Process Indicators Considering the 7 Domains of Healthcare Quality
This section ensures a structured assessment of process indicators based on the WHO QI dimensions (Safe, Efficient, Effective, Timely, Patient-Centered, Equitable, Integrated). The justification for each domain is as follows:
- Safe (Minimizing Risks and Harm to Patients) Justification
- Infection Prevention & Control (IPC) Compliance is a WHO-recommended measure for reducing hospital-acquired infections (HAIs).
- Hand hygiene compliance (≥90%) is essential for preventing cross-contamination and improving patient safety.
- Efficient (Optimizing Resource Use) Justification
- Patient waiting time (OPD, diagnostic, pharmacy) ensures that services are well-managed to avoid delays.
- Length of hospital stay (LOS) should be within benchmarks to ensure efficient use of hospital resources.
- Effective (Providing Evidence-Based Care) Justification
- Compliance with clinical guidelines (e.g., NTP, IMCI, WHO) ensures that treatment is standardized and based on best practices.
- Referral appropriateness prevents unnecessary hospital visits and ensures patients receive the right level of care.
- Timely (Reducing Delays in Care Delivery) Justification
- Emergency response time (≤10 minutes for ER, ICU) is critical for reducing avoidable deaths and complications.
- Turnaround time for diagnostics ensures that delays in test results do not compromise treatment decisions.
- Patient-Centered (Respecting Patient Preferences & Needs) Justification
- Informed consent & shared decision-making ensures patients have autonomy over their care.
- Respect for cultural, religious, and personal values improves patient trust and adherence to treatment.
- Equitable (Ensuring Access for All) Justification
- Coverage of vulnerable populations (≥95% service availability) ensures inclusion of marginalized groups.
- Gender-sensitive healthcare services ensure that women, children, and other at-risk populations receive proper care.
- Integrated (Coordinated Care Across Providers) Justification
- Referral & counter-referral efficiency ensures that patients receive seamless care transitions.
- Use of electronic medical records (EMR) improves continuity of care and patient data tracking.
This section ensures that process indicators are systematically monitored, leading to real-time improvements in patient care. It fully aligns with WHO’s quality dimensions and supports a data-driven approach to QI in Bangladesh.
Process Indicators (Considering the 7 Domains) for Healthcare Quality Assessment
Quality Domain
Key Indicators
Assessment Criteria
Safe (Minimizing
risks and harm to patients)
- Infection
prevention & control (IPC) compliance
- Medication safety (adverse drug reactions, prescription accuracy)
- Patient safety protocols (falls, surgical safety checklist)
- Hand hygiene compliance
- Adherence
to IPC guidelines
- No medication errors reported
- Implementation of WHO surgical safety checklist
- ≥90% compliance with hand hygiene
Efficient
(Optimizing resource use without waste)
- Patient
waiting time (OPD, diagnostic, pharmacy)
- Length of hospital stay (LOS)
- Cost per patient visit
- Utilization rate of healthcare resources
- OPD waiting
time <30 minutes
- LOS within benchmark for specific conditions
- Cost per visit aligned with national benchmarks
- No overuse or underuse of resources
Effective
(Providing evidence-based care that improves health outcomes)
- Compliance
with clinical guidelines (e.g., NTP, IMCI, WHO)
- Adherence to treatment protocols
- Referral appropriateness (right patient, right level of care)
- Post-treatment follow-up & continuity of care
- 90%+
compliance with treatment guidelines
- Protocol adherence tracked and reviewed
- Effective referral mechanisms in place
- Post-discharge follow-up conducted
Timely
(Reducing delays in care delivery)
- Time to
emergency response (ER, ICU)
- Turnaround time for diagnostics (lab & imaging)
- Time from admission to treatment initiation
- ER response
time ≤10 minutes
- Lab results within standard reporting time
- Treatment starts within recommended timeframes
Patient-Centered
(Respecting patient preferences, needs, and values)
- Informed
consent & shared decision-making
- Patient satisfaction & feedback system
- Respect for cultural, religious, and personal values
- Availability of patient education materials
- Informed
consent documented 100% of the time
- ≥80% patient satisfaction rate
- Culturally sensitive care practiced
- Education materials provided in local languages
Equitable
(Ensuring care is accessible to all, without discrimination)
- Coverage of
vulnerable populations (poor, disabled, elderly)
- Gender-sensitive healthcare services
- Geographic accessibility of services
- ≥95%
service availability for all income groups
- Gender equity policies in place
- Facilities accessible within recommended distance
Integrated
(Coordinated care across providers and settings)
- Referral
& counter-referral efficiency
- Care coordination among primary, secondary, and tertiary levels
- Use of electronic medical records (EMR) for continuity
- Functional
referral linkages in place
- 90%+ counter-referral compliance
- EMR used for patient history tracking
Summary
- Part 1 establishes the rationale for integrating Donabedian, WHO QI, and 5S-CQI-TQM.
- Part 2 defines indicators & assessment criteria, ensuring measurability.
- Part 3 details process indicators aligned with global healthcare quality domains.
This comprehensive QI framework ensures a systematic, globally aligned, and action-oriented approach to improving healthcare quality in Bangladesh.