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MPH-Course 2003. Quality Management. Step 1. Introduction and Definitions. Extract form the “Hammurabi codex” 5000 b. c. If a master builder builds a house and fails to make it strong enough, so that it collapses and causes the death of the builder-owner, this master builder shall be killed.

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slide1
MPH-Course 2003

Quality Management

slide2
Step 1

Introduction and Definitions

slide3
Extract form the “Hammurabi codex” 5000 b. c.
  • If a master builder builds a house and fails to make it strong enough, so that it collapses and causes the death of the builder-owner, this master builder shall be killed.
  • If the collapsing house kills a son of the builder-owner, a son of the master builder shall be killed
slide4
Some definitions on Quality of Care:
  • 1. “Quality of care is the extent to which actual care is in conformity with preset criteria for good care.” (Definition by Donabedian)
slide5
2. Quality of health care is the production of improved health and satisfaction of population within the constraints of existing technology, resources, and consumer circumstances.

(Definition by Donabedian, Palmer, Povar)

slide6
3. Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

(Definition by Lohr)

slide7
4. Quality of care is the performance of specific activities in a manner that either increases or at least prevents the deterioration in health status that would have occurred as a function of a disease or condition. Employing this definition, quality of care consists of two components:
  • .the selection of the right activity or task or contribution of activities, and
  • .the performance of those activities in a manner that produces the best outcome.
  • (Definition by Brook, Kosecoff)
slide8
5. Appropriate care means that the expected health benefit (increased life expectancy, relief of pain, reduction in anxiety, improved functional capacity) exceeds the expected negative consequences (mortality, morbidity, anxiety of anticipating the procedure, pain produced by the producer, misleading of false diagnoses, time lost from work) by a sufficiently wide margin that the procedure is worth doing.
  • (Definition by Chassin, Park, Fink)
slide9
According to WHO:
  • “Quality as a characteristic of health care may be understood at two different levels. At the more general level, one may speak of the quality of the health care system as awhole. In this approach, the resources, the activities, the management, and the outcomes of health care are all implicated: quality is the merit or excellence of the system in all its aspects.
    • At a more restrict level, quality may be considered to be one of the features of the healthcare resources and activities. Do they comply with certain established standards? Thus, it may be stated that the attributes of a given set of resources included: their category or type, their quantity, their unit cost and their quality..
    • The attributes of a set of activities include: their type, quantity, effectiveness in regard to the health problems addressed, coverage of the target population, and quality, . In this perspective, the outcomes or effects of the system would depend o the attributes of the resources and activities, including their quality. The quality and other attributes of the resources and activities would themselves depend on the financing, resource development, planning, organization, and management of the system. The more restricted view of quality makes it possible to handle it as a set of variables that can be easily defined, measured, assessed, and improved. It is, therefore, quite appropriate for operational purposes.”
slide10
Seven attributes of health care define its quality:
  • Efficacy: the ability of care, at its best, to improve health
  • Effectiveness: the degree to which attainable health improvements are realized
  • Efficiency: the ability to obtain the greatest health improvement at the lowest cost
  • Optimality: the most advantageous balancing of costs and benefits
  • Acceptability: conformity to patient preferences regarding accessibility, the patient practitioner relation, the amenities, the effects of care, and the cost of care
  • Legitimacy: conformity to social preferences concerning all of the above: and
  • Equity: fairness in the distribution of care and its effects on health.
slide11
Five key elements for good quality
  • The working place (hospital, HC, ) is equipped according to assigned tasks
  • .Adequately trained and motivated staff is available in sufficient number
  • .Standards and norms exist and are utilized
  • .The client is satisfied by the service offered to him
  • .“We can do even better” is shared by everybody (room for improvement)
slide12
Quality Control
  • Quality control focused mainly on the quality of products without taking into account the “human factor”
slide13
Quality assurance/assessment
  • People are making mistakes, therefore they must be controlled. If you control them very carefully, they make less mistakes. This approach focuses on inspection, supervision, checklists, guidelines etc.
slide14
Comprehensive Quality Management / Continuous Quality Improvement
  • The majority of the people is willing to perform will. Problems are mainly caused by the procedures and processes in place. These are often too complicated, faulty and incorrect. Together with the people involved, it should be possible to improve such procedures and processes. CQI puts client’s satisfaction into the focus.
common demotivators
No opportunity to influence

Strict hierarchies

Low salaries

Boring tasks

Staff fluctuation

Lack of corporate identity

No recognition

Insufficient resources

Physical / mental stress

No career prospects

No room for creativity

Common Demotivators
slide16
Step 2

Quality of Care Policy in Tanzania

slide17
CQM includes all levels of the health system

· The MOH formulates policies, provides standards and guidelines for health care delivery and quality monitoring as well as training manuals.

· The professional organisations should be involved in developing performance standards and guidelines (code of conduct).

· The RHMT co-ordinates the CQM activities in the Region

· The Local Government has got the overall responsibility for the district health system.

slide18
The DHMT is responsible for the close follow-up (supervision, MTUHA, but can also initiate quality circles and peer groups).

· The health workers themselves are responsible for their performance with regard to their client’s needs.

· Finally the clients and their representatives in the community have to be involved in the process of improvements, too.

slide19
Some key - statements in the foreword:
    • The mission of the MoH is to provide the highest affordable quality of Health services
    • This training introduces health workers to the concept of quality
    • Quality assurance focuses on assisting health workers to achieve full potential through improvement of the systems and processes
    • Its primary goal is to support health workers rather than blame individuals
    • Quality of care can ensure greater satisfaction for the clients
slide20
Definitions
  • Quality is a measure of how good something is. Something has quality if the object or the service meets or exceeds the expectations of the user. There are various definitions of quality.
    • Respect of standards
    • “Doing the right think in the right way at the right time”
    • Doing best with the resources available
slide21
Components of quality
    • 1. Policy
    • 2. Technical competence
    • 3. Efficiency
    • 4. Interpersonal relationship
    • 5. Effectiveness
    • 6. Accessibility
    • 7. Continuity
    • 8. Safety
    • 9. Acceptability
    • 10. Equity
slide22
Policy:
    • Thus it is important for the government to have sound policies to protect the poor, unprivileged and the at risk groups as one aspect of quality of care
  • Equity
    • There are two dimensions to ensuring equity in health care. These are the issue of density and geographical distribution of health services and equitable funding in the national health system.
slide23
According to the guidelines Quality contains also:
  • How to plan?
  • Monitoring and evaluation
  • Supportive / facilitative Supervision
  • Managing Time, Space, Equipment and Supplies
  • Communication in Health care
  • Organization a Health Education Session
  • Population Estimates in Health Services
  • Utilization of Data in Health Facilities
slide24
The guidelines don’t answer the following questions:
    • Quality in Health as a Public issue
    • Scoring and Ranging
    • Quality circles / Peer group review
    • Continuous Quality Management as a new concept
    • Accreditation/ Certification / Licensing
slide25
Summary:
  • Quality assurance in Tanzania has become an issue for the MoH and the different departments, but a clear concept is yet lacking.
slide26
Step 3

Concepts and Tools

frameworks for quality management
ISO 9000 ff

EFQM

Focus on processes

The European Foundation for Quality Management,

Non prescriptive, comprehensive

Frameworks for Quality Management
slide28
What is ISO?
    • The International Organization for Standardization (ISO) is a worldwide federation of national standards bodies from some 140 countries, one from each country.
    • ISO is a non-governmental organization established in 1947. The mission of ISO is to promote the development of standardization and related activities in the world with a view to facilitating the international exchange of goods and services, and to developing cooperation in the spheres of intellectual, scientific, technological and economic activity.
  • ISO's work results in international agreements which are published as International Standards.
slide29
What are standards?
    • Standards are documented agreements containing technical specifications or other precise criteria to be used consistently as rules, guidelines, or definitions of characteristics, to ensure that materials, products, processes and services are fit for their purpose.
    • For example, the format of the credit cards, phone cards, and "smart" cards that have become commonplace is derived from an ISO International Standard. Adhering to the standard, which defines such features as an optimal thickness (0,76 mm), means that the cards can be used worldwide.
  • International Standards thus contribute to making life simpler, and to increasing the reliability and effectiveness of the goods and services we use.
slide30
How are ISO standards developed?
  • ISO standards are developed according to the following principles:
  • ConsensusThe views of all interests are taken into account: manufacturers, vendors and users, consumer groups, testing laboratories, governments, engineering professions and research organizations.
  • Industry-wideGlobal solutions to satisfy industries and customers worldwide.
  • VoluntaryInternational standardization is market-driven and therefore based on voluntary involvement of all interests in the market-place.
slide31
There are three main phases in the ISO standards development process.
    • First phase: involves definition of the technical scope of the future standard. This phase is usually carried out in working groups which comprise technical experts from countries interested in the subject matter.
    • Second phase: Countries negotiate the detailed specifications within the standard. This is the consensus-building phase.
    • Third phase: comprises the formal approval of the resulting draft International Standard
  • It is now also possible to publish interim documents at different stages in the standardization process.
slide32
Most standards require periodic revision. Several factors combine to render a standard out of date: technological evolution, new methods and materials, new quality and safety requirements. To take account of these factors, ISO has established the general rule that all ISO standards should be reviewed at intervals of not more than five years. On occasion, it is necessary to revise a standard earlier.
  • To date, ISO's work has resulted in some 12 000 International Standards, representing more than 300 000 pages in English and French (terminology is often provided in other languages as well).
  • A list of all ISO standards appears in the ISO Catalogue.
slide33
EFQM
  • The EFQM Model is a non-prescriptive framework recognizing that there are many ways to achieve sustainable excellence. It helps organizations to understand the gaps, and allows them to stimulate solutions.
  • Why EFQM?
      • Quality management tool
      • It is sector-independent
      • Helps to understand the gaps
      • Gives components to estimate whoeness
      • Makes organization ask ”How?”
slide34

Key statement of the EFQM Model

Customer Satisfaction, People (employee)

Satisfaction and Impact on Society are achieved

through Leadership driving Policy and Strategy,

People Management, Resources and Processes,

leading ultimately to excellence in

Business Results.

slide35
What is EFQM Excellence Model?
  • History of EFQMThe European Foundation for Quality Management (EFQM) was founded by the presidents of 14 major European companies in 1988.
  • EFQM’s mission is:To stimulate and assist organizations throughout Europe to participate in improvement activities leading ultimately to excellence in customer and employee satisfaction, influence society and business results; and to support the managers of European organizations in accelerating the process of making Total Quality Management a decisive factor for achieving global competitive advantage.
slide36
Overview of EFQM Excellence Model
  • The EFQM Model is a non-prescriptive framework that recognizes there are many approaches to achieving sustainable excellence. The model’s framework is based on nine criteria. Five of these are ‘Enablers’ and four are ‘Results’. The ‘Enabler’ criteria cover what an organization does. The ‘Results’ criteria cover what an organization achieves. ‘Results’ are caused by ‘Enablers’. The nine criteria are:
      • Leadership
      • Policy and Strategy
      • People
      • Partnership and Resource
      • Processes
      • Customer Results
      • People Results
      • Society Results
      • Key Performance Results
  • EFQM gives great ground for self-estimation.
slide37

The EFQM Model for Business Excellence

People

Satisfaction

90 points (9%)

People

Management

90 points (9%)

Business

Results

150 points

(15%)

Leadership

100 points

(10%)

Processes

140 points

(14%)

Policy &

Strategy

80 points (8%)

Customer

Satisfaction

200 points (20%)

Resources

90 points

(9%)

Impact on Society

60 Pkte (6%)

Results 500 points (50%)

Enablers 500 points (50%)

slide38

The two categories of criteria of

the EFQM

  • Enabler criteria are concerned with how
  • the organisation undertakes key activities.
  • Results criteria are concerned with what
  • results are being achieved.
slide39

The EFQM Model for

Business Excellence

1. Leadership

How the behaviour and actions of the executive team and all other

leaders inspire, support and promote a culture of Total Quality

Management.

Evidence is needed of how leaders:

1a. visibly demonstrate their commitment to a culture of

Total Quality Management

1b. Support improvement and involvement by providing

appropriate resources and assistance.

1c. are involved with customers, suppliers and other external

organisations.

1d. recognise and appreciate people´s efforts and achieve-

ments.

slide40

The EFQM Model for

Business Excellence

2. Policy and Strategy

How the organisation formulates, deploys, reviews and turns

policy and strategy into plans and actions.

Evidence is needed of how policy and strategy are:

2a. based on information which is relevant and comprehensive.

2b. developed.

2c. communicated and implemented.

2d. regularly updated and improved.

slide41

The EFQM Model for

Business Excellence

4. Resources

How the organisation manages resources effectively and efficiently.

Evidence is needed of how:

4a. financial resources are managed.

4b. information resources are managed.

4c. supplier relationships and materials are managed.

4d. buildings, equipment and other assets are managed.

4e. technology and intellectual property are managed.

slide42

The EFQM Model for

Business Excellence

6. Customer Satisfaction

What the organisation is achieving in relation to the satisfaction of its

external customers.

Evidence is needed of:

6a. the customers perception of the organisation´s products,

services and customer relationships

6b. additional measurements relating to the satisfaction of the

organisation´s customers.

tools for qm
The Deming Cycle

Ishikawa (fish bone) diagram

Pareto analysis

Peer review

Benchmarking

Quality improvement teams

Guidelines, standards

Improvement projects

Self assessment

External assessment, audit

Accreditation/certifi-cation/awards

Tools for QM
tools for qm44
The Deming Cycle

Ishikawa (fish bone) diagram

Pareto analysis

Peer review

Benchmarking

Quality improvement teams

Guidelines, standards

Improvement projects

Self assessment

External assessment, audit

Accreditation/certifi-cation/awards

Causes and effect diagram

Tools for QM

Resources

Rules

Insufficiently elaborated

Inappropriate

Problem

Inprecise

Lack of knowledge

Procedures

Personnel

tools for qm45
The Deming Cycle

Ishikawa (fish bone) diagram

Pareto analysis

Peer review

Benchmarking

Quality improvement teams

Guidelines, standards

Improvement projects

Self assessment

External assessment, audit

Accreditation/certifi-cation/awards

Tools for QM
tools for qm46
The Deming Cycle

Ishikawa (fish bone) diagram

Pareto analysis

Peer review

Benchmarking

Quality improvement teams

Guidelines, standards

Improvement projects

Self assessment

External assessment, audit

Accreditation/certifi-cation/awards

Review by colleagues with the same or similar qualification and experience

Tools for QM
tools for qm47
The Deming Cycle

Ishikawa (fish bone) diagram

Pareto analysis

Peer review

Benchmarking

Quality improvement teams

Guidelines, standards

Improvement projects

Self assessment

External assessment, audit

Accreditation/certifi-cation/awards

Benchmarking:

... the continuous process of measuring products, services and practices against the leading health care providers.

Lead question:

Not only who is best, but how can I become best

Tools for QM
tools for qm48
The Deming Cycle

Ishikawa (fish bone) diagram

Pareto analysis

Peer review

Benchmarking

Quality improvement teams

Guidelines, standards

Improvement projects

Self assessment

External assessment, audit

Accreditation/certifi-cation/awards

Guidelines:

Instructions or principles, which precisely describe actual or future ways of acting

Standards

Standards are fixed indicators which are derived from actual practice and are generally used to compare medical care in one setting with that in another

Tools for QM
tools for qm49
The Deming Cycle

Ishikawa (fish bone) diagram

Pareto analysis

Peer review

Benchmarking

Quality improvement teams

Guidelines, standards

Improvement projects

Self assessment

External assessment, audit

Accreditation/certifi-cation/awards

Quality discussions

Project groups

Quality circles

Tools for QM
quality circles
Quality Circles
  • Voluntary peers (preferably without hierarchy)
  • Self selected problems/topics
  • Moderated group discussion

- up to 15 participants

- inclusion of experts on request

- increased job satisfaction

- continuous learning

tools for qm51
The Deming Cycle

Ishikawa (fish bone) diagram

Pareto analysis

Peer review

Benchmarking

Quality improvement teams

Guidelines, standards

Improvement projects

Self assessment

External assessment, audit

Accreditation/certifi-cation/awards

Self-Assessment is a comprehensive, systematic and regular review of an organisation’s activities and results referenced against a model of excellence

Tools for QM
introducing qm
Introducing QM
  • Announcement of quality policy by leadership
  • Introduce basic principles of QM to DHMT
  • Self Assessment
  • Prioritisation of areas for improvement
  • Training of moderators
  • Formation of quality circles
  • Plan of action and indicators
tools for qm57
The Deming Cycle

Ishikawa (fish bone) diagram

Pareto analysis

Peer review

Benchmarking

Quality improvement teams

Guidelines, standards

Improvement projects

Self assessment

External assessment, audit

Accreditation/certifi-cation/awards

Special projects initiated to improve particular quality aspects which have been identified as a problem

Tools for QM
tools for qm58
The Deming Cycle

Ishikawa (fish bone) diagram

Pareto analysis

Peer review

Benchmarking

Quality improvement teams

Guidelines, standards

Improvement projects

Self assessment

External assessment, audit

Accreditation/certifi-cation/awards

In-depth assessment and evaluation of efficiency and effectiveness of the structure and processes of an organisation or section. Audits are carried out by independent specially qualified experts.

Tools for QM
slide59
Step 4

Framework for QM in the German Health System

slide60

BASIC PRINCIPLES OF THE

GERMAN HEALTH CARE SYSTEM

  • First: Principle of solidarity
  • - everyone should have access to the
  • same quality of care on equal terms
  • independent of financial means
  • * the wealthier pay for the poor
  • * the young pay for the old
  • * the healthy pay for the sick
  • * small families (singles) pay for
  • large families
slide61

BASIC PRINCIPLES OF THE

GERMAN HEALTH CARE SYSTEM

  • Second: Principle of Supplementarity
  • - government as regulator only when the
  • system fails to meet social goals
  • * government spends relatively little
  • directly on health care
  • * government is only marginally
  • involved in direct service provision
  • * the health care sector is left to
  • govern itself, within set federal
  • rules
slide62

BASIC PRINCIPLES OF THE

GERMAN HEALTH CARE SYSTEM

"Governance by Competition"

  • Third: Patients have freedom of
  • choice of doctors and
  • hospitals
  • - uniform compensation system for
  • providers
slide63
Step 5

Quality Management in Tanga Region

slide64
Why introduce CQM in Tanzania
      • The applied methods and tools for quality monitoring in district services include traditional ones like
  • Integrated regular supervision of all health facilities (HF) by the DHMT
  • Reporting by using the MTUHA system
  • Training of health workers to improve technical and communication skills
  • Active community participation
slide65
Supervision has proved to be of limited effectiveness, with two major problems:
  • As the responsibility for quality is not shared by the staff as a whole, but becomes the specialty of the supervisors, the supervision easily becomes perverted to a mere control with the threat of sanctions, the staff rather trying to hide problems than discussing them frankly. Even if staff manages to “survive” supervision, daily practice hardly improves.
  • Superiors who are supposed to supervise, tend not to like this job and prefer to stay in their office, consulting room or theatre.
slide66
There is a huge network of HF but low level of quality
  • Q-control / Q-assurance (supervision, HMIS) with little impact so far
  • HSR can only succeed if quality of care is improving
  • People request better quality (cost sharing)
slide67
New quality tools
  • Commitment of leadership
  • Health workers themselves take responsibility for monitoring (e.g. in quality circles)
  • Client / community satisfaction with the health services is considered as important part of quality
  • Strict monitoring using a standardised set of indicators with scoring and ranking of the health facilities according to their performance
  • Information of the public and local authorities (and creating public concern)
  • Awarding of well performing services
slide68
How the 8 areas of CQM were assessed in Tanga Region?
  • During routine supervision once per quarter a checklist was filled by checking topics related to these 8 areas
  • An additional annual questionnaire focused mainly on output indicators
  • A third questionnaire was worked out to assess user satisfaction
  • The findings of these three questionnaires were computer proceeded by the CHMT themselves and analyzed by a computer based ranking and scoring approach
slide71
Further steps of CQM in Tanga?
  • Awarding of good performing HF during the Public Health Day
  • Regular supervisions are crucial to assess the performance of all Health Services
  • Individual instructions and support by the DHMTs for low performing HF’s
  • Annually information of the public about quality in the health sector
slide72
Constraints to overcome
  • Scoring and ranking is only fair, if all CHMTs conduct regular supervision and fill in the supervision checklist thoroughly
  • There should be a fair competition between private and public providers. Criteria are lacking, how to compare the performances of both systems
  • How to take into account factors like “remoteness” and “lack of staff” on which the staff itself has no impact?
case study qm in a tanzanian health region
Case study: QM in a Tanzanian Health Region
  • Health indicators in Tanga Region in %

1. Utilization rate of curative care (visits/ inhabt./year) 54.2

2. DPT 3 coverage of children < 1 y 86.1

3. ANC First Attendances 86.1

4. Proportion of deliveries with medical assistance 43.7

5. Proportion of caesarian sections per expected births 1.5

6. Maternal mortality among reported deliveries 0.3

7. Couple Year Protection (CYP) 16.4

8. Detection rate of new TB cases 0.2

9. Bed occupancy rate in Hospitals 73.6

10. Case Fatality Rate of Malaria in all HUs 3.9

11. HIV-Prevalence among blood-donors in 8.5

12. Severe Malnutrition Rate 5.1

13. Safe water in surveyed households 44.8

14. HH with acceptable toilets 77

case study qm in a tanzanian health region74
Case study: QM in a Tanzanian Health Region
  • Why introduce CQM in Tanzania?
case study qm in a tanzanian health region75
Case study: QM in a Tanzanian Health Region
      • The applied methods and tools for quality monitoring in district services include traditional ones like
  • Integrated regular supervision of all health facilities (HF) by the DHMT
  • Reporting by using the MTUHA system
  • Training of health workers to improve technical and communication skills
  • Active community participation
case study qm in a tanzanian health region76
Case study: QM in a Tanzanian Health Region

New quality tools

  • Commitment of leadership
  • Health workers themselves take responsibility for monitoring (e.g. in quality circles)
  • Client / community satisfaction with the health services is considered as important part of quality
  • Strict monitoring using a standardised set of indicators with scoring and ranking of the health facilities according to their performance
  • Information of the public and local authorities (and creating public concern)
  • Awarding of well performing services
case study qm in a tanzanian health region77
Case study: QM in a Tanzanian Health Region
  • There is a huge network of HF but low level of quality
  • Q-control / Q-assurance (supervision, HMIS) with little impact so far
  • HSR can only succeed if quality of care is improving
  • People request better quality (cost sharing)
case study qm in a tanzanian health region78
Case study: QM in a Tanzanian Health Region
  • Adaptation of the EFQM model to local needs
case study qm in a tanzanian health region79
Case study: QM in a Tanzanian Health Region

People

Management

90 points (9%)

People

Satisfaction

90 points (9%)

Leadership

100 points

(10%)

Processes

140 points

(14%)

Business

Results

150 points

(15%)

Policy &

Strategy

80 points (8%)

Customer

Satisfaction

200 points (20%)

Impact on Society

60 Pkte (6%)

Resources

90 points

(9%)

Enablers 500 points (50%)

Results 500 points (50%)

case study qm in a tanzanian health region80
Case study: QM in a Tanzanian Health Region
  • EFQMAdaptation
  • Leadership Leadership
  • People Management Personnel Management
  • Resource Management Resource Management
  • Processes Health Care Performance
  • People satisfaction Staff Satisfaction
  • Consumer Satisfaction Client Satisfaction
  • Impact on Society Health Service Output
  • Business Result Health Service Outcome
case study qm in a tanzanian health region81
Case study: QM in a Tanzanian Health Region
  • HF provide good CQM, if
  • 1. Leadership is strong
  • 2. Personnel Management is powerful
  • 3. Resource Management is appropriate
  • 4. Health Care Performance is in line with national and international standards
  • 5. Staff Satisfaction Staff is motivated and satisfied at the working place
  • 6. Clients Satisfaction Clients attend and appreciate the HF
  • 7. Health Service Output HF achieve set goals
  • 8. Health Service Outcome is strengthened by the HF
case study qm in a tanzanian health region82
Case study: QM in a Tanzanian Health Region
  • Step 6:
  • Organization of a baseline study to get data on service quality
case study qm in a tanzanian health region83
Case study: QM in a Tanzanian Health Region
  • How the 8 areas of CQM were assessed in Tanga Region?
  • A baseline study was perceived by the Regional Health Management Team as the starting point of the CQM process
  • Elaboration of appropriate questionnaires by the RHMT
  • All public health facilities in the Region were visited by DHMT members, who applied the questionnaires
  • Analysis of the results and scoring of the HF according to their performance
case study qm in a tanzanian health region84
Case study: QM in a Tanzanian Health Region
  • 3. How the questionnaires look like?

Main

Questionnaire

User

satisfaction

Client

satisfaction

case study qm in a tanzanian health region85
Case study: QM in a Tanzanian Health Region

OPD

      • Handeni Tanga Region
  • No HF 32 154
  • Privacy provided 59% 54%
  • Patient greeted 43% 44%
  • Pat. given enough time to explain 67% 32%
  • Appropriate counselling 38% 32%
  • History taken 60% 52%
  • Proper examination 51% 42%
  • Appropriate lab investigation 7% 10%
  • Diagnosis consistent 64% 53%
  • Treatment accordingly 68% 58%
  • Drug dosage appropriate 64% 58%
  • Pat instructed correctly 41% 45%
  • Card filled correctly 56% 50%
  • Pat understanding checked 41% 26%
case study qm in a tanzanian health region86
Case study: QM in a Tanzanian Health Region
  • Family Planning
          • Handeni Tanga Region
  • Qualified FP nurse/midwife available 81% 84%
  • FP service offered daily 94% 94%
  • HF offers pills 78% 72%
  • HF offers injectables 84% 94%
  • HF offers IUD 31% 33%
  • HF offers condoms 69% 78%
  • HF ensures privacy 81% 82%
  • FP cards correctly filled in 66% 57%
  • Pills out of stock 31% 32%
  • Injectables out of stock 25% 29%
  • IEC available 72% 71%
  • Assess drop outs 47% 63%
case study qm in a tanzanian health region88
Case study: QM in a Tanzanian Health Region
  • Answer the following questions:
      • Which are the different categories of HF?
      • Are their any areas with cannot be scored?
      • How to weight the remaining areas?
      • How weighting should be done within an area?
case study qm in a tanzanian health region89
Case study: QM in a Tanzanian Health Region
  • 1. Leadership 50 10%
  • 2. Personal Management 50 10%
  • 3. Resource Management not scored
  • 4. Health Care Performance 200 40%
  • 5. Staff Satisfaction not scored
  • 6. Clients Satisfaction 75 15%
  • 7. Health Service Output 125 25%
  • 8. Health Service Outcome not scored
  • Max. Points 500 100%
case study qm in a tanzanian health region90
Case study: QM in a Tanzanian Health Region
  • Why these areas were not scored?
  • Financial Management: HF are not comparable because of different financial schemes
  • Staff Satisfaction: In this first round the questionnaires was anonymous
  • Health Service Outcome Difficult to measure from a HF perspective

** Only Health Centers could reach 500 points, for dispensaries without IPD and laboratory the denominator is 363 points

this approach was not accepted
This approach was not accepted!
  • Supervision was not done according to the planned schedule
  • Supervisions checklist have not been filled in
  • If Supervision checklist have been filled in, filling in was very often incomplete