International Seminar :

Quality Improvement in Health Care

Toward the Challenging of Global Competitiveness in The ASEAN Countries

Continuous Quality Improvement (CQI)

in Health Care
~ Bustami MS, MQIH ~
Padang, December 15th, 2016
 Bustami MS, MQIH
Formal Education :
• S2 – Quality Improvement in Health Care, Newcastle – Australia
• S1 – Public Health, University of North Sumatera – Medan

Work Experiences :
• Lecturer @ Health Science College of Alifah – Padang
• Lecturer @ Master Program of Biomedic, Andalas University – Padang
• Lecturer @ Faculty of Public Health, Andalas University – Padang
• Lecturer @ Faculty of Public Health, Baiturrahmah University – Padang
• Lecturer @ Health Science College of Dharma Landbow – Padang
• Lecturer @ Health Science College of Fort Dekoch – Bukittinggi
• Head of Health Science College of Alifah – Padang (2005 – 2016)
• Senior Trainer @ Provincial Health Training – West Sumatra
• Head of Health Education Section @ Regional Health Office –
Payakumbuh

Publication of books :
• Penjaminan Mutu Pelayanan Kesehatan dan Akseptabilitasnya –
Penerbit Erlangga
Quality
• The Oxford English Dictionary (1988) defined quality as “the
degree or grade of excellence”.
• Agency for health care research and quality, defined
quality as "the degree to which health care services for
individuals and populations increase the likelihood of desired
health outcomes and are consistent with current
professional knowledge."
Quality (continue)
 National Association of Quality Assurance Professionals
described quality as “the level of excellence produced and
documented in the process of patient care, based on the
best knowledge available and achievable at a particular
facility.”

 The Community Health Accreditation Program defined quality

as “the degree to which consumers progress toward a desired
outcome”
Quality (continue)
Carrying out interventions correctly according to pre-
established standards and procedures, with an aim of
satisfying the customers of the health system and
maximizing results without generating health risks or
unnecessary costs.
Quality Improvement ?
A method for ensuring that all the
activities necessary to design,
develop and implement a product or
service are effective and efficient
with respect to the system and its
performance.
Continuous Quality Improvement (CQI)
in Health Care
 CQI is a cyclical process.
 It involves identifying an area where there is
an opportunity for improvement then
outline the sequence of activities that
should occur in order to solve that problem,
and implementing them.
 Once the cycle is completed it has to be
determined whether the problem has been
solved.
 If the problem continues, the cycle should
be repeated.
CQI in Health Care ? (continue)

Emphasizes organization and system

Focus on “process” not individual
Scientific method
Most things can be improved
Core Concept of CQI
• Meeting or exceeding customer expectations
• Problems are in processes, not people
o Not blame
o Process improvement
• Reduce or eliminate unwanted variation in
processes
• Small, incremental changes using scientific method
• The way everyday work is done
Core Steps in Continuous Improvement
• A team with knowledge of • Brainstorm strategies for
system improvement
• Define goal (standard) • Use data for decision
• Understand the needs of making
people served by system • Apply the scientific method
• Identify measures of
success
CQI Process
• CQI activities most frequently are accomplished by
team who have knowledge of the process needing
improvement
• CQI required that the improvement process be
ongoing. Organizations can implement a PDCA cycle
(QI cycle)
• The PDCA cycle is one of many ways to conduct QI
activities
The Four Steps of PDCA cycle :
I. Plan _ the change
• Selection of the change or identification of the need to
implement change
• Reflection on and interpretation of relevant information
concerning the existing process
• Definition of the current process and the opportunities
for improvement
• Planning of how you will monitor the progress and the
effectiveness of the change
• What improvement (changes) you expect to see
The Four Steps of PDCA cycle (continue) :
II. Do _ implement the change
• Carry out the change or new practice
• Document the activities of implementation
The Four Steps of PDCA cycle (continue) :
III. Check _ monitor and review the change
• Monitoring the progress and effectiveness of the
change according to your plan
• Recording of observations and results (planed and
expected) in comparison with the original data or
the project goals, measures and objective
• Studying the results – what did you achieve / what
did you learn ?
The Four Steps of PDCA cycle (continue) :
IV. Act
• Act on data / evaluation
• Decide next steps
o Successful changes become SOP
o Analyze unsuccessful changes
• Design new solutions
• Repeat the PDCA cycle
Quality Improvement Project

1. Identify an issue
2. Build a team to address it
3. Define the problem
4. Choose a target
5. Test the change
6. Reconsider or extend the improvement
effort
Quality Improvement Project :

1. Identify an issue
A process that is causing concern or a
possible opportunity for a positive change
2. Build a team to address it
Representation from groups involved –
this step is critical
Quality Improvement Project (continue) :

3. Define the problem

Identify and carefully describe what it is
you really want to improve; the source of
the problem you are confronting, etc.
4. Choose a target
Introduce and evaluate interventions,
using quality improvement tools and skills.
Quality Improvement Project (continue) :

5. Test the change

Data measures to determine when a
process change over time is likely to be
due to chance and when it is not
6. Reconsider or extend the improvement
efforts
Reconsider, sustain, and/or extend
process improvements
How to organize a team in QI process ?
• Perform quality team such as Quality Control Circle
• What is Quality Control Circle ?
 Voluntary groups of employees who work on similar task
or share an area of responsibility
 They agree to meet on regular basis to discuss & solve
the problem related to work
 They operate on the principle that employee
participation in decision making and problem solving
improve the quality of work
What is Quality Control Circle ? (continue)
 Encourage circle to elect their own leader toward the
problems related to work the end of training period
 Frequency and duration of meetings is set by the group
 Circle should be autonomous in that it should select the
problems that it wishes to solve QCCs useful for mutual-
self-development and process control and improvement
with in their workshop
 Using basic quality control circle tools
How do quality circles work?
• All members of a circle need to receive training
• Members need to be empowered
• Members need to have the support of senior
management
• Characteristics :
 Volunteers
 Set Rules and Priorities
 Decisions made y consensus
 Use of organized approaches to Problem Solving
Wassalammu’alaikum Wr. Wb.