PDF Quality of care

Quality of care

A PROCESS FOR MAKING STRATEGIC CHOICES IN HEALTH SYSTEMS

Quality of Care

A process for making strategic choices in health systems

WHO Library Cataloguing-in-Publication Data

Quality of care : a process for making strategic choices in health systems.

1.Quality assurance, Health care. 2.Health services administration. 3.Decision making. I. World Health Organization.

ISBN 92 4 156324 9 ISBN 978 92 4 156324 6

(NLM classification: W 84.1)

? World Health Organization 2006

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Printed in France

Contents

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii

Structure of the document . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1. Background and assumptions . . . . . . . . . . . . . . . . . . . . . . . . 3 Why a focus on quality now? . . . . . . . . . . . . . . . . . . . . . . . . . 3 Why a focus on health systems and decision-makers? . . . . . . . . . . . . 3 Improving quality and whole-system reform . . . . . . . . . . . . . . . . . 5 Policy-making and evidence . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2. Basic concepts of quality . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Definitions and the dimensions of quality . . . . . . . . . . . . . . . . . . 9 Roles and responsibilities in quality improvement . . . . . . . . . . . . . .10

3. A process for building a strategy for quality: choosing interventions . .13 An overview of the suggested process. . . . . . . . . . . . . . . . . . . . .13 Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Element 1. Stakeholder involvement . . . . . . . . . . . . . . . . . . . .15 Element 2. Situational analysis . . . . . . . . . . . . . . . . . . . . . . .16 Element 3. Confirmation of health goals . . . . . . . . . . . . . . . . . .17 Building the strategy: Choosing interventions for quality . . . . . . . . . . .19 Element 4. Development of quality goals . . . . . . . . . . . . . . . . .19 Element 5. Choosing interventions for quality . . . . . . . . . . . . . . .20 Mapping the domains . . . . . . . . . . . . . . . . . . . . . . . . . . .20 Linking the domains to the decision-making process . . . . . . . . . . .25 Deciding on interventions . . . . . . . . . . . . . . . . . . . . . . . . .26 Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Element 6. Implementation process . . . . . . . . . . . . . . . . . . . .28 Element 7. Monitoring progress . . . . . . . . . . . . . . . . . . . . . . .29

ANNEX A: A self-assessment questionnaire for detailed analysis of Element 5 of the decision-making process . . . . . . . . . . . . . . . . . . . . . . . . .31

ANNEX B: A matrix to map quality interventions by roles and responsibilities in a health system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

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