PAHS 423

PRINCIPLES OF HEALTHCARE
QUALITY ASSURANCE
STUDY GUIDE
Session 7 – Key issues in healthcare Quality Assurance

Lecturer: Nana Nimo Appiah-Agyekum (PhD), UGBS

Contact Information: nnappiah-agyekum@ug.edu.gh

College of Education
School of Continuing and Distance Education
2014/2015 – 2016/2017
 Session Overview
Healthcare quality assurance is as important as health
service provision. This is because access to the patient
(both by volume and payment level) is determined by
demonstrating high quality and cost efficiency through
quality assurance. This session is thus dedicated to some of
the core quality assurance issues that influence healthcare.
At the end of the session, the student will be able to
• Explain the how to ensure quality assurance effectiveness
• Describe the unique settings of healthcare quality
assurance in developing countries
• Explain the key considerations of contemporary
healthcare quality assurance
Slide 2
 Session Outline
The key topics to be covered in the session are as follows:
• Topic One : Quality assurance efficiency and
effectiveness
• Topic Two : Key issues in modern day quality assurance
• Topic Three : Healthcare quality assurance in developing
countries

Slide 3
 Reading List
• Szczerban J (2009), Quality Assurance in Healthcare, in Mansourian
B P (ed). Global Perspectives in Health-Volume II. Vol. 3. EOLSS
Publications

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Topic One

QUALITY ASSURANCE EFFICIENCY

AND EFFECTIVENESS
Slide 5
 Making quality assurance initiatives
efficient
Healthcare Quality is assured if the QA initiatives are
efficient and generate desired outcomes. Healthcare
managers must
• Evaluate population coverage of the QA initiative
• Evaluate the technological merit of health
interventions
• Determining which objective standards to use as
benchmarks
• Continuously assess the quality of services
compared with prescribed standards
 Underlying factors for Quality
Assurance effectiveness
• Contextual factors:
context subsumes the general properties of
the situation into which quality assurance is to be
introduced and in which it is to operate
• Operational factors:
Relates to the general and specific activities that
are actually done in the quality assurance process
as well the principles, standards and ethics
governing them
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 Contextual factors
• Leadership
• Culture
• Change management
• Sponsorship
• organization of the healthcare enterprise
(whether formal or informal)
• Networking and communication
• Globalization
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 Operational factors
1. There is a demonstrable, consequential,
legitimate need.
2. Something can be done to meet the need.
3. That which will be done, or is done, is the right
thing, done in the right way.
4. There are demonstrable, useful results, free of
unforeseen, harmful consequences

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Topic Two

KEY ISSUES IN MODERN DAY

QUALITY ASSURANCE
Slide 10
 Focus of modern-day Quality
assurance
1.Assessment of patient care problems that
have substantial effect on treatment
outcomes
2.Use of objective criteria and/or standards
developed by peer-professionals as the
measure of quality care
3.The elimination of impediments that
restrict the benefits of care
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 Key considerations of modern day
Quality assurance (1)
• Drivers: there are psychological, economic, ethical
and legislative forces driving QA activities.
• Inconsistency: quality assurance occurs as a
strong component of healthcare in some periods
only to suffer neglect in others
• Time barriers: Though the time required to collect
quality assurance data is an inhibiting factor,
practitioners skilled in quality assurance must
learn to blend it into the ongoing treatment
process Slide 12
 Key considerations of modern day
Quality assurance (2)
• Assessment avoidance: a strong emotional need to
avoid formal assessment of patient outcomes.
• Paternalism: Instead, professionals focus on
treatment we believe to be beneficial than to look
at patient outcome and face possible changes.
• Cost considerations: total direct and indirect costs
discourages QA
• Commitment: backed by the appropriate
stakeholder commitment, QA can solve major
problems in productivity and healthcare outcomes
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Topic Three

HEALTHCARE QUALITY ASSURANCE

(HQA) IN DEVELOPING COUNTRIES
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 Determinants of HQA in developing
countries
Healthcare quality assurance activities in
developing countries varies from country to
country depending on
• Political ideology and political leadership
• Health beliefs, systems and expectations
• Health infrastructure
• Economic development
• Human resources Slide 15
 Components of HQA in developing
countries
The most relevant components of HQA in
developing countries include
• Medical education and health worker training
• Standardization of healthcare procedures
• Technology adoption, appropriateness and
transfer
• Monitoring, evaluation and regulation
• Patient rights and involvement
• Research
 Benefits of HQA in developing countries
• helps to reduce waste
• promotes confidence, improves communication
and fosters a clearer understanding of community
needs and expectations
• offer health workers an opportunity to excel,
thereby increasing their job satisfaction and status
in the community
• Affords donors, governments, healthcare providers,
and communities the chance to realize more
benefits from existing investments in health care
Slide 17
 Barriers to HQA in developing countries
Barriers may be country-specific, community-
specific or facility-specific. General ones include
• Poorly trained or oriented personnel
• Limited finances and investment in healthcare
• Lack of equipment and logistics
• Poor understanding of the QA process
• Weak institutional and regulatory regime
• Lack of stakeholder collaboration and
involvement
 Sample Question
• What are the key issues of healthcare quality assurance in
Ghana?
• What makes these issues key in your view?

Slide 19
 References
• Brown, L. D., Franco, L. M., Rafeh, N., & Hatzell, T. (1992). Quality
assurance of health care in developing countries. Quality assurance
project.
• Donaldson, M. S., Corrigan, J. M., & Kohn, L. T. (Eds.). (2000). To err is
human: building a safer health system (Vol. 6). National Academies
Press.
• IOM (2001) ‘Crossing the quality chasm: a new health system for the
21st century’, Committee on Quality of Health Care in America. xx.
Washington, D.C.: National Academy Press; 2001. p. 337.

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