Module 1: Holistic approach of QI Framework

A Holistic QI Framework for Health care Structure, Process and Outcome Based Improvement.

Ensuring high-quality healthcare is a fundamental priority for any health system striving to achieve Universal Health Coverage (UHC) and improve overall population health outcomes. Recognizing the need for a structured and evidence-based approach to quality improvement, we have developed a Quality Improvement (QI) Framework that integrates internationally recognized methodologies and standards. This framework is built upon the Donabedian Model (Structure-Process-Outcome), WHO QI Framework, Provision of Care, Experience of Care, Health System Responsiveness, and the 5S-CQI-TQM approach. By aligning these global models, we ensure that all domains of quality are addressed in a systematic, measurable, and sustainable manner.

Integrating Global Best Practices into the QI Framework

At the core of this framework is the Donabedian Model, a time-tested approach that evaluates healthcare quality across three key dimensions: Structure, Process, and Outcome. The Structure component assesses the foundational elements necessary for quality care, including infrastructure, human resources, equipment, and policies. The Process dimension focuses on service delivery, clinical protocols, and patient-provider interactions, ensuring that care is efficient, effective, and safe. Finally, the Outcome component measures the impact of healthcare services on patient health, satisfaction, and overall system performance.

To strengthen the operational relevance of this framework, we have aligned it with the WHO QI Framework, which defines the fundamental dimensions of healthcare quality—safety, effectiveness, efficiency, patient-centeredness, timeliness, equity, and integration. This ensures that our QI efforts are in harmony with internationally recognized principles that guide quality improvement in healthcare systems worldwide.

Furthermore, we have incorporated Provision of Care and Experience of Care as essential pillars of this framework. Provision of Care focuses on the availability, accessibility, and appropriateness of healthcare services, ensuring that facilities are equipped to deliver high-quality, standardized care. Experience of Care, on the other hand, addresses patient-centered aspects, such as dignity, respect, communication, and satisfaction, which are critical for building trust in the health system and improving adherence to treatment plans.

An equally vital consideration in our QI framework is Health System Responsiveness, which measures how well the healthcare system meets the needs and expectations of patients. A responsive health system ensures timely access to care, effective communication, financial protection, and respect for patient autonomy, all of which contribute to better patient outcomes and overall trust in the healthcare system.

To ensure continuous improvement and sustainable implementation, we have adopted 5S-CQI-TQM as an operational modality within this framework. The 5S methodology (Sort, Set, Shine, Standardize, Sustain) enhances workplace organization, resource optimization, and efficiency, laying the foundation for a well-structured healthcare environment. Continuous Quality Improvement (CQI) introduces a data-driven, iterative process of identifying gaps, implementing corrective actions, and monitoring improvements. Meanwhile, Total Quality Management (TQM) embeds a culture of accountability, collaboration, and excellence, ensuring that quality improvement is institutionalized at all levels of the healthcare system.

Addressing All Domains of Quality in Alignment with Global Standards

By integrating these internationally recognized frameworks, the Bangladesh QI Framework comprehensively addresses all key domains of healthcare quality. The safety of patients and healthcare workers is prioritized through rigorous infection prevention and control measures, adherence to clinical guidelines, and robust patient safety protocols. Effectiveness is ensured by promoting evidence-based care, monitoring health outcomes, and enhancing provider compliance with treatment protocols. Efficiency is improved by optimizing resource utilization, reducing waste, and ensuring that service delivery processes are well-coordinated.

This framework also emphasizes patient-centeredness, ensuring that healthcare services are designed around patient needs, values, and expectations. Timeliness is improved by minimizing delays in emergency response, diagnostics, and treatment initiation. Equity is strengthened by addressing disparities in healthcare access and ensuring that marginalized populations receive adequate care. Finally, integration across different levels of care enhances continuity of care, strengthens referral pathways, and promotes coordination between primary, secondary, and tertiary healthcare facilities.

A Holistic and Actionable Framework for Quality Improvement

The QI Framework developed for Bangladesh is not just a conceptual model—it is an actionable strategy that translates quality improvement principles into measurable outcomes. By integrating Donabedian’s Model, WHO QI Framework, Provision of Care, Experience of Care, Health System Responsiveness, and 5S-CQI-TQM, we have created a holistic and contextually relevant framework that aligns with global standards while addressing the unique challenges of Bangladesh’s healthcare system.

Total 8 section of this Annexure, aim to institutionalize a culture of continuous improvement, accountability, and excellence in healthcare service delivery. By systematically monitoring quality indicators, engaging healthcare providers, and fostering patient-centered care, this approach will drive measurable improvements in health outcomes, system efficiency, and patient satisfaction, ultimately strengthening the foundation for a resilient, high-performing, and equitable healthcare system.

QI Framework

This section establishes the foundation of the QI framework by integrating multiple globally recognized models—Donabedian’s Structure-Process-Outcome model, WHO QI Framework, 5S-CQI-TQM, and Health System Responsiveness. The justification for each element is as follows:

1. Donabedian Model Justification:
   • This model is globally recognized for quality assessment in healthcare by evaluating Structure (inputs), Process (service delivery), and Outcome (health impact).
   • It ensures that quality improvements are systematically addressed rather than focusing on isolated interventions.
2. WHO QI Framework Justification:
   • The WHO QI framework provides the seven dimensions of quality—Safe, Effective, Efficient, Patient-Centered, Timely, Equitable, and Integrated.
   • Aligning with this framework ensures that Bangladesh’s QI initiatives meet international healthcare quality benchmarks.
3. Provision & Experience of Care Justification:
   • Provision of Care ensures availability, accessibility, and appropriateness of healthcare services.
   • Experience of Care addresses dignity, respect, patient engagement, and satisfaction, which are critical for trust-building and adherence to care plans.
4. Health System Responsiveness Justification:
   • This component ensures that the healthcare system is timely, patient-centered, and financially protective.
   • It enhances trust and reduces barriers to accessing care, particularly for vulnerable populations.
5. 5S-CQI-TQM Justification:
   • 5S (Sort, Set, Shine, Standardize, Sustain) ensures a well-organized, clean, and efficient healthcare facility.
   • CQI (Continuous Quality Improvement) enables data-driven decision-making for ongoing improvements.
   • TQM (Total Quality Management) institutionalizes a culture of excellence and standardization.

 

By integrating these models, Section 1  justifies the development of a comprehensive QI framework that is both globally aligned and contextually relevant for Bangladesh. It ensures that all domains of healthcare quality are systematically addressed and continuously improved.

Structure:

Process:

Outcome :

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Key Enhancements in this  QI Framework

1. Fully aligned with WHO’s Quality Dimensions – Ensures comprehensive quality assessment.
2. Differentiates Technical & Functional Quality – Captures clinical vs patient-centered care aspects.
3. Integrates 5S-CQI-TQM Principles – Ensures structured workplace organization, continuous QI, and system-wide improvements.
4. Links with WHO’s Provision & Experience of Care Framework – Ensures health system responsiveness & patient expectations.