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QA: Tools & How-to Manuals
- Materials especially relevant to low and middle income countries
PIHOA Quality Assurance Baseline Assessment Tool
Durand AM, 2008. Key Reference
This assessment instrument designed for Pacific island jurisdictions can be used for district hospitals, public health programs as well as community health centers. Part 1 of the tool assesses the readiness of the organization to undertake a QA program. Part 2 is an inventory of current QA practices in the organization. Notes regarding possible approaches for gathering information for each item and explaining its usefulness are included. The assessment provides a foundation for planning to build QA program activities in the organization/jurisdiction.
PIHOA QA Baseline Assessment Tool
Quality Assurance for Healthcare Services in Developing Countries
Cowan M. Cowan Consulting Services. 2007. Key Reference
Step-by-step manual for the establishment of a QA system, developed over several years of experience with QA program start-ups in the Federated States of Micronesia. Very clear and practical. Discusses formulation of standards, policies and procedures and audit instruments. Also covers QA coordinator responsibilities and suggestions for training, discusses pitfalls to avoid, and linking of audit results to staff performance appraisals and incentives.
For copies contact: marymarmy@hotmail.com
Standards-Based Management and Recognition (SBM-R), A Practical Approach to Improving the Quality of Health Services
Field guide and facilitator’s guide for a system of QA that is very similar to that developed independently in the Federated States of Micronesia, consisting of the development criteria based on general standards, implementing these standards, periodic audits to determine whether criteria are being met, and a process and incentives for responding to audit results. SBM-R was developed by JHPIEGO, a non-profit organization affiliated with the Johns Hopkins University School of Public Health. So far, SBM-R has been applied to HIV programs, family planning programs, maternal and neonatal health care, and infection control programs in a number of developing countries in Asia, Latin America and Africa. Available at:
http://www.jhpiego.org/media/focuson/sbmr_ovw200702.htm
Tools and Methods for Health System Assessment: Inventory and Review
Division of Analysis, Research and Assessment, WHO, 1998.
A review of ten developing country standards sets, ranging from general health service to program-specific, that can be used in QA programs.
Tools & Methods for Health System Assessment
Toolkit for Accreditation Programs- Some Issues in the Design and Redesign of External Health Care Assessment
Charles D. Shaw, International Society for Quality in Health Care. 2004
The purpose of this WHO and World-Bank funded document is to provide a straightforward tool for assessing readiness and implementing health service accreditation (or internal assessment) within a nation, state or health care organization. (This is a very useful document.)
http://www.isqua.org/isquaPages/Accreditation/
ISQuaAccreditationToolkit.pdf
A Self-Assessment Questionnaire for Detailed Analysis of Elements of Decision Making Process for Quality Improvement Initiatives
(Annex A of: Quality of Care: A Process for Making Strategic Choices in Health Systems, p31-35) Bengoa R, et. al. WHO, 2006.
This document provides decision makers at the country level with a systematic process for designing and implementing effective interventions to promote quality in health systems. Annex A serves as a self-administered tool to assess readiness to proceed with quality improvement initiatives.
http://www.ihi.org/NR/rdonlyres/8BFABE30-2EEC-4990-A42E-
2644896B0C39/0/QualityCare_HDef.pdf
Institute for Healthcare Improvement (IHI)
In addition to information on QA methods, measures and case studies the website contains interactive tools which can be used for setting up a QA activity for a priority topic or problem, collecting and posting QA data in a way that generates time graphs to track progress on indicators, and setting up team e-mail discussion groups.
http://www.ihi.org
Skymark
A for profit consulting firm with a website that offers a number of quality management tools, free of charge.
Useful features include a page with descriptions and “how-to” discussions of various data display options (bar charts, scatter plots, histograms, pareto charts, etc.) and process display options (cause and effect diagrams, force field displays, affinity diagrams, etc.).
http://www.skymark.com/resources/tools/management_tools.asp
Skymark also offers a “data analyst” tool which guides the user through the construction of various charts to display data, with data provided by the user.
http://www.skymark.com/pathmaker/captivateVideo/DataAnalyst.htm
A Modern Paradigm for Improving Healthcare Quality.
Massoud R, et. al., 2001
This monograph gives an overview of quality improvement methodology, as well as a discussion on how to implement improvement for single-issue style QA. It also details a number of approaches or “tools” for improvement, such as various styles of charts for display of data, prioritization tools, types of flowcharts, etc. in a user-friendly “When to use it/ How to use it” format.
http://www.qaproject.org/pubs/PDFs/improhq601bk.pdf
The Quality Assurance Kit
This kit from the Quality Assurance Project of the U.S. Agency for International Development is in CD-ROM format, available for US $20. It provides interactive and text-based information on quality assurance principles, methods, and tools. This CD-ROM was designed to build capacity in QA skills and to support QA teams seeking to use the QA methods and activities in a problem-solving program. The QA Kit's computerized tools include a budget tool, client classification matrix tool, flowchart, prioritization matrix and Gantt chart, to name a few. This is a very useful “nuts and bolts” collection (2001)
http://www.qaproject.org/QAKitorder.htm
Management Sciences for Health – Health Manager’s Toolkit.
Contains a variety of quality improvement related tools, especially related to family planning services and inventory and supply management. Among the tools, is a quality assurance manual, spreadsheets, audit questionnaire and patient satisfaction surveys designed for a QA program in the outpatient clinics of the Bolivian Social Security Administration. This manual could easily be adapted to outpatient clinics and CHC’s in the Pacific region.
http://erc.msh.org/mainpage.cfm?file=2.56.htm&
module=toolkit&language=English
Integrating Best Practices for Performance Improvement, Quality Improvement, and Participatory Learning and Action to Improve Health Services - Guidance for Program Staff., 2005
This guidance was developed by an NGO, EngenderHealth, is a how-to manual for field staff for the AQUIRE (Access, Quality, and Use in Reproductive Health) project in the use of three approaches to improving provider performance and the quality of services and to mobilizing communities to drive improvements in health care: performance improvement (PI), quality improvement (QI), and participatory learning and action (PLA). While it was developed for use by reproductive health programs, the approaches are suitable for general health service improvement.
http://www.acquireproject.org/fileadmin/user_upload/
ACQUIRE/Guidelines_PI_QI_PLA_06-16-05.pdf
The PRIME II Project Manual.
(EngenderHealth, 2004)
Prime II was a 5-year, USAID-funded global initiative in 25 countries to improve the quality of reproductive health services (especially by interventions designed for health staff performance improvement). The manual and toolkit are also applicable to general health services. This website also links to country-by-country descriptions of PRIME II’s work around the world, and all of the project’s publications, resources and interactive tools.
http://www.prime2.org/sst/index.html
- Materials relevant to higher income countries:
The Joint Commission for the Accreditation of Healthcare Organizations guide for preparing for hospital accreditation
This is a checklist with suggestions for hospitals that wish to be accredited by the U.S. organization, JCAHO, that accredits hospitals. By becoming accredited, hospitals in the U.S. system are eligible for reimbursement by government and private health insurance plans.
http://www.jointcommission.org/AccreditationPrograms/Hospitals/
AccreditationProcess/preparing_for_survey.htm
International Principles for Healthcare Standards (3rd Ed.): A Framework of Requirements for Standards
Published by The International Society for Quality in Health Care – December 2007
The International Society for Quality in Health Care (ISQua) is a non-governmental organization that gives international approval to national quality standards and accreditation programs (i.e. ISQua “accredits the accreditors”). This document gives the set of criteria that the International Society for Quality in Health Care uses to evaluate sets of health care system standards.
http://www.isqua.org/isquaPages/
Accreditation/ ISQuaIAPPrinciplesV3.pdf
ISQua also offers a checklist to aid in the development of new accreditation programs (the same checklist is also applicable to internal quality assurance programs). Endorsed by WHO.
http://www.isqua.org/isquaPages/Accreditation/
Toolkit%20Checklist.pdf
Guidelines: Incentives for Health Professionals
Guidelines based on a review of health professional recruitment, retention and performance incentives research, published in 2008 by the International Council of Nurses, International Hospital Federation, International Pharmaceutical Federation, World Confederation for Physical Therapy, World Dental Federation, World Medical Association.
http://www.ihf-fih.org/pdf/Incentives_Guidelines%20EN.PDF
- QA and Accreditation for Public Health Agencies
The Local Health Department Self-Assessment Tool for Accreditation Preparation of the National Association of City and County Health Officials (NACCHO)
NACCHO is a partner with the Public Health Accreditation Board in the ongoing development of an accreditation system for local and state public health departments in the U.S. It offers assistance, including this self-assessment tool for local and state health departments that are preparing for accreditation. The tool standards are based on the Operational Definition of a Functional Local Health Department which defines what people in any community should expect from their local health departments. The tool allows LHDs to measure themselves against the Operational Definition and identify areas of strength and areas for improvement.
The Self-Assessment Tool is available as a PDF and as an online scorecard. The online version is an interactive module where scores can be analyzed, sorted, and reported with color-coded guidance. The online software can be used to identify areas for improvement and track continuous quality improvement progress over time.
(This tool is somewhat theoretical and the “Operational Definition Indicators” are non-specific, so this tool may not be very useful as a way to improve “nuts and bolts” management and coordination in the health department. However, it may be useful for public health divisions/departments in the U.S. flag territories that already have a strong administration and wish to start preparing for accreditation. )
http://www.naccho.org/topics/infrastructure/
accreditation/OpDef.cfm
National Public Health Performance Standards Program (of the U.S. Centers for Disease Control and Prevention)
In partnership with the Association of State and Territorial Health Officials, the National Association of City and County Health Officials, the American Public Health Association (APHA), the National Association of Local Boards of Health, the National Network of Public Health Institutes, and the Public Health Foundation, the Program has produced three sets of performance assessment instruments:
A user’s guide to each of the instruments above and other related documents (an instrument to assess local health department governance, introductory powerpoint presentations and an instrument to assess state health departments) are available at:
http://www.cdc.gov/od/ocphp/nphpsp/orderForm.htm
The National Public Health Performance Standards Program also offers a directory of post-assessment improvement tools at:
http://www.cdc.gov/od/ocphp/nphpsp/Improving.htm
The NPHPSP online data and reporting system (http://www.nphpsp-results.org/) allows users of the NPHPSP instruments to request user IDs, input data from their current performance assessment, and retrieve reports from their assessments.
(The NPHPSP materials are based on the 10 essential public health services. The standards and measures for each of the essential servies are logical, but general. These standards would be most useful for public health divisions/departments in the U.S. flag territories which already have well-functioning administrative systems but are wanting to strengthen community partnerships the alignment of their organizations with core public health functions.)
Embracing Quality in Local Public Health
Michigan’s quality improvement handbook for local health departments. (A how-to manual for topical problem focused improvement of processes using Plan-Do-Study-Act cycles). Also gives a good background history for the quality and accreditation movements in public health in the U.S. and for available resources related to QI. (The local health department component of the National Public Health Performance Standards Program, the NACCHO self-assessment process and Michigan’s accreditation system are all similar systems based on the 10 essential services or the definition of a functional local health department).
http://accreditation.localhealth.net/MLC-2%20website/
Michigans_QI_Guidebook.pdf
The Public Health Memory Jogger II, a Pocket Guide of Tools for Continuous Improvement and Effective Planning
Developed by the Public Health Foundation, this handbook is designed to facilitate QA initiatives and is one of the most widely used quality improvement resources among public health officials in the U.S.
http://www.asq.org/quality-press/display-item/
index.pl?item=P1334
- QA for Community Health Centers
Bureau of Primary Care Program Assistance Letter for Quality Indicators
Bureau of Primary Care Program Assistance Letter for Quality Indicators
This U.S. Bureau of Primary Health Care program guidance document outlines 12 required, standardized performance measures for Community Health Center grant recipients. These indicators are required as part of the routine Uniform Data Set that all CHCs must report each year and must include as part of all new and continuation CHC grant requests. The document also gives a link to websites that discuss the significance of each indicator and give detailed methods for collecting them.
bureau_of_primary_care_program_assistance_letter
_for_quality_indicators_(4-08).pdf
Community Health Center Core Measures Slide Show
Key Reference
This excellent slide show (prepared by the U.S. Bureau of Primary Health Care officials to train CHC QA consultants) provides more detailed information about the prescribed clinical core measures, including how these measures can be integrated into the quality improvement program of a community health center.”
chc_clinical_core_measures_slide_show_(3-09).ppt
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