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.