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Health Care

The Principle of Quality Improvement

Quality in healthcare is the degree in which a healthcare institution provides its healthcare service for populations and individuals by increasing the likelihood of the desired health results, and they are consistent with current professional skills and knowledge. Despite the proven and common outcome of the healthcare industry, quality improvement and also safety implementation lags in this sector arena. Improving the safety of the patient and the quality of care they need requires a clear comprehension of the leadership, system design and function, teamwork, the motivation of the worker, and statistical/ scientific assessments of whether the changes in the institution are heading to improvement. Therefore this paper will focus on quality improvement in healthcare institutions, its benefit, and the application to improve service provided to patients.
Therefore in health care institutions, there are analytical frameworks for quality assessment that guide the measure development initiative in the health sector. The most influential is the framework that is put forward by the institution of medicine (IOM) includes the following aims in the healthcare system:
Safe: avoiding harm to the patient.
Effective: the services that are given to patients should base on professional scientific knowledge.
Patient-centered: the care given to the patient should be respectful and responsive to the personal patient preferences, values, and needs and make sure that the patient values guide all clinical care decisions.
Timely: duration of care should minimize by reducing the patient’s waiting time which may cause more harm to his health.
Efficient: the element of wastage should be avoided that include waste of supplies, equipment, energy, and ideas.
Equitable: the quality of the services or care provided should not base the personal properties of gender, location, ethnicity and socioeconomic status.
This IOM framework aims to assist in guiding the health care institution to provide equal quality care to the patient regardless of their personalities.

Benefits of healthcare quality

The benefits of the health care quality are distinguished base on its ability to meet the needs of the patient and the healthcare institution. That is social, patient health, and business benefits
Social benefits
Improve mutual understanding and respect between healthcare organizations and patients.
Promote participation of the community in the health issues that create awareness in case there is an outbreak of certain illness in the community and how to manage it.
Quality healthcare improves healthcare for the patient and families and their responsibilities to health.
Improve trust of the community to the health institution.
Patient health benefits
Quality health care can provide patient satisfaction that increases the number of patients seeking treatment in health centers.
It improves the continuity of care by providing correct measures for the prevention and management of chronic disease in patients.
In many cases, quality care reduces hospitalization and ED patients and lower the cost of treatment for the patients.
Quality healthcare increase population based on monitoring and planning, hence improving the quality of life of the patients and families.
Well, plan health care institutions reduce the wastage of resources and time. It reduces the waiting time for the patient to get treated.
Business benefits
Quality healthcare incorporates different perspectives, strategies, and ideas into a common decision-making process for the progress of the health organization.
It assists the organization to move forward to meet the legal and regulatory guidelines for better service provision to their patients. This reduces barriers that lower the progress of the organization.
Quality services of healthcare increase the market share of the health organization by improving the efficiency of the healthcare services that it provides to its patients. It increases the revenue generated by the organization.
Information or records of the patient are safely and correctly kept for future reference and analysis.
Quality healthcare improves the utilization of the organization’s resources that reduces its wastage, thus the effective operation of the healthcare organization.

Compare the principle of quality assurance and quality improvement.

Quality assurance is the effort of the healthcare organization to find and overcome the issues with quality. It provides confidence that the issues to deal with quality will be fulfilled. The confidence given by quality assurance is normally in two-fold that is internal to the management of the organization and external to the customer of the organization. Quality assurance directs the performance and behavior of the institution and practitioners toward appropriate and acceptable results and expenditures. For example, the customary approach to hospital quality assurance consists a team of an individual or an individual that are concerned about a certain aspect of a procedure or treatment. They use previous information to improve the performance of the health organization as a whole.
Quality improvement is also called total quality management; it is another way of improving quality that is introduced in healthcare. Quality improvement combines scientific methodology and management philosophy to improve the operation of the organization. It uses statistical process controls where it collects previous information about the performance of the health organization, analyze them, and takes appropriate action to improve the quality operation of the organization. Therefore, there is a clear strategy developed in quality improvement that is followed to provide quality services.
Quality improvement differs from quality assurance because it’s based on data, facts, and specifications rather than on standards. Hence quality improvement is a method of quality management by facts that offer physicians data without blame. It stimulates learning and curiosity by making it educational rather than punitive. It normally has the objective of progressive improvement of the healthcare process, which will improve results than improving results alone as it happens in quality assurance. Quality improvement always deals with the process; it normally focuses on the whole group, not the statistical tail that leads to a philosophy of quality of the best possible. As opposed to quality assurance is good enough. The effective way of improving the quality of the service given by the health sector is to improve failures before they occur by establishing quality in the processes rather than adding it at the end. Quality at the end is analogs that rely on terminal inspection to improve produced products as they appear on an assembly line.

Comparison of quality improvement and quality assurance


Quality Assurance Quality improvement
Objective outcome Process and outcome
Based on Standard, threshold Specification, data
focus Statistical tail Entire group
philosophy Good enough Best possible
effect judgmental Education


Quality improvement processes and methods

Quality improvement methods are used to improve the quality of the service provided by the healthcare organization. They include clinical in-service training, improvement collaboration, COPE, accreditation, SBM_R, and supervision.
SBM-R (Standard based management and recognition)
It is a standardization approach that attempts to bridge the gap between the practice evidence in low and middle-income nations. The main goal of this method is to identify the desired results and the process that will lead to those results. The first stage of this approach is to train the supervisors and the team on the content of the standards and the quality improvement process. The approach facilitator then takes the baseline assessment and works with a set team, normally at the health facilities. Then analyze the obstacles that hinder the implementation of the standards. The intervention that corrects the issues must be all the factors that affect performance. These will involve things like available resources, providers’ skills, and knowledge, and the motivation of the health worker. In the next stages of the process, external and internal supervisor monitor and measure staff progress to recognize the progress made. The SBM-R method recognizes the role of all the workers and supervisors and finds a way to mobilize the community for health.
It is a risk reduction strategy; It works by employing standards and evaluating adherence to them. Every organization normally chooses its way to attain accreditation standards. The processes are the method of quality improvement. As this strategy requires regular review, thus it encourages a culture of continuous quality improvement. The strength of the accreditation approach is its emphasis on the healthcare system. Therefore, accreditors observe all the healthcare processes, materials, and workers that are involved in the organization and evaluate them against consensus standards. It promotes new working relationships across a section of the healthcare system which improves the quality of performance.

Collaboration improvement

It is the strategy of improving quality that is based on the relationship within the healthcare organization. In the organization there encourage the formation of a team where it promotes learning from peers that test different paths to improve the common indicator. The strategy support analysis of the healthcare processes by collecting data and deriving care on the results being studied. A collaborative approach can address managerial and clinical topics like waiting time and recordkeeping.


It is a strategy for quality improvement by developing appropriate constraints to monitor healthcare processes. It gives management the duty to supervise the processes in the in healthcare organization. Each processor department is headed by qualify expert who coordinates all the activities in the section. Therefore the manager led all activities in his department to improve the quality of the products that are provided. Management has the role to train their junior worker and supervise their performance to improve the quality of services they provide to their customer.

Clinical in-service training

It is a strategy that is employed by the healthcare organization to improve the skill and knowledge of their worker by training them so that they can improve the quality of healthcare they provide to patients. Uniformed workers are trained, or further education is provided to all workers to improve their performance, this improves the quality of the service they give patients, but the strategy can change large issues like employee motivation and poor working environment.

Plan do study act (PDSA)

It is a healthcare improvement model or strategy for improving the quality of services that are provided to patients. Its a simple strategy but a very powerful tool for accelerating quality service improvement. In this strategy, the team of workers is set and develops objectives and measures to determine if the change can lead to improvement. The next stage is to test the change to the real work setting. It is shorthand to test changes that include planning, trying, observing the outcomes, and act on the findings. Thus its scientific strategy that used in action-oriented learning.

Steps in the PDSA cycle

Plan: in this step, it includes planning for the observation or test and collection of data.
Do: a test is done in this step but on a small scale.
Study: analysis of the data collected is done and the study of the outcomes.
Act: correct action is taken in this step base on the finding that was learned from the test.
An example of the PDSA model can be done at the hospital check deck where the patient is asked to fill a survey form on how they are satisfied with the services they receive in the hospital. All the information collected is then analyzed, and corrective action is taken to improve the quality of hospital performance.

Using data to make a decision

Healthcare quality in health organizations is done by collecting information from the patient who visited that health center and asking if they were satisfied with the service they got. Therefore the data collected is used to analyze the performance of that health center. In the case of improving the quality of performance, one of the quality improvement strategies should be applied to improve the quality of healthcare. However, there are several characteristics of healthcare data that make them unique. The particular healthcare data is as follows:
Most of the data is in multiple places: the data are gotten from different sources of systems las HR or EMR software, which are used in different departments like pharmacy or radiology. This makes the data come in a different format. Therefore aggregating the data into a single centralized system is not easy.
Healthcare data is structured and unstructured because they come from different platforms that may differ in format. This makes it difficult to document these data.
There is an element of inconsistent or variable healthcare data. A group of clinicians may define patient differences that lead to variation in the data collected in a healthcare organization.


Quality improvement tools

Check sheet: it is a structure preparation form for analyzing and collecting of data
Control charts: it is graphs used which is used to study how the process changes over a stipulated time.
Histogram: a graph that shows the frequency distribution of the occurring data.
Pareto chart: it is a bar graph that is used to represent factors that are more significant.

Nursing role in healthcare quality

Staffing: nurses ensure that the health center is adequately covered with nursing staff for relevant specialties and cadres.
Provision of therapeutic wards which is social, physically and psychologically conducive to the patients
The nurse provides good interpersonal communication with patients and provides quality nursing care.
Leadership role: nurse leaders should have a different leadership style that is used to provide high productivity and optimal performance from subordinates.
A delegation of responsibility: nurse leaders should assign responsibility to subordinates by considering their skills, knowledge, and attitudes.


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