THE CONCEPT OF T.Q.M. IN HEALTHCARE Dr. A. Ziko MRCP, FRCPCH, C.P.H.Q. (Certified Professional in...
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Transcript of THE CONCEPT OF T.Q.M. IN HEALTHCARE Dr. A. Ziko MRCP, FRCPCH, C.P.H.Q. (Certified Professional in...
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THE CONCEPT OF T.Q.M. IN HEALTHCARE
Dr. A. Ziko
MRCP, FRCPCH, C.P.H.Q. (Certified Professional in
Healthcare Quality)
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“Quality”
Having high degree of excellence
Doing right things right first time
Is cost - reduction, not a cost
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Concepts
WHAT IS QUALITY?
Freedom from deficiency
Product feature
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TQM as a management philosophy
Aims to:
Customer service
Productivity
Profits
Market share
Cost
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T.Q.M.
It is a broad management philosophy, espousing quality and leadership commitment, which provides the energy and the rationale for implementation of the process of continuous quality improvement within the organization wide quality strategy.
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Aspects of Quality
1. Measurable
2. Appreciative
3. Perceptive
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Dimensions of Quality
Appropriateness Competency Effectiveness Efficiency Timeliness Prevention and early detection
Availability Continuity Efficacy Safety Respect and care
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Key Concepts of TQM
Top management leadership Creating corporate framework for quality Transformation of corporate culture Customer focus Process-focus Collaborative approach to process improvement! Employee education & training Learning by practice & teaching Benchmarking Quality measurement & statistics Recognition & reward Management integration
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TQM believes in the values of:
1. Customers:- Needs- Expectations- Opinions2. Staff:- Willingness & desire- Abilities & desire- Opinions- Access to Top Management- Involvement in:
1. DECISION MAKING2. PROBLEM SOLVING3. GOAL SETTING4. PLANNING
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3. Management:- Commitment & Visibility- Active Leadership- Participation- Empowerment of Employee- Accountability4. Teamwork: - Unity- Ownership- More & better ideas- Openness- Encouragement- Mutual respect- Incentive & reward
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Basic Elements of A Process
Supplier Processors Customers
Inputs Sequence of steps Output
System, Function, Process & Step
System
Function Function
Process Process Process Process
Step Step Step Step
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Module of Donabedian
CAUSAL RELATIONSHIP
Structure Process Outcome
Effective Efficient Good
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Change in Emphasis
In part focus on- What of care i.e. patient care GIVEN.- Who of care i.e. patient care GIVER.
Concentrate on improving system & process, most of the time:-
- The how of care patient care PROCESS- The result of care patient care OUTCOME
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Structure
The arrangement of parts of care system or elements that facilitate care
e.g.Resources
Equipment
Number of staff
Qualification of staff
Work space
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Process
Refer to the procedures, methods, means or sequence of steps for providing or delivering care, producing outcomes.
- Clinical process
- Care delivery process
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Outcome
Refers to the results of care, adverse or beneficial e.g.
CLINICAL- Short term- Complication
FUNCTIONAL- Long term health status- Activities of daily living
PERCEIVED
Patient / family satisfaction
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Quality Management Trilogy
Control / measurement Improvement Planning
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Continuous Quality Improvement Process
DO
PLAN STUDY
ACT
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Decision Making: Traditional Model(Data Deficient)
Intuition
Opinion
Logic Recommendations/
Rationalization Action
Rumor
Hearsay
NO DEFINED PROCESS
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Decision Making: Q.M. Model(Data-based)
Q. Planning Q. Improvement Q. Control
Decision Decision
Interpretation/ Proposal/
Understanding Hypothesis
Statistical
Analysis Collection
Knowledge
Data
Information Design
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General Management Functions
Management is the sum of these activities to improve human and material resources toward achievement of stated goals.
PLANNING ORGANIZING & STAFFING DIRECTING COORDINATING IMPROVING
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Core Quality Improvement Standards
Quality leadership Data collection for quality monitoring Analysis of monitoring data Quality improvement
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Do We Need These?
Medical record Information system Protocol & clinical guidelines Teaching session Appraisal system Review / audit of mortality & morbidity Quality department
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مفهوم إدارة الجودة الشاملة فى الخدمات
الصحية
د. عادل زيكوزميل الكلية الملكية البريطانية
رئيس قسم األطفالمستشفى مصر للطيران
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الحالة سنوات يسكن قرية / عزبة 3مرزوق ع.ع عمره
الخصوص. أمه ست بيت و أبوه موظف فى وزارة الشئون .بالقاهرة
سنوات، و 10 سنة, سعاد 15له ثالث شقيقات: خضرة . سنوات5سيدة
أحضرته أمه للعيادة الخارجية بسبب حدوث حرارة و .مغص و قئ لمدة ثالث أيام، لم يستجب للعالج
:العيادة الخارجية
لم تتمكن أم خضرة من الكشف إال بعد ومزدحمة مزاحمة أمام الطبيب لمدة ساعة، و قد سألها و وضع
دقائق فقط حتى 5السماعة على بطن مرزوق فى مدة حالة وحده. بالفحص تبين أن 50يتسنى له الكشف على
/دقيقة و ال يوجد 150درجة م و سرعة القلب 40الحرارة طفح جلد، و الولد بحالة جيدة برغم الحرارة العالية.
اليوم األول:
الطبيب طالب أذن قبول الحالة بقسم األطفال الداخلى لألطفال مع أمه
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طالب التحاليل:صورة دم كاملة•أيونات بالدم•تحليل بول•أشعة على القلب و الصدر•
العالج:محاليل بالوريد•جارامايسين )وريد(•حقنة أسبيجيك )وريد(•
اليوم الثانى:مرور النائب:
درجة م و توقف القئ38 ,5الحرارة أفضل األشعة فقط هى التى ظهرت و كانت طبيعية
لم يتم سحب بقية عينات الدم إال اليومالعالج السابق كما هو مع بدء األكل
تحليل براز و •مزرعة
وظائف كلى و كبد•
أمبيسلين )وريد(•
باراسيتامول •)لبوس(
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اليوم الثالث:مرور اإلستشارى:
درجة م، ظهور طفح 39مرزوق عاود القئ بصورة أشد و الحرارة جلدى بسيط على البطن. لم يظهر سوى صورة دم كاملة:
جرام10هيموجلوبين = مليون4عدد كرات الدم الحمراء =
15 ,000عدد الكرات البيضاء = 450 ,000صفائح دموية =
تم تغيير العالج:وقف االمبيسلين و الجارامايسين•فورتم الوريد•متابعة التحاليل•
فى آخر اليوم ظهرت نتيجة تحليل البول خاليا صديدية أكثر من 100
اليوم الرابع:مرور النائب:
درجة م 38 ,5مرزوق تحسن القئ عنده و كذلك الحرارة اختفى الطفح الجلدى و حالته العمومية أفضل
وقف •االسبيجيك
عودة •المحاليل
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تحاليل:للبول • مزرعة عملحساسية • أطهرت الدم Staph Aurtausمزرعةحساسية • Fortran Ciprofloxacinوطبيعية • الكلى و الكبد وظائفبعد • تظهر لم البراز مزرعة:العالج
فورتم • ابدأ و الكالفوران ورقالعين • قاع فحص طالبكل • الحرفة انعكاسات و الوعى درجة ساعات 6متابعةشوكى • نخاع زرع لطالب باالستشارى االتصال محاولة
: الخامس اليوم: االستشارى مرور
حرارة من أفضل يبدو و 38 ,5 مرزوق بالقسم يلعب و م درجة. الجلدى الطفح اختفى و القئ توقف
العالج:سوتريم • شرابللبول • مظهر فوار
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معامل:ترتيب أشعة تليفزيونية على البطن•
اليوم السادس:
مرور النائب:مرزوق يبدو أفضل كثيرا و ذو شهية أفضل لألكل و اللعب،
لم يتمكن النائب من ترتيب األشعة التليفزيونية اليوم
اليوم السابع:خرج الطفل و أمه بعد عمل األشعة التليفزيونية و ظهور مزرعة البول و حساسية إلى سوتريم مع موعد للمتابعة
من العيادة بعد أسبوع.
ملخص الحالة: أيام بالمستشفى7بقاء مرزوق و أمه 1.المضادات الحيوية : أمبيسلين – جارامايسين – كالفوران 2.
– فورتم – سوتريمخافض الحرارة : باراسيتامول - اسبيحيك3.
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وريدية .4 محاليلأيام 4لمدة •
تحاليل:5.مزرعة – و دم 2/7صورةكلى – و كبد 2/7وظائفمزرعة – و براز 1/7تحليلمزرعة – و بول 4/7تحليلالصدر – و القلب على 1/7أشعةالبطن – على تليفزيونية 7/7أشعة
مرتان 6. اإلستشارى 5/7، 3/7مرور
مرزوق 7. مع خضرة أم أن 7/7حجز حتى البيت أربكبالبيت مكثت اإلعدادية طالبة لترعى 3خضرة أيام
. الصغرى أختها