Figure 1: Factors affecting the quality of care

1
Figure 1 Factors affecting the quality of care
Economic, social and cultural environment
Supply health system
Demand expectations and needs
Quality of Care
Impact (change in health status)
2
Figure 2 Immediate Determinants of High Quality
Care
Staff motivation
Staff competency
High Quality Care
Adequate resources
Patient responsiveness and compliance with
standards
Appropriate content of care defined
Good flow and organization of care
3
Figure 3 QA interventions and their effects on
determinants of high quality care
Build culture of quality (leadership, focus on
client, teamwork, incentives)
Staff motivation
On-going capacity building
Pre-service training Certification Licensing
Staff competency
High Quality Care
Accreditation
Adequate resources
Define Scope of practice
Standards/Norms (health tech. assessment,
evidence-based guidelines)
Appropriate content of care defined
Quality improvement quality design, process
improvement
Good flow and organization of care
Quality monitoring
4
Figure 4 Health sector reform and its effect on
quality of care
Human resource mgmt

• Provider payment systems
• incentives
• level

Staff motivation
Staff competency
Regulation
Quality of care

• Rationalization of health system
• decentralization
• separation of functions

Adequate resources
Resource allocation
Adequate content of care defined

• Distribution of financial burden
• public/private resource generation

Basic benefit package
Good flow and organization of care
Improved managerial capacity
5
Figure 5 Interventions to improve staff
motivation

• Rationalization of health system
• decentralization
• separation of functions

Human resource mgmt
Build culture of quality (leadership, focus on
client, teamwork, incentives)
Staff motivation

• Provider payment systems
• incentives
• level

Quality improvement quality design, process
improvement
6
Figure 6 Interventions to improve staff
competency
Human resource mgmt
On-going capacity building
Pre-service training Certification Licensing
Staff competency
Accreditation
Regulation
7
Figure 7 Interventions to improve adequacy of
resources

• Rationalization of health system
• decentralization
• separation of functions

Human resource mgmt
Resource allocation
Adequate resources

• Distribution of financial burden
• public/private resource generation

Accreditation

• Provider payment systems
• incentives
• level

Regulation
8
Figure 8 Interventions to improve definition of
content of care
Regulation
Resource allocation
Define Scope of practice
Appropriate content of care defined
Standards/Norms (health tech. assessment,
evidence-based guidelines)
Basic benefit package
9
Figure 9 Interventions to improve flow and
organization of care
Quality improvement quality design, process
improvement
Good flow and organization of care
Quality monitoring
Improved managerial capacity