Quality Improvement

National Quality Framework for Public Health Facilities

Background-Quality of Care has emerged as key thrust area for both Policy Makers and Public Health Practitioners as an instrument of optimal utilization of resources and improving health outcomes and client satisfaction. The NHP 2017 clearly states in its objective – Improve health status through concentrated policy action in all sectors and expand preventive, promotive, curative, palliative and rehabilitative services provided through the public health sector with focus on Quality.

Ministry of Health & Family Welfare, Government of India in collaboration with state health departments has developed and implementing a comprehensive quality assurance framework for public health facilities and Programs. This Framework comprises of four interrelated approach and activities to achieve patient centric quality system

  • Instituting Organizational Framework for Quality
  • Defining Standards of Service Delivery and Patient Care
  • Continuous Assessment of services against set standards
  • Improving Quality through closing gaps and implementing opportunities for Improvement.

The framework based works on following principles –

1. Systems approach –Quality System should be integral part of Health Systems. Rather then working on isolated themes and facilities, the approach should be holistic quality improvement involving all components of health system. Quality processes should be interlaced with healthcare planning and provision processes to give optimal results. This is achieved by instituting a system of continuous assessment, hand holding and participative quality improvement through coordinated efforts of all stakeholders.

2. Client Focus –The quality system should enable providers to meet and surpass the expectations of it's clients. These may be patients, beneficiaries and community at large. The patient care and quality assurance processes should be designed keeping in mind the users of public health facilities, so these are accessible, affordable, dignified and user-friendly to its seekers. This is achieved though taking continues objective feedback from users and using it for improving the services.

3. Recognizing the champions- Healthcare Quality improvement on large scale thrives upon success stories, role models, inspirational leaders and champions to spread quality culture. The quality framework gives provision of promoting and recognizing champions through incentives and reward mechanism.

4. Team work– Quality can only be achieved by concentrated, coordinated & sustainable efforts of all stakeholders be it policy makers, health administrators, clinicians, patient care staff or front line community health workers. Quality Assurance committees and units have been instituted at National, state and district level to facilitate team work. At facility level Quality Team have been constituted so all service providers can pool their efforts to for quality improvement.

5. Process Focus– Healthcare quality is comprises for three component – structure, process and outcome. The desired outcome can only be achieved when optimal infrastructure and human resources is utilized by efficient processes. Though structure is important component to ensure quality, National Quality Framework is predominately relying on improving the outcome by optimizing the processes within given structural limitations. This is achieved by through assessment, improvement and standardization healthcare processes.

6. Continual Improvement –Quality is a long journey, requires concentrated and sustained efforts. The quality framework believes in incremental improvement in healthcare process through continual quality improvement cycle. This enables service providers

7. Objective Quality Measurement – The journey towards quality improvement starts with objective and unbiased measurement of quality of existing healthcare processes and services. Under Quality Framework, National Quality Assurance Standards have been instituted of all level of public health facilities. Explicit assessment tools and scoring system has been developed for objective measurement and fact based decision making for quality improvement.

8. Concern & Context – Public hospitals provide service to a large section of society especially to the vulnerable and poor section for whom the services are either inaccessible or unaffordable. Public system also has almost exclusive responsibility for implementing preventive and promotive health programs. National Quality Framework works towards develop indigenous quality system of public health facilities that meets specific requirements of its users as well global benchmarks.

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