed to the accreditation program.

A global review resulted from a study conducted by the International Society for Quality in Health Care (ISQua) under contract to the World Health Organization. The first of this report’s three parts describes structures and activities at national and international levels around the world to promote quality in health care. The second part catalogues quality concepts and tools in local use in various countries. The third part outlines initiatives in health service accreditation and analyses the operation of functioning national programmes around the world. The appendices include recommendations of major international bodies and meetings on quality assurance.

This study indicates that healthcare professionals are using mostly clinical handover meetings, seminars and workshops for their continued professional development (CPD). There is need to improve access to relevant professional journals. The regulatory or licensing boards for healthcare professionals in Malawi should seriously consider mandatory CPD credits for re-certification. [author’s description]