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A MANAGEMENT PERSPECTIVE

QUALITY OF CARE & SERVICE. A MANAGEMENT PERSPECTIVE. QUALITY OF CARE & SERVICE. A MANAGEMENT PERSPECTIVE PROGRAMME JUSTIFICATION FOR QUALITY Demographic approach & unmet needs Is quality the missing link? Target free approach Reward system and donors Wasted resources & opportunity costs

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A MANAGEMENT PERSPECTIVE

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  1. QUALITY OF CARE & SERVICE A MANAGEMENT PERSPECTIVE

  2. QUALITY OF CARE & SERVICE A MANAGEMENT PERSPECTIVE • PROGRAMME JUSTIFICATION FOR QUALITY • Demographic approach & unmet needs • Is quality the missing link? • Target free approach • Reward system and donors • Wasted resources & opportunity costs • Programme sustainability • Stakeholders

  3. HEALTH & SOCIAL JUSTIFICATION FOR QUALITY • Direct relationship between high fertility and maternal & child deaths • Access to and use of FP Services is critical • Determinants of fertility known • Attitudinal & socio-psychological variables • Decision-making processes in human reproductive behaviour

  4. MORAL & ETHICAL OBLICATIONS • Ethical concerns • Heightened Expectations

  5. Conceptual Framework of Family Planning Programme Impact on Fertility in the Context of Supply and Demand Source: Bertrand, et.al, 1992

  6. Family Planning Supply Factors Source: Bertrand, et.a., The Evaluation Project 1992)

  7. KEY SYSTEMIC FEATURES OF A FP PROGRAMME • High interdependence • Complex service delivery system • Large information gaps between the entities • No consensus on output measure

  8. SPECIAL INTEREST GROUPS IN FP PROGRAMME • Religious and cultural groups • Political mistrust • Human rights groups • Feminists groups

  9. WHY? • Reduces wastage of scarce resources • Provides a fuller understanding of the problem • Prevents recurrence of a problem • Doing it Right the First Time (DRIFT)

  10. DEFINITION OF QUALITYISO 8402 (1986) ON QUALITY VOCABULARY The definition advanced by the ISO draws attention to three key embedded concepts: “Quality is the totality of features and characteristics of a product or service that bears on its ability to satisfy stated or implied needs”. This definition of quality encapsulates its complexity and multidimensionality.

  11. INDUSTRIAL QUALITY MODEL Quality is conformance to specifications that relate to customer satisfaction. • Five quality dimensions relate to customer satisfaction in industrial quality. Quality measurement in industry necessarily reflects these dimensions. They are: • specification (preservice expectation) • conformance (in relation to the expectation) • reliability (over time) • cost (value) • delivery (timeliness)

  12. QUALITY IN HEALTH CARE • Self regulation • External Regulation • Medical Audits • Quality in FP • Bruce QOC Model • Other Models

  13. SERVICE CHARACTERISTICS • Intangible Experience • Co-production • Simultaneity of production and consumption • Client decides the continuation of the relationship • Deficiencies, evident during transaction or even later affects perception of quality

  14. SERVICE CHARACTERISTICS • Quality service requires that critical ‘behind-the-scene’ activities meet quality critieria before the first client-provider interaction and service experience occurs. This can happen only if organizational processes are predetermined and quality standards preset for the organization, which providers can strive to reach in service production and delivery

  15. A Conceptual Model of Service Quality (Haywood - Farmer)

  16. DIFFICULTIES IN MEASUREMENT OF SERVICE QUALITY • Client’s mental model • Courtesy bias • Empowerment of the customers • Diversity of Perspectives on Quality

  17. INTERPERSONAL PROCESS • ‘The virtues’ of the interpersonal process of privacy, confidentiality, informed choice, concern, empathy, honesty, tact and sensitivity identified by Donabedian (1988) be applied as programmatic guidelines to assess and improve services in the QOC model

  18. HEALTH CARE MANAGER’S PERSPECTIVE • The production and maintenance of high quality service • Non-physician manager • Clinician manager

  19. HEALTHCARE MANAGER’S PERSPECTIVE • Managers tend to feel that technical competence, efficiency, access and effectiveness are the most important dimensions of quality (Brown et al., 1993). Less importance is given to the interpersonal dimensions of service.

  20. HEALTH CARE PROVIDER’S PERSPECTIVE • Management enabling the internal customers • Commitment & motivation depends on the organization enabling them

  21. HEALTH CARE PROVIDER’S PERSEPCTIVE • Providers tend to focus on technical competence, effectiveness and of course, safety. This is for good clinical, ethical and legal reasons. They need and expect effective and efficient technical, administrative and supportive services in providing high quality service. Providers tend to underestimate the importance of the role they play and the attitudes they and other front-line staff have in shaping the interpersonal experience of the client and her perception of quality.

  22. DONOR/FUNDER PERSPECTIVE • Major donor interests in family planning, until recently, have been driven mostly by concerns related to reaching numerical targets to measure impact, efficiency and equity, and to a lesser extent by considerations of ethics

  23. CLIENT PERSPECTIVE • Family planning clients and communities in developing countries often focus on interpersonal process, geographic and financial accessibility, effectiveness of method, continuity of provider and physical amenities as the most important dimensions of quality. May clients in developing countries cannot adequately assess technical competence because power and knowledge asymmetries between provider and client are too large

  24. SERVICE QUALITY MODEL Quality of service is when client’s perception of service received conforms to client’s expectation of service • Tangibles: the physical facilities, equipment, appearance of personnel • Reliability: the ability to perform the desired service dependably, accurately and consistently • Responsiveness: the willingness to provide prompt service and help customers • Assurance: employees’ knowledge, courtesy and ability to convey trust and confidence • Empathy: the provision of caring, individualised attention to customer

  25. TOTAL QUALITY MANAGEMENT (TQM) • Systems model of a Quality Loop • Market research & specifications • Quality management system • Quality control system • Internal quality assurance systems • External quality assurance systems

  26. MANAGEMENT AND QUALITY ASSURANCE • Finding & fixing problems in processes of work • Identify performance gap • Cyclical continuous activity • Role of Leadership

  27. Selected Quality Assessment Tools • Case Follow-up • Client Satisfaction Studies • Clinic Management System • Competency testing • Consumer/Client Intercept Studies • Counselor Training Evaluation • Demographic and Health Survey Oversample • Focus Group Discussions • Hypothetical Cases • Management Information Systems • Matrix (CEDPA) • Matrix (Enterprise) • Monitoring Voluntary Surgical Contraception • Procedures • Observation

  28. Selected Quality Assessment Tools(cont’d) • Operations Research • Panel Studies • Patient/Client Flow Analysis • Peer Review • Programme Quality Assessment Tool (PQAT) • Quality Definition and Assessment • Record Review • Self-Assessment • Simulated/Mystery Client Studies • Situation Analysis • Structured Interviews/Surveys • Supervision Tool (CARE) • SWOT Analysis • Use and Discontinuation Studies Source: Katz et,al.1993

  29. The Service Performance Gap Adapted from Berry et al., 1990

  30. ANALYSIS AND JUSTIFICATION OF PQAT CONTENT

  31. ANALYSIS AND JUSTIFICATION OF PQAT CONTENT-cont’d

  32. ANALYSIS AND JUSTIFICATION OF PQAT CONTENT-cont’d

  33. An Example of PQAT use from FHS Nigeria 1990-Clinic 7

  34. An Example of PQAT use from FHS Nigeria 1990-Clinic 7 (cont’d)

  35. An Example of PQAT use from FHS Nigeria 1990-Clinic 7 (cont’d)

  36. “Would you tell me please, which way I ought to go from here?” “That depends a good deal on where you want to get to,” said the Cat. “I don’t much care where,” said Alice. “Then it doesn’t matter which way you go,” said the Cat. “So long as I get somewhere,” Alice added as an explanation. “Oh, you’re sure to do that,” said the Cat, “If you only walk long enough”. Lewis Carroll, Alice in Wonderland

  37. Key References: Quality of Care 1. P.Raghavan-Gilbert, 1997 Service Quality Management in Family Planning: The Program Quality Assessment model, a multipurpose management tool, Doctoral Thesis, University of Exeter 2. Berry, L.L, Parasuraman, A, Zeithaml, V.A.1990 Quality Counts in Services too. In: Clark G (ed), Managing Service Quality. An IFS Executive Briefing, IFS Publications, UK 3. Bruce, J. 1989 Fundamental elements of quality of care: A Simple Framework, The Population Council, Working Papers (1). 4. Network FHI, Vol. 14 No. 1 1993 Quality of Care - Ways to Improve Care Focusing on Clients.

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