QUALITY

HEALTH
CARE AND
NURSING

Course Description:
This course deals with the concepts,
principles and dimension of quality health
care, quality standards for Health Provider
Organizations and implementing a
Performance Improvement/management
program in the health care system. It
provides students with an introduction to
quality improvement in a health care
setting. The course challenges students to
think in an interdisciplinary manner when
problem solving for quality improvement
and will provide students with models and
tools for leading quality improvement

Course Objectives:
At the end of the course, and given actual health care management and clinical case scenario, the students will be able to develop
strategies, using common quality measures, to implement continuous quality improvement in a variety of healthcare settings.

Specifically, the students will be

able to:

Implement the PhilHealth Quality Standards

Apply Performance Improvement and TQM
philosophy
Utilize the different quality standards for nursing
and health care organizations
Implement the Plan-Do-Check-Act (PDCA) Cycle
Use appropriately Quality Improvement Tools
Form Quality Circles and Quality Teams
Implement Quality Improvement activities.

Learning Objectives:
After lecture-discussion, the students will be able
to:
Define quality, quality care and standard.
List the dimensions of quality care.
Identify key leaders in the field of quality and
their contributions.
Identify features of the TQM and Quality
Improvement in health care organizations.
Explain the different standards affecting the
delivery of health care and nursing services.

INTRODUCTION

What is QUALITY?
A high level of value or
excellence (Merriam-Webster
Dictionary).
Quality is an optimal balance
between possibilities realized
and a framework of norms and
values (Harteloh, 2003).

What is QUALITY CARE?

Fitness to use by the customer (Joseph
Duran).
Conformance to requirements (Philip
Crosby).
It is the complete satisfaction of the needs of
those who are in most need of health
services, for the lowest organizational costs,
within the given limit and guidelines of
higher administrative bodies and those
paying (Ovretveit in Ritonja, 1998)

What is QUALITY CARE?

This refers to the degree to which health care
increases likelihood of desire health outcomes, and
is consistent with current professional knowledge
(Institute of Medicine, 1990).
It takes into account three (3) factors:

a.) the variability of the achievement of quality

each time care is rendered;

b.) health care cannot guarantee the attainment

of outcomes that clinicians and patients expects;

c.) scientific evidence and professional standards

are crucial in defining care.

 The end goal and ultimate

recipient of any effort towards
quality of health care is the
PATIENT.

19th Century Quality of Health Care Thinking

Dr. Edwin Chadwick
In 1842, he reported on unsanitary conditions in communities
and the lack of public health professionals to provide quality
service.
He recommended the creation of guidelines for the
training of public
health workers.

Dr. Lemuel Shattuk

At about the same time, in the United States, published
a similar report on sanitary conditions in
Massachusetts.

 Florence Nightingale
A little over a decade later, in 1854, then serving as a nurse
in the Crimean War, introduced the idea of quality care in
army hospitals and posited that adequate nursing care to
wounded soldiers would decrease the mortality rate among
them.
This was the first time that the relationship between quality
of care and positive outcomes was established (WHO 2001).
In 1999, the Joint Commission on Accreditation of Healthcare
Organizations (U.S.) published excerpts from her book as
Florence Nightingale: Measuring Hospital Care Outcomes.

Why is QUALITY OF CARE

important?
Jonas and Rosenberg (1986) have
identified four(4) broad categories which
explain the need for quality of care:
1) Hippocratic oath principle of primum non
nocere (First do no harm);
2) The social and humanitarian motivation
to use resources for the good of those in
need;
3) Professionalism;
4) Survival.

Why is QUALITY OF CARE

important?
1. Tougher Competition
2. Frequent Medical Errors
3. Rising Costs, Limited Health
Expenditures
4. Rising Demands, Limited Health
Resources
5. Concern with Variations in Health
Care Outcomes and Costs

Where Quality of Health Care

Starts
Quality health care, whether delivery
is seen at the patients end or from the
provider organizations perspective,
starts with two principal actions:
1.) Decision-making selection of the
most appropriate health intervention.
2.) Performance action effective,
efficient and timely application of the
selected intervention.

Health Care Customers

INTERNAL
CUSTOMERS
1. Staff and
Employees
2. Funders

EXTERNAL
CUSTOMERS
1. Patients
2. Payors of
Health
Care
3. Contractors

Quality of Care Dynamics: Dimensions and Cross-Dimensional

Issues

Dimensions of Quality Health Care

Most clusters of quality indicators were and often
continue to be comprised of the 5Dsdeath, disease,
disability, discomfort, and dissatisfactionrather than
more positive components of quality.
The most recent IOM work to identify the components
of quality care for the 21st century is centered on the
conceptual components of quality rather than the
measured indicators: quality care is safe, effective,
patient centered, timely, efficient, and equitable.
Thus safety is the foundation upon which all other
aspects of quality care are built.

Dimensions of Quality Health Care

The work of the American Academy of Nursing
Expert Panel on Quality Health focused on the
following positive indicators of high-quality
care that are sensitive to nursing input:
a.) achievement of appropriate self-care
b.)demonstration of health-promoting
behaviors
c.) health-related quality of life
d.)perception of being well cared for, and
e.) symptom management to criterion.

IOMs Six(6) Aims for Improving Health Care Quality

PhilHealths Dimension of Quality Health Care

Assessment focus points of PhilHealths new Quality Assurance

framework

PhilHealths Cross-Dimensional Issues of Quality Health Care

THANK YOU
FOR
LISTENING!