Improving The Quality Of Health Services - Tools And Resources
Improving the qualityof health services tools and resources
Improving the quality of health services: tools and resourcesISBN 978-92-4-151508-5 World Health Organization 2018Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence(CC BY-NC-SA 3.0 IGO; igo).Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the workis appropriately cited, as indicated below.In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. Theuse of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalentCreative Commons licence. If you create a translation of this work, you should add the following disclaimer along with thesuggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for thecontent or accuracy of this translation. The original English edition shall be the binding and authentic edition”.Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of theWorld Intellectual Property Organization.Suggested citation. Improving the quality of health services: tools and resources. Turning recommendations into practice.Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests forcommercial use and queries on rights and licensing, see http://www.who.int/about/licensing.Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures orimages, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from thecopyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely withthe user.General disclaimers. The designations employed and the presentation of the material in this publication do not imply theexpression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or areaor of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps representapproximate border lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed orrecommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, thenames of proprietary products are distinguished by initial capital letters.All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, thepublished material is being distributed without warranty of any kind, either expressed or implied. The responsibility for theinterpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use.Printed in Switzerland
Improving thequality ofhealth services tools and resourcescompiled by theWHO Service Delivery andSafety DepartmentDECEMBER 2018This document has been developed by anImprovement cross-cut team within theDepartment of Service Delivery and Safety(SDS) at WHO headquarters. The documentaims to support implementation of qualityimprovement approaches to make healthservices more effective, safe and peoplecentred. The document brings together themain tools and resources focused on qualityimprovement currently in use within the SDSdepartment.
Contents8Introduction10 Service delivery and qualityimprovement12 Tools and resources for improvingthe quality of health services45 Quality improvement resources indevelopment52 Annex 1: Rapid mapping of qualityimprovement definitions57 Annex 2: Further information58 Annex 3: Process note – WHO SDSimprovement cross-cut
THE COMPENDIUM AT A GLANCEWhat is the compendium?The tools and resources described in this document (hereafter referred to as “the compendium”)are a resource for WHO Member States aiming to improve the quality of service delivery. Thecompendium collates current tools and resources on quality improvement (QI) developed by theWHO Service Delivery and Safety Department (SDS) and provides examples of how the tools andresources have been applied in country settings.Who is the compendium for?Why is it needed? Ministries of health, quality improvementteams, researchers and developmentagencies.WHO technical programmes, regional andcountry offices in their technical cooperationwork with country counterparts and donors.Those working to improve the quality ofhealth service delivery. The compendium has been developed tocollate existing resources that facilitatequality improvement in service delivery.As a technical resource for countries insupport of quality improvement efforts withinhealth service delivery.Highlight adaptable tools and resourcesthat can support local quality improvementefforts.SDS technical areas and type of toolsTechnical AreasTraditional complementaryand integrative medicineEmergency and essentialsurgeryPrimary careBlood safetyPalliative careHospital managementPeople-centred careInfection prevention andcontrolEmergencyPolicies, strategies and plansCommunity engagementInstitutional healthpartnershipsPatient safetyTypes of toolsand gTraining resources
How could I use the compendium? As a reference list of helpful tools and resourcesaimed at improving the quality of health services. As an overview of available tools and resources forquality improvement that have been developed byWHO. As a starting point for further technical collaborationwith partners and WHO expertise in these respectivesubject areas. The current compendium is not an exhaustive listof QI interventions. It should be used in conjunctionwith other existing evidence-based guidance. Thecompendium is grouped into two sections: the firstpart of the compendium provides an overview offinalized tools and resources. The second part of thecompendium collates tools and resources currentlyunder development. Where applicable, case studieshave been provided.7
Introductionhe adoption of thesustainable developmentgoals (SDGs) placedadditional emphasison improving overall humandevelopment by 2030.Improving health outcomes isat the forefront of this globalcommitment, with Goal 3calling on all stakeholdersto “ensure healthy lives andpromote well-being for allat all ages”. The SDGs alsoreaffirm a global commitmentto advancing universal healthcoverage (UHC). Its focus isto ensure that all people andcommunities have access tothe quality health services theyneed, without facing financialhardship. The momentumtowards UHC is rooted in theprinciples of the Alma-AtaDeclaration (1) which identifiedhealth as a human right. Torealize the goal of health for alland achieve universal accessto quality health services, theT18Declaration of Alma-Ata. InternationalConference on Primary Health Care, AlmaAta, USSR, 6-12: World Health tadeclaration en.pdf?ua 1 accessed 20August 2018)Improving the quality ofhealth services: tools and resourcesWHO Framework for IntegratedPeople-Centred Health Services(IPCHS) calls for a fundamentalshift from health systemsdesigned around diseases andhealth institutions towardshealth systems designedfor people (2). Globally, thereis a need to look beyondservice coverage and financialprotection and emphasizeimprovements in quality servicedelivery at the core of countryaction. This is because qualityof health services, coupledwith service coverage will playa critical role in strengtheningnational health systems andimproving health outcomes.Global consensus on qualityis emerging. Three majorpublications on quality havebeen published in 2018:first, the joint WHO-WorldBank-OECD publication onthe delivery of quality healthservices as a global imperativefor UHC; then, the Lancet Global2Framework on integrated people-centredhealth services. Report by the secretariat:World Health Organization ( http://apps.who.int/gb/ebwha/pdf files/WHA69/A69 39-en.pdf?ua 1 accessed 20 August2018)
high quality health systems in the SDG era; andthird, the US National Academies of ScienceReport on Improving the Quality of HealthCare Globally. Each call for action on qualityimprovement. This document is developed inanticipation of and in support of this collectivecall and will be refined further over time. integrated: providing care that is coordinatedacross the entire spectrum of health careservices and providers and makes availablethe full range of health services throughoutthe life course; efficient: maximizing the benefit of availableresources and avoiding waste.There is an increasing collective recognition thatquality health services should be: effective: providing evidence-based healthcare services to those who need them; safe: avoiding harm to people for whom thecare is intended and reducing the risk ofunnecessary harm associated with healthcare to an acceptable minimum; people-centred: adopting the perspectives ofindividuals, carers, families and communitiesas participants in, and beneficiaries of,trusted health systems that are organizedaround the comprehensive needs of people,rather than individual diseases, and thatrespect social preferences.In addition, in order to achieve the benefits ofquality health care, health services should alsobe: timely: reducing waiting times andsometimes harmful delays for both thosewho receive and those who give care; equitable: providing care that does not varyin quality on account of age, sex, gender,race, ethnicity, geographical location, religion,socioeconomic status, linguistic or politicalaffiliation;INTRODUCTION 9
Service delivery and qualityimprovementmprovement in the quality ofhealth care is a pivotal entrypoint for health systemsstrengthening. Qualityimprovement (QI) approachesplay a role in improving thequality of health servicesdelivered across the variouslevels of the health system– primary, secondary andtertiary. QI approaches supportthe identification of variousservice delivery gaps, producesolutions to address identifiedgaps and mitigate potentialservice delivery bottlenecks.The experience surrounding QIapproaches in improving care inspecific areas such as maternal,neonatal and child health, HIV/AIDS, TB/Malaria programmesis well documented. Technicalprogrammes and developmentagencies have adhered tovarious definitions of qualityimprovement.IFindings from a rapid mappingof these quality improvementdefinitions can be found inAnnex 1.The collation of thesedefinitions points to aconsensus on certainessential principles for qualityimprovement to be effectiveand sustainable.Principles: commitment from senior leadership ownership by people and teams developing locally identifiedsolutions improvement of input structures clearly identified roles andresponsibility of team members continuous monitoring and learningfor improvement feedback and incentivemechanisms.10Improving the quality ofhealth services: tools and resources
Building on this rapid scanning and thegrounding principles, a quality improvementintervention can be defined across various levelsof the health system.Focusing on change processes, a qualityimprovement intervention can be defined as “achange process in health care systems, services,or suppliers for the purpose of increasing thelikelihood of optimal clinical quality of caremeasured by positive health outcomes forindividuals and populations” (3).At the organizational level, a quality improvementintervention can be defined as “an organizationalstrategy that formally involves the analysis ofprocess and outcomes data and the applicationof systematic efforts to improve performance”(3).Building further, a working definition of qualityimprovement definition co-developed by theWHO headquarters SDS Improvement cross-cutteam reads as follows:Quality improvement is the action of every personworking to implement iterative, measurablechanges, to make health services more effective,safe and people-centred.3Evidence-based Practice Center systematic review protocol: closingthe quality gap 2010:quality improvement interventions to addresshealth disparities. Rockville, MD: Agency for Healthcare Researchand Quality; 2012 rities-quality-improvement/research-protocol, accessed 19February 2018)Service delivery and quality improvement 11
Tools and resources forimproving the qualityof health servicesGoal and objectiveshe overall goal of thisdocument is to providea resource for countriesseeking to improve thequality of their health servicedelivery.TThe document: collates existing WHO toolsand resources on qualityimprovement; and outlines the use of the toolor resource as applied inservice delivery.The primary inclusion criteriafor the tools and resourcesincluded in this document isthat they must be applicable forcountry support. Thereby, thedocument provides practicalexamples of how the tool wasapplied in-country, includingrelevant links with other areas,such as measurement.beyond. Of particular note, thedocument is not designed as astandards setting tool.The categorization of the toolsand resources in this documenthas been informed by the WHOpublications categorizationsystem. Types of tools includetraining and capacity-buildingtools, along with text booksand guidance documents.Resources include advocacydocuments, country reports,meeting reports and technicalreports. Documents listedas guidelines have all gonethrough the WHO GuidelineReview Committee process.Target audienceThe target audience for thisdocument are ministriesof health, facility qualityimprovement teams,researchers and developmentagencies.WHO technical programmes,regional and country officesThe document focuses on toolscan also use the document inand resources developed withintheir technical cooperation workthe WHO Service Delivery andwith the identified audience.Safety Department. It is not,Those working to improve thetherefore, an exhaustive list ofquality of health service deliveryservice delivery and safety toolscan also make good use of thisand resources across WHO orresource.12Improving the quality ofhealth services: tools and resources
GapsImplications for countries and WHODevelopment of the document allowed gaps tobe identified in the quality improvement toolsand resources that exist. Of particular note isthat:The document has clear implications for thework on service delivery for country levelengagement and internally within WHO. Thedocument can: improvement and measurement are interrelated; however, a number of the identifiedQI tools and resources made little or nomention of measurement considerations; provide framing and catalyse action onquality improvement activities and facilitateWHO’s support to ministries of health onquality of care; there is currently no mechanism to trackthe application of SDS tools and resourcesin-country, once finalized, such an approachwould contribute to the refinement ofthe tools, informed by implementationexperience. support the implementation of WHOnormative standards on quality of care byhighlighting available tools and resources inservice delivery; serve as a facilitator and bring aboutconvergence of the work on qualityimprovement within WHO, working closelywith the WHO Taskforce for Quality UHC.These gaps will allow a set of recommendationsto be developed that will inform futuredevelopment of quality improvement resources.A feedback loop mechanism is currentlyunder development to prospectively track theapplication of the resource at the country level.This feedback mechanism will allow for inputinto the adoption and usage of tools at thecountry level. It could also help to shed light onthe adaptation of emerging global tools and toidentify promising case studies at the countrylevel. This mechanism will be linked stronglywith the WHO SDS corporate web page, onceactivated.Structure of the documentEach section addresses a technical area.The structure is standardized with detailedinformation on finalized WHO SDS documents.The first level of the document provides anoverview of WHO SDS tools and resources.Where applicable, case studies and key lessonslearnt have been provided. A second section ofthe document outlines tools and resources thatare currently in development within SDS.Tools and resources for improving thequality of health services13
Part I. structure Tools and resources finalizedName of tool(Year)Type of toolAudienceSummarydescriptionKey lessons learntInterlinkages withother areas1. Quality improvement in emergency settingsName of tool(year)Type oftoolAudienceSummary descriptionKey lessons learntInterlinkages withother areasRecoveryToolkit(2015)Training /capacitybuildingPolicy-makers,front-line staff,civil society,academicresearchersThe Recovery Toolkit is alibrary of guidance resourcesin a single place whichcan be quickly and easilyaccessed, to guide action. Akey purpose of the RecoveryToolkit is to supportcountries in the reactivationof health services whichmay have suffered as aresult of a public healthemergency. These servicesinclude ongoing programmessuch as maternal andchild health services, andnoncommunicable diseases.But in addition, and becausethe Toolkit contains coreinformation needed toachieve functioning nationaland sub-national healthsystems, it also supportscountries to implement theirnational health plans duringthe recovery phase of apublic health emergency.Use of the earlyRecovery Toolkitaddresses a keychallenge – how toidentify and accessthe best and mostup-to-date technicalresources to supportaction planning andaction. Bringingtogether the resourcesof vertical programmesin one place has thepotential to enhanceefficiency.The “resourcesupplement” of theWHO, World Bankand OCED report“Delivering qualityhealth services: aglobal imperativefor UHC” providesa compendiumof resources thatmeasure and reportquality of care atthe internationallevel, accordingto pre-determinedmeasurement tools.Building back from the Ebola outbreak in Liberia: spotlight on country voicesLiberia: I’m confident that the early recovery toolkit will increase awareness and access among partners and countries of theproducts/resources available. This awareness can help to achieve high standards, prevent inefficient duplication of effort and wheelreinvention and encourage communication and coordination when it is most needed.- Alex Gasasira, WHO Representative, Liberia14Improving the quality ofhealth services: tools and resources
Tools and resources for improving thequality of health services15Type oftoolGuidanceCapacitybuilding,advocacyName of tool(year)Deliveringquality healthservices:a globalimperativefor universalhealthcoverage(2018)WHOHandbookfor NationalQuality Policyand Strategy(2018)The WHO Global LearningLaboratory for QualityUHC hosts tools andresources to supportimplementation ofnational quality policiesand strategies alongsidea mechanism foractive learning throughdiscussion.1. Co-development of the Handbook with nationalquality leads and those with expert knowledgeon quality of care secured early stakeholderbuy-in and ensured content was relevant to theend user.The WHO Handbook for national quality policyand strategy (NQPS) outlines an approach for thedevelopment of national policies and strategiesto improve quality of care. The NQPS Handbook isnot a prescriptive process guide, but is designedto support teams developing such policies andstrategie
national health systems and improving health outcomes. Global consensus on quality is emerging. Three major publications on quality have been published in 2018: first, the joint WHO-World Bank-OECD publication on the delivery of quality health services as a global imperative for UHC; then, the Lancet Global 2 Framework on integrated people-centred
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
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Dr. Sunita Bharatwal** Dr. Pawan Garga*** Abstract Customer satisfaction is derived from thè functionalities and values, a product or Service can provide. The current study aims to segregate thè dimensions of ordine Service quality and gather insights on its impact on web shopping. The trends of purchases have
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Chính Văn.- Còn đức Thế tôn thì tuệ giác cực kỳ trong sạch 8: hiện hành bất nhị 9, đạt đến vô tướng 10, đứng vào chỗ đứng của các đức Thế tôn 11, thể hiện tính bình đẳng của các Ngài, đến chỗ không còn chướng ngại 12, giáo pháp không thể khuynh đảo, tâm thức không bị cản trở, cái được
Food outlets which focused on food quality, Service quality, environment and price factors, are thè valuable factors for food outlets to increase thè satisfaction level of customers and it will create a positive impact through word ofmouth. Keyword : Customer satisfaction, food quality, Service quality, physical environment off ood outlets .
Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. Crawford M., Marsh D. The driving force : food in human evolution and the future.
