How to address quality of health services
The toolkit addresses quality with a health systems approach as noted with the five foundational requirements. This acknowledges the multidisciplinary and interdependent nature of health systems. Here, some basic quality concepts are highlighted that are helpful to know when considering how to address quality of health services.
Quality health services across the world should be:
Effective: providing evidence-based health care services to those who need them.
Safe: avoiding harm to people for whom the care is intended.
People-centred: providing care that responds to individual preferences, needs and values.
Timely: reducing waiting times and sometimes harmful delays for both those who receive and those who give care.
Equitable: providing care that does not vary in quality on account of age, sex, gender, race, ethnicity, geographic location, religion, socioeconomic status, linguistic or political affiliation.
Integrated: providing care that is coordinated across levels and providers and makes available the full range of health services throughout the life course.
Efficient: maximizing the benefit of available resources and avoiding waste.
It is recommended to draw a local definition for quality from these domains that would help to guide and focus direction and allocation of resources. These inter-linked domains contribute to the quality of health services within the wider system. Indeed, “quality” is often considered as an attribute of the health system and/ or its specific components but can be understood more broadly as how well the system is functioning. This can be described as a type of journey, which requires continuous adaptation and adjustment.
The field of quality often refers to three parts in understanding and supporting a quality journey at multiple levels of the system. This approach considers three interdependent functions:
Planning for quality: The structured inputs and processes within the design and coordination of health services aimed at ensuring the needs of users and populations are met.
Assuring quality: Internal and external assessment processes and mechanisms to ensure that services are fulfilling stated requirements for quality (internal assessment processes may be referred to as quality control, and external reviews as quality assurance)
Improving quality: The actions taken by every person working to implement iterative, measurable changes, to make health services more effective, safe and people-centred.
Lastly, it is helpful to organize your approach by understanding the various components of implementing a tool that enhances quality health services. The ‘Donabedian Model’ provides a useful structure to help organize and understand the
components that lead to the intended outcome. The three parameters used to evaluate quality of health services are:
Structure: The setting within which care is delivered (including facility, human resources and assets/financial resources).
Process: The provision of care itself (including aspects of interaction between receivers and providers of care and interactions across the different levels of the health system).
Outcome: The measurable effect on health status (which may be influenced by a range of additional factors).