Quality improvement in health care organizations: A general systems perspective

Abstract

A systems analysis of healthcare organizations demonstrates that methods for improving quality involve the effective feedback regulation of key organizational performance parameters. Information flow is impaired in dysfunctional healthcare organizations, which often disregard significant clinical problems while preferentially tracking nonclinical indicators and clinical data considered most likely to meet the organization's standards. Such organizations thus achieve "pseudocompliance" with external requirements, but do not systematically work to improve the quality of clinical care or their performance as organizations. Efforts by government agencies and national organizations to foster quality improvement activities have had limited success precisely because local organizations perceive these efforts as externally imposed. Leaders' anxieties about their own and their organizations' autonomy, control, and performance can cause unwillingness to review data indicating performance problems, oversimplification of decision criteria, and reluctance to formulate meaningful conclusions and act on them. Contemporary quality improvement models, such as Continuous Quality Improvement (CQI) and Total Quality Management (TQM), reconnect leaders to their organizations' quality processes by emphasizing the leaders' roles in promoting quality as an organizational value, setting meaningful quality goals, and actively u sing information to improve organizational effectiveness.

Development of key performance indicators to evaluate centralized intake for patients with osteoarthritis and rheumatoid arthritis

“…Once tested for feasibility, the KPIs will be used to develop and evaluate an optimal centralized intake system for arthritis care for OA and RA. Measuring the impact of changes to a centralized intake system using standardized metrics is critical for ongoing quality assurance and quality improvement in health systems [ 38 ], and this work represents a critical first step in optimizing access to healthcare delivery for patients with OA and RA.…”

Patients' satisfaction with health services at the National Institute of Public Health of Kosova

“… Baseline data ( 6 ), Quality of service ( 3 ) with twelve sub-questions- structure and process quality indicators Patients’ comments as open questions ( 1 ). …”

“…Total Quality Management introduced since 1970s with Avedis Donabedian concepts on quality assurance as new management philosophy, systematic approach and set of guiding principles for continuous improvement, followed by Donald Berwick known as “father” of Total Quality Management (TQM) with great merit for health care quality improvement ( 1 ) is embraced by healthcare decision makers in Kosovo, too. Leadership commitment on quality improvement processes, information and analysis, focused on culture of continuous change, problem solving and monitoring of performance and also patients satisfaction is very important for fostering TQM philosophy and quality as an organizational value ( 2 , 3 ). Beside leadership and employee commitment, effective and efficient use of available resources and competitiveness are necessary for quality improvement and increase of organization’s productivity.…”

Process Potential Screening

“…• Furthermore,toensure good results,precise definitions anda lignments of the process aren eeded.T his is particularly the case for the difficult to grasp "product" health [24].…”

“…The overall matrixcontains 30 quality aspects (indicated by numbers )and 16 quality criteria. connecting-pointswithotherprocesses 9 process activities and contacts between staff, patient and/or other customers goal,purpose,results, method of execution, time needed 10 number, sequence, start and end point 11 resources (persons, rooms, materials, information), for each of them*: purpose/characteristics/ properties [12][13][14][15] number, extent [16][17][18][19] availability [20][21][22][23] Monitoring andcontrolling responsibility for wholeprocess 24 processmonitoring kindofefforts, execution, responsibility and results 25 number and frequency 26 reporting and communicating the results 27 processcontrolling type of efforts, execution, 28 responsibility and results number and frequency 29 reporting and communicating the results 30 QUALITY ASPECTS -The hospitalprocessshouldhave (a)"good"…: A1 It is beneficial to tailor the questionst o the specific characteristicso ft he process, e.g., naming the doctor's letterorthe patient record as specificinformation resources instead of using the generalterm"information resources". If the hospitalp rocess to be evaluated is known before the meeting of the project group, aq uestionnaire can also be drawn up on the basiso ft he relevant quality aspectsand criteria.Inany case, the PPS can be used by the person whoi sr esponsible or involved in the process, by a moderator,a sw ella so therr epresentatives of the targetgroup (e.g., quality managers).…”