A brief description of quality assurance of healthcare services and comparison between quality assurance and quality control

1. Col Zulfiquer Ahmed Amin
M Phil, MPH, PGD (Health Economics), MBBS
Armed Forces Medical Institute (AFMI)

3. A measure of excellence or a state of being free from defects,
deficiencies and significant variations.
Quality as "the totality of features and characteristics of a product or
service that bears its ability to satisfy stated or implied needs.“
Definition of Quality

4. Dimension of Quality

6. • ‘A part of quality management
focused on providing
confidence that quality
requirements will be fulfilled’.
‘Quality
Assurance’: ISO
9000 Standard,
Clause 3.2.11
• ‘A part of quality management
focused on fulfilling quality
requirement’.
‘Quality Control’:
ISO 9000
Standard,
Clause 3.2.10
ISO: International Organization for Standardization

7. QA is defect prevention, differs subtly from defect detection and
rejection , which is Quality Control
(GMP= Good Manufacturing Practices)

8. GMP
Good manufacturing practices (GMP) are the practices required in
order to conform to the guidelines recommended by agencies that
control the authorization and licensing of the manufacture and sale
of food and beverages, cosmetics, pharmaceutical products, dietary
supplements, and medical devices. These guidelines provide
minimum requirements that a manufacturer must meet to assure
that their products are consistently high in quality, from batch to
batch, for their intended use.

9. Purpose of QA
• To meet the rising expectations of consumers of quality of
services
• Help patients by improving quality of care.
• Assess competence of medical staff, serve as an impetus to keep
up to date and prevent future mistakes.
• Bring to notice of hospital administration, about the deficiencies
and in correcting the causative factors.
• Help exercise a regulatory function.
• Restricting undesirable procedures.
• Eliminating medical errors.

10. Principles of Quality Assurance
• QA is a never ending process of continuous improvement, and
continuous updating with rapid advances in science and
technology and medical knowledge.
• The emphasis is on establishing professional excellence and
patients’ satisfaction at reasonable cost.
• Quality is not proportionate to the use of sophisticated
technology or to be expensive.
• Technical imperative should not insist on prolonging life at any
cost, with no consideration to quality of life.
• Decisions must be based on data.
• Customers define the quality.

12. 1. Consistency of purpose:
To stay in business requires that leaders spend time on innovation,
research and education. They must constantly improve the design of
their product and service.
2. Adopt new philosophy:
Learn and adopt the new philosophy, one of cooperation to
everyone’s benefit.

13. 3. Cease dependence on mass inspection:
Quality does not come from inspection, but from improvement of the
process. Improve the process so that defects aren’t produced in the first
place.
4. End lowest tender contracts:
Price has no meaning without measure of the quality purchased.
5. Improve every process:
Improvement isn’t a project with a finite end. Instead, think continuous,
never ending improvement.

14. 6. Institute training on the job:
Training must be done on the job, learning by doing; going into the
work and experimenting with work methods and new ideas, studying
the results, and striving for perfection.
7. Institute leadership of people:
Adopt and institute leadership aimed at helping people to do a better
job.

15. 8. Drive out fear:
Many organizations are run by fear; fear of not getting their bonus,
being afraid that they can’t meet their annual rating, or fear that
they will be low on rating ladders. To achieve better quality people
need to feel secure.
9. Break down barriers:
Break down barriers and silos between departments. Traditionally
each silo becomes independent kingdoms, each trying to maximize
their own figures. In other words build a system.
10. Eliminate exhortations:
Posters ask people to do what they can not do. Eliminate slogans,
warnings and targets for the work force asking for zero defects. Such
urging only creates hostile relationships. Majority of low quality and
low productivity is caused by faulty system.

16. 11. Eliminate arbitrary numerical targets:
Traditionally quantity rules over quality. Managers must focus on
quality, rather than sheer numbers.
12. Permit pride of workmanship:
We need people to have pride in their work, not in their ability to
meet ratings. Barriers to pride (a basic human need) among other
things, results in low morale and absenteeism.
13. Encourage education:
Institute a vigorous program of education and encourage self
improvement for everyone.
14. Top management commitment and action:

17. Methods of QA
A retrospective quality assurance measures actual documented
outcomes against desirable and valued outcomes. Data for
documentation of actual outcomes are obtained from the medical
records of a specific patient population after the patients have been
discharged.
A concurrent quality assurance evaluates patient care while it is in
progress. Documentation of the caliber of care being delivered is
obtained through review of the patient's chart, interview,
observation, and examination of the patient. The advantage of
concurrent review is that it can provide opportunities for
improvement of patient care while it is in progress.

18. Components of Quality Assurance
1. Strategic or organizational level (dealing with the quality policy,
objectives and management and usually produced as the Quality
Manual);
2. Tactical or functional level (dealing with general practices such as
training, facilities etc); and
3. Operational level (dealing with the Standard Operating Procedures
(SOPs) worksheets and other aspects of day to day operations).

19. Models of QA

22. Approaches of Quality Assurance Program
1. General Approach:
It involves a large governing or official bodies’ evaluation of a
person or agency to meet established criteria or standards at a
given time.
- Credentialing
- Licensure
- Accreditation
- Certification
2. Specific Approach:

23. Credentialing:
Process by which the eligibility of an entity for a particular job or task
is established by determining if the entity has the specified
qualifications and fulfills the defined requirements. eg, credentialing
the licensing of medical providers like physicians, nurse practitioners.
Licensure:
Individual licensure is a contract between the profession and the
state, in which the profession is granted control over entry into and
exit from the profession and over quality of professional practice. eg,
medical and legal practices.

24. Accreditation:
Accreditation is the process of formally obtaining credibility from an
authorized body, such as the International Organization for
Standardization (ISO), Joint Commission International (USA),
Accreditation Canada International etc.
Certification:
Certification is usually a voluntary process within the profession. A
person’s education, experience and performance on examination are
used to determine the person’s qualification for functioning in an
identified specialty area.

25. Specific Approaches

26. Org Providing Quality Indexes

28. Types of QA
External QA:
QA can be evaluated by independent assessors from outside the
hospitals.
Internal QA:
QA can be evaluated by local assessors (Usually by senior persons)
from the same hospitals.

29. QA Cycle

30. QA Committee
- Medical Administrator
- Two Senior Clinicians
- Pathologist
- Radiologist
- Matron (Senior Nurse)
- Medical Record Officer (Secretary)
- Additional Personnel: eg Super-Specialists, consultants

31. Factors Affecting QA in Healthcare

32. QA & QC

33. Although QA and QC are closely related concepts, and are both
aspects of quality management, they are fundamentally different in
their focus:
- QC is used to verify the quality of the output;
- QA is the process of managing for quality.