QUALITY MANAGEMENT

IN
HEALTH SYSTEMS

Dr. Syed Aftab Rahim

syedaftabrahim@hsa.edu.pk
 A SYSTEM ??
• SET OF SPECIFIC ACTIVITIES
• REPETITIVE, SYSTEMTATIC ACTIONS
• DONE AS A ROUTINE
• MAY BECOME MONOTONOUS
• MAY CAUSE BOREDOM AND SLACKNESS
• DAILY IT’S THE SAME ACTION
• IN HEALTH SECTOR, ITS LIFE & DEATH
MATTER, SO !!! ADD, STRESS, TOO !!!
• BUT HEALTH SERVICES NEED “QUALITY”
• MONOTONY, REPETITIVE ACTIONS IN
ANY STRESSFULL ENVIRNOMENT
BECOME VOID OF VIRTUE !!! “QUALITY”
• Processionary caterpillars move through the
forest in a long procession feeding on pine
needles.

• They derive their name from their habit of

following a lead caterpillar, each with its eyes
half closed and head fitted snugly against the
rear end of the preceding caterpillar.

• The renowned French Naturalist, Jean-Henri

Fabre, in an experiment with processionary
caterpillars, was able to entice them on to the
rim of a large flowerpot.
• Fabre succeeded in getting the lead caterpillar
to connect up with the last one, creating a
complete circle, which moved around the pot in
a never ending procession.
• He thought that, after a few circles of the pot,
the caterpillars would discover their
predicament or will become tired of their
endless progression and move off in another
direction.
• But they never varied their movements. And
kept on moving in that circle.
• Through force of habit, the caterpillars kept
moving relentlessly around the pot at about the
same pace for a period of seven days.

• They would have continued even longer if they

had not stopped from sheer exhaustion and
hunger.

• As part of the experiment, food had been

placed close by in sight of the group; but
because it was out of the path of the circle, they
continued in their procession to what could
have been their ultimate destruction.
• In their procession around the pot, they were
blindly following their
• instincts,
• habits,
• past experience,
• past practices,
• tradition,
• custom and
• precedent—the way they always had done
things.
• In reality, they got nowhere.
 instincts

past experience,

habits

tradition

practices

custom

precedent
 As the old adage states,

“It is a form of insanity

to do the same things over and over
and
then expect different results”
Quality’ has different definitions, ranging from traditional to those
that are strategic.

The American National Standards Institute (ANSI)

and American Society for Quality (ASQ) defines “quality as the totality
of features and characteristics of a care or service that bears on its
ability to satisfy given needs.”

W Edwards Deming, the father of concept

of TQM has defined quality as a strategy aimed at the needs of the
customer. This strategic definition has received widest international
acceptance.

Quality is a unit less value system interpreted as diverse viewpoints.

The precise meaning of quality of care in HCO is ambiguous. It
involves more than the earlier perception of ‘clinical quality’.

The delivery quality of the health care service is determined

by the patient satisfaction, is based on the patient expectations
and linked with training and human interpersonal relations.
IMPROVING QUALITY
• QUALITY DEFINED: IN DIFFERENT WAYS

• QUALITY IS RELATIVE

• QUALITY IS SUBJECTIVE

• QUALITY IS A PROCESS (NOT AN END)

• DIFFERENT LEVELS
– QUALITY CONTROL
– QUALITY ASSURANCE
– QUALITY MANAGEMENT
• TECHNICAL QUALITY: CONFORMITY
TO STANDARDS
• PERCEIVED QUALITY: CLIENT
EXPECTATION
Quality Management

Quality Assurance

Quality
Control
 Quality control
• A method of sampling the output of a
process with the objective of detecting
and controlling preventable variations
in quality
• This method is rather effective in the
clinical-laboratory setting or hospital
maintenance departments
 Quality Assurance (QA)
• Identifying/designing all the processes
and sub-processes
• Developing measures for quality
• Collecting data to monitor compliance
with these measures
• Analyzing data and designing options
• Applying solutions to improve health
care
 Quality Management
• Set of assessment and improvement
techniques and tools to improve the overall
performance of systems including Quality
Assurance techniques

• Organisation and system wide comprehensive

management system including values,
participation, teamwork and empowerment

• (Self)-Improvement cycles oriented towards

sustainable innovation and improvement
Models and Methods
4 S’s of QUALITY
• SPACE
• STAFF
• STUFF
• SYSTEM