Define Indicators & Assessment criteria

Quality Improvement (QI) Framework for Bangladesh – Key Indicators & Assessment Criteria  ( Donabedian-Based)

 

This section operationalizes the QI framework by defining measurable indicators and assessment criteria for each category (Structure, Process, and Outcome). The justification for each component is as follows:

  1. Structure (Inputs & Readiness) Justification
  • The availability and quality of inputs (e.g., infrastructure, workforce, equipment, policies) directly impact service delivery and patient outcomes.
  • For example:
    • Workforce Availability (≥85% positions filled) is justified because healthcare personnel shortages lead to service delays and poor quality of care.
    • Health Information Systems (HIS) & Digital Records are essential for data-driven decision-making and continuity of care.
  1. Process (Service Delivery & Quality) Justification
  • This section ensures that care is delivered in a way that is safe, timely, effective, and patient-centered.
  • For example:
    • Patient Safety (IPC, medication safety, surgical safety) ensures adherence to WHO’s standards to prevent medical errors and infections.
    • Waiting Time & Service Efficiency (OPD waiting time <30 mins, emergency response <15 mins) ensures patients receive timely care, reducing complications.
  1. Outcome (Impact & Performance) Justification
  • This section ensures that quality interventions lead to measurable improvements in patient health and system performance.
  • For example:
    • Maternal & Neonatal Mortality Rate (MMR, NMR, U5MR) is a critical indicator of maternal and child health service effectiveness.
    • Financial Protection (Catastrophic Health Expenditure Rate <5%) ensures that healthcare is affordable and reduces financial hardship.

By linking each indicator to clear assessment criteria, this section ensures that healthcare facilities can track, measure, and improve their performance. It aligns with international standards (WHO, Donabedian, 5S-CQI-TQM) while being adaptable to Bangladesh’s context

Donabedian-Based Quality Improvement (QI) Framework for Bangladesh

Structure (Inputs & Readiness)

Indicator Measurement Data Source
Hospital Infrastructure & Essential Utilities (Water, Sanitation, Electricity, Waste Disposal, Internet) Compliance with infrastructure standards Environmental health reports
Structural Integrity, Safety Compliance Inspection reports, engineering assessment Facility audits, government records
Total Number of Beds, Bed Occupancy Rate Patient admission/discharge records Hospital management system, reports
Availability of Emergency Rooms, ICU Beds, Equipment Time taken for emergency patient admission, ICU occupancy Hospital logs, ICU records
Equipment Availability, Functionality, Maintenance Equipment audits, downtime analysis Maintenance logs, procurement data
Essential Medicines & Consumables Availability No stockouts, temperature control Pharmacy records, supply chain data
Policy & Governance (SOPs, Guidelines, Compliance) Full implementation of quality protocols Policy documents, audit reports
Health Information System (HIS) & Digital Records System uptime, data accessibility IT department records
Facility Safety & Security (Fire Safety, Disaster Preparedness, Hospital Security) Compliance certificates, safety drills Security logs, government audits
Workforce Availability (Doctors, Nurses, Technicians, Support Staff) ≥85% positions filled HR records
Workforce Availability (Doctors, Nurses, Technicians, Support Staff) % of positions filled with trained personnel (≥85%) HR records
Doctor-Patient Ratio Number of doctors per 1,000 patients seen daily OPD logs
Nurse-Patient Ratio Number of nurses per admitted patients per shift HR records
Training & Competency Development % of staff completing CPD training HR training records
Workload Indicator of Staffing Need (WISN) Score WHO tool-based calculation of workforce adequacy WISN assessment

 Process Indicators (Service Delivery & Quality)

Indicator Measurement Data Source
Bed Occupancy Rate (BOR) % of hospital beds occupied (Optimal: 75–85%) Hospital admin records
Average Length of Stay (ALOS) Mean duration of inpatient stay (Target: 3–5 days for general cases) EHR, patient records
OPD & Emergency Waiting Time Average time from arrival to consultation (Target: <30 mins for OPD, <15 mins for emergency) Time-motion study, ER logs
Referral & Emergency Transport System % of emergency cases referred within 30 minutes Referral logs, transport records
Clinical Effectiveness (Guideline Adherence) >90% compliance with treatment protocols Medical chart reviews
Patient-Centered Care >90% patient satisfaction, informed consent compliance Patient satisfaction survey
Incident Reporting & Learning System % of incidents reported and analyzed within 72 hours Incident reporting system
Emergency & Disaster Preparedness % of staff trained in emergency protocols (Target: >80%) Emergency preparedness audits
Training & Competency Development % of staff completing required training (Target: >85%) HR training records
Hand Hygiene Compliance Rate % of staff following hygiene protocols (Target: >90%) Compliance audits
Safe Surgery Checklist Adherence % of surgeries following WHO checklist (Target: >95%) Surgery observation logs
30-Day Readmission Rate <5% readmission within 30 days of discharge EHR, readmission logs
Hospital-Acquired Infection Rate <7 per 1,000 patient-days Infection control records
Surgical Site Infection Rate <2% of all surgical procedures Infection control reports
Adverse Drug Reaction Rate <2% of all prescribed medications Pharmacy reports
Patient Mortality Rate <2% of total admissions (adjusted for case severity) Mortality records
Waiting Time in OPD & Emergency OPD: <30 mins; Emergency: <15 mins Patient logs, time-motion studies
Timeliness of Care % of patients receiving care within national guidelines (Target: >90%) EHR, patient records
Communication Quality % of patients reporting clear communication with doctors and nurses (Target: >85%) Patient surveys
Respect & Dignity % of patients reporting being treated with dignity (Target: >90%) Patient experience survey
Ease of Access to Service % of patients who find services easily accessible (Target: >85%) Facility accessibility audit
Electronic Health Record (EHR) Utilization Rate % of patient encounters recorded digitally (Target: >95%) EHR logs
Interoperability Score % of health data successfully shared across facilities (Target: >80%) IT system logs
Telemedicine Adoption Rate % of consultations conducted via telemedicine (Target: >20%) Telehealth records
System Usability Score (SUS) Average usability rating by hospital staff (Target: >75 on a 100-point scale) SUS survey
IT Downtime Rate % of operational hours affected by system failure (Target: <2%) IT logs
Digital Prescription Rate % of prescriptions issued electronically (Target: >85%) EHR, pharmacy logs

5S-Based Indicators (Workplace Organization & Efficiency)

📌 Assessment Tools: 5S Checklist Audits, Direct Observation, Staff Surveys

Indicator Definition/Measurement Data Source
Workplace Organization Score (5S Compliance Rate) % of departments meeting 5S implementation standards 5S audit checklist
Availability of Essential Supplies % of workstations stocked with necessary medical supplies Direct observation
Response Time for Emergency Equipment Access Time taken to access emergency medical tools (oxygen, defibrillator, etc.) Time-motion study
Staff Adherence to Clean & Safe Workplace Standards % of staff following proper organization & cleanliness Observation & staff feedback
Reduction in Equipment & Supply Retrieval Time Time saved in accessing tools due to 5S implementation Pre & post-5S audit comparison


CQI-Based Indicators (Continuous Quality Improvement)

📌 Assessment Tools: PDSA (Plan-Do-Study-Act) Cycle Analysis, Quality Improvement Reports, Process Audits

Indicator Definition/Measurement Data Source
Number of QI Projects Implemented Total number of active quality improvement projects QI reports
Process Cycle Time Reduction % improvement in workflow efficiency (e.g., OPD registration time, discharge process) Time-motion study
Adherence to PDSA Cycles % of departments actively applying PDSA cycles for improvements Quality audit reports
Reduction in Medication Errors % decrease in reported prescription & dispensing errors Incident reporting system
Improvement in Compliance with Clinical Protocols % increase in adherence to updated treatment guidelines Medical chart reviews

TQM-Based Indicators (Total Quality Management)

📌 Assessment Tools: Patient Satisfaction Surveys, Staff Engagement Surveys, Hospital Performance Dashboard

Indicator Definition/Measurement Data Source
Leadership Commitment to Quality Score % of management actively engaged in quality initiatives Leadership survey
Patient-Centered Care Implementation Rate % of care processes designed with patient feedback integration Policy & process review
Employee Engagement in Quality Improvement % of staff participating in hospital QI initiatives Staff QI survey
Rate of Staff Suggestion Implementation % of employee suggestions for service improvement adopted Suggestion box records
Cross-Departmental Collaboration in Quality Initiatives % of departments engaged in joint QI projects QI committee reports


Summary of Additional Indicators (5S, CQI, TQM)

Summary of Additional Indicators

Category Key Indicators
5S – Workplace Organization Workplace Organization Score, Emergency Equipment Response Time, Staff Adherence to 5S
CQI – Continuous Improvement QI Projects Implemented, Process Cycle Time Reduction, Reduction in Medication Errors
TQM – Total Quality Management Leadership Commitment, Employee Engagement, Cross-Departmental Collaboration

 Outcome (Impact & Performance)

Indicator Measurement Data Source
Maternal & Neonatal Mortality Rate (MMR, NMR, U5MR) MMR <50 per 100,000 live births, NMR <5 per 1,000 Birth & mortality records
Post-Surgical Complication Rate <2% complications post-surgery Surgical outcome records
Hospital Readmission Rate <5% within 30 days Readmission records
Hospital-Acquired Infection (HAI) Rate % of infections per patient admissions Infection control records
30-Day Readmission Rate % of readmissions within 30 days EHR, readmission logs
Adverse Drug Event (ADE) Rate % of medication errors causing harm Pharmacy reports
Financial Protection (Catastrophic Health Expenditure Rate) <5% households spending >10% on healthcare Health financing records
Equity in Service Utilization ≥90% marginalized populations accessing care Patient demographic reports
Overall Patient Satisfaction Score % of patients rating care as ‘satisfactory’ Patient satisfaction survey
Complaint Resolution Rate % of patient complaints addressed within standard time Patient grievance records
Digital Health & IT System Integration (EHR, Telemedicine, Interoperability) % of patient encounters recorded digitally, % consultations via telemedicine EHR logs, telehealth records
Number of Quality Improvement (QI) Projects Implemented Total QI initiatives active QI reports
Process Cycle Time Reduction % improvement in workflow efficiency Time-motion study
Leadership Commitment to Quality Score % of management engaged in QI Leadership surveys
Cross-Departmental Collaboration in QI % of departments engaged in joint QI QI committee reports

Justification for This QI Framework

  • Aligns with Donabedian’s Model (Structure, Process, Outcome) to ensure systematic quality assessment.
  • Incorporates WHO Quality Standards (safety, efficiency, patient-centeredness, equity).
  • Uses 5S-CQI-TQM principles for continuous improvement, facility organization, and process efficiency.
  • Includes Facility Assessment Tools to measure performance objectively.