G S SGGS S S G SFSS S

1
????????G??? ??? ?S?????? ???S?GG?S? ??S
????????S ???G????? ???SF???S?S ????????S

• ??. ???st??a ?. ??????µ?p?????
• I??????, 2004

2
? ??S??S ???S ??F??? ???????????? ??? ?? ???? ??S
?F?S ???, ? ??S??S ???S ?G???????? ??? ?? ????
??S G?OS?S ??? ??? ? ??S??S ???S ??G???? ??? ??
???? ??? ???????S ???

• ?? ????S ???S??S
• ??a? ?????p??, ?p?ase s???t?s? µe t?e?? ?t?ste?
  p?? d???e?a? se µ?a ????d?µ?. ?? ???e?? e?e??
  ??t?se t?? ?a???a.
• ????? t? ??µ? µ??, ap??t?se ? p??t??.
• ??p??et? ta t??ß?a, e?pe ? de?te???.
• ?t??? ??a? ?a?ed???? ?a?, ap??t?se µe
  e????s?asµ? ? t??t??.

?p? t? ??ß??? ? S?????G??? ??S ????????S John
Maxwell Jim Dornan
3
?G??? - ????????

• ???s??te ?a?? t??ta ta ????a. ????? t?se?
  fa?e??? ?s? ?a? ???f?? s?µas?e?.
• ????? ??????p?????

4
??e?a

• Teµe???de? a????p??? d??a??µa
• E?asf???s? s??????? ??a p????s? ?a? a?ta???s?
  t?? a????p???? ????
• WHO, 1978

5
S?S???? ?G???S Health care system Health system

• ???S??S
• ??a ?esµ??? ???a??µ??? s?st?µa ??a ??a?
  ded?µ??? p????sµ?, t?? ?p???? ? ???µat?d?t?s?,
  ? d?????s?, ? ap?st??? ?a? ?? ep?µ?????
  ?p??es?e?, ?a???????ta? µ?s? t?? ??µ??es?a? ?a?
  ????? ep?s?µ?? ?e?µ???? ?a? d?at??e??. ?? s?st?µa
  d?asfa???e? ?p??es?e? ?? ?p??e? ap?s??p??? st??
  ße?t??s? t?? ??e?a? ?a? pa?????ta? st?? p????sµ?,
  se s???e???µ????? ??????, ?p?? ?at ?????, se
  a?ad?µa??? ?d??µata, e??as?a???? ??????,
  d?µ?s???? ??????, st?? ?????t?ta, se ??s???µe?a
  ?a? ????????. ???? WHO, 1998a

6
S?S???? ??????S F??????O? ?G???SHealth care
(delivery) system

• ?? s?st?µa ??e?a? af??? ?p??es?e? pa?????
  f???t?d?? ??e?a?, ?? ?p??e? p??sf????ta? se
  p??t?ß??µ??, de?te??ß??µ?? ?a? t??t?ß??µ??
  ep?ped?, e??a? t? s?st?µa t? ?p??? as???e?ta? µe
  ?at????? ?a? ?e?ape?t???? d?ad??as?e? ?? ?p??e?
  ap?s??p??? st?? d?asf???s? ? t?? ße?t??s? t??
  ?at?stas?? t?? ??e?a? e??? as?e??.
• ???? (WHO, 2000b).

7
?G??? ?? ???????.

• The provision of health care, like the road to
  hell, is paved with good intentions...

8
??????? ???????S?S G?? ?? S?????S?? ??? ??
S?G?????S? ???S ???????O????? S?S??????S ?G???S
???????G??? ??????? ??????s? ?a? ?e?t?????a t??
s?st?µat?? (operational level)
??????? T?S?O? ??? ??S?O? ?e??t? ?a? d?µ?
?esµ???? p?a?s??? (structural level)
??????? T?????O?O? ???O? ??? ???O? ?a????sµ??
t?? p???t???? ep?????? ????O???? ???????? ??S?
??? S?S??????S (level of values)
9
WH0S????? ??S S?????G???S ?G??? 21

• ???s??s? t?? ?s?t?ta? ?a? t?? a????e?????
• ?e??s? t?? ep?pt?s?? ?a? t?? s????? eµf???s?? t??
  as?e?e???
• ??µ??????a ???e???te??? pe??ß?????t??
• ?e?t??s? t?? p???t?ta? ?a? t?? ap?te?esµat???t?ta?
  t?? s?st?µ?t?? ??e?a?.
• ??µ??????a ?????????? ????µat?? ??a t?? ??e?a.

10
WHOS????? ??S S?????G???S ?G??? 21

• ?e?t??s? t?? p???t?ta? ?a? t??
  ap?te?esµat???t?ta? t?? s?st?µ?t?? ??e?a?
•  
• ??a? ????????µ???? t?µ?a? ??e?a?.
• ? ??????s? ??a p???t??? f???t?da .
• ? ???µat?d?t?s? t?? ?p??es??? ??e?a? ?a? ?
  ?ata??µ? t?? p????.
• ? a??pt??? t?? a????p???? p???? ??a t?? ??e?a.

11
? ?????? ??S ????????S

• ISO AWARD

12
?p??e? ? a????p??? ??? ?a e??a? ??t? p??s?a???,
p??s?a??? ? ??? t?? a????p?t?ta? t?? p?a??t?
µa?, t?? s?µpa?t??. ??t? ?µ?? de? s?µa??e? ?t?
de? ????? a??a ?sa pe?ast??? pe????e?. ?e? ta
?ata????e? ? ?????? a??? ? ????t?ta?. ?s?ts??
13
Hamlet, act II, scene 2
Come Give us A Taste of Your Quality
14
? ?????a t?? p???t?ta?

• ????S??????
• ???a??t?ta - ?st?????? apa???? t?? ???? ??et?,
  ???ste?e??, ?pe?????? ?µµe?a?
• ?S??????
• ? pe???d?? t?? pa?ad?s?a??? p??s????s?? ???sµ??a
  p?????ta ? ?p??es?e? d?a??????ta? ??a t??
  µ??ad???t?t? t???, ?pe?????? ?a? ?? a?t? e??a?
  a???ß?te?a. ?e? ?eµe??????ta? ?a? de? e?f???eta?
  µ?s? te?????? ? p??t?p??.
• ? pe???d?? t?? eµpe??????µ???? ?a? a?a??t?? ?
  p??sd????sµ?? t?? ?????a? ???eta? µe ß?s? t?
  ???µ?, t?? a?t????? e?d???? ?? ?p????
  ?e?t??????? sta p?a?s?a e??? ???a??sµ??
  p???t?ta?.
• ? pe???d?? est?as?? st?? pe??t?.

15
? s??????? f???s?f?a t?? p???t?ta?

• ?st???eta? se t?e?? ep?µ????? ap??e??
• ? p??t? ?e??e? ?t? ? p???t?ta e??a? ??a?
  e?e???µ???? t??p?? d?????s?? ?p?? ?? e??a??µe???
  s?µµet????? e?e??? st?? ???? ap?f?se?? ?a?
  p??spa???? ??a t? s??e?? ße?t??s? t?? pa?a??µ????
  p?????t?? ?a? pa?e??µ???? ?p??es??? µ?s? t??
  a?µ?????? s??e??as?a? µe ta ??et??? ste????.
• ? de?te?? ?p?st????e? ?t? ? d?????s? ?a p??pe? ?a
  d?aµ??f??e? ta p?????ta ?a? t?? ?p??es?e? a?????a
  µe t?? apa?t?se?? p?? ????? ?? ap?d??te? a?t??.
• ? t??t? ?e??e? ?t? ? pa?e??µe?? p???t?ta ?a
  p??pe? ?a e????eta?, ?a ße?t???eta? ?a? ?a
  p????aµµat??eta? s??e???.

16
? S?????? ??? ? ???S?GG?S? ??? W. EDWARD
DEMING? pat??a? t?? t??t?? ??µat?? t??
ß??µ??a????? epa??stas??

• ????a s?µe?a t?? ?e???a? t?? Deming
• ? d?????s? µ?a? eta??e?a? p??pe? ?a est???eta? se
  µa????????a p?????µµata ße?t??s?? t?? p???t?ta?
  ?a? ??? st?? a???s? t?? ???d??? ß?a??p???esµa.
• ? ?µfas? p??pe? ?a d??e? t?? ??es?a, st?? s??e??
  e?pa?de?s? ?a? a??pt??? t?? ??a??t?t?? t??
  e??a??µ???? a?t? st?? ??e??? ?a? t??? p?s?t?????
  st????? pa?a????? ?? ?p???? s???? ap?ßa????? se
  ß???? t?? p???t?ta?.
• ? d?asf???s? t?? p???t?ta? ßas??eta? st?? a?????
  s?ed?as? ?a? t? d?ad??as?a pa?a????? e???
  p?????t?? ?a? ??? st?? ??e??? µet? t?? ????????s?
  t?? d?ad??as?a? pa?a?????.

S????e?a
17
? S?????? ??? ? ???S?GG?S? ??? W. EDWARD
DEMING? pat??a? t?? t??t?? ??µat?? t??
ß??µ??a????? epa??stas??

• ????a s?µe?a t?? ?e???a? t?? Deming
• ? e???????s? ?a? d?ast????p???s? ?µ?d?? se
  d?af??et??? tµ?µata µ?s? s?st?µat???? ?a?
  d?a????? e?pa?de?s?? ? ?p??a ef?d???e? t???
  e??a??µe???? µe t?? ???se?? ?a? t?? µe??d??? ??a
  ?a ße?t??s??? t?? p???t?ta ?a? ?a a?s?a?????
  ?pe??fa??? ??a t?? e??as?a t???.
• ? a???p???s? t?? µe??d?? stat?st???? p???t????
  ??e???? ??a t?? pe?????sµ? t?? d?a??µa?s??
  (µetaß??t?t?ta?) sta ßas??? ?a?a?t???st??? t??
  p???t?ta? ?a? ?at? s???pe?a t?? a???s? t??
  ??a??p???s?? t?? pe??t?.

18
? S?????? ??? ? ???S?GG?S? ??? JOSEPH
JURAN???e???d?? e?????? p???t?ta?, 1951
?ap???a 1950

• ? t??????a t?? J. Juran
• S?ed?asµ?? ??e???? ße?t??s? p???t?ta?
• ?? t?e?? a?t?? ?e?t?????e? ap?te???? t??
  ?at?????? µ??a??sµ? ??a t?? ??a??p???s? t??
  apa?t?se?? t?? pe??t?, ? ?p??a ap?te?e? ?a? t??
  ßas??? st?at????? st??? ???e eta??e?a?
• ? Juran ?e??e? ?? ßas??? de??t? ??a t??
  a???????s? t?? ep?p?d?? p???t?ta? µ?a? eta??e?a?
  t? ??st?? p???t?ta? ?a? ?p?? ?a? ?? Deming ?a?
  Crosby ?e??e? apa?a?t?t? p???p??es? t?? d?sµe?s?
  ?a? e?e??? s?µµet??? t?? ??es?a?.
• ????e? ?a pa?at???s??µe ?t? ? Juran ???s?µ?p??e?
  s???? ???????a ap? t??? ?????? t?? ??e?a? ?a? t??
  ?at????? t? d?a???st??? ta??d?, ? ?e?ape?t???
  d??s?, ?? ?e?ape?e? p???t?ta? ??p

19
? S?????? ??? ? ???S?GG?S? ???PHILLIP
CROSBYS????af?a? t?? best sellers ? p???t?ta
e??a? d??e??, ????t?ta ????? d????a, ? t????
t?? ?a ep?t?????e?? a?t? p?? ???e??

• ? p??s????s? t?? Crosby e??a? e???te?a ???st? µe
  t?? a???
• ???e ta p???µata s?st? ap? t?? p??t? f??? ?a?
  µ?d?? e?att?µata.
• ? f???s?f?a t?? s??????eta? ep???aµµat??? st??
  ?e??µe?e? t?sse??? ?p???te? T?se?? (four
  absolutes)
• ????t?ta s?µa??e? s?µµ??f?s? st?? apa?t?se?? t??
  pe??t? ?a? ??? p?s? ?a?? e??a? ??t?.
• ? p???t?ta ep?t?????eta? µe t?? p?????? ?a? ???
  µe t?? ??e??? ?a? t?? a???????s? af?? ??e?
  ?????????e? ? d?ad??as?a pa?a?????.
• ?? p??t?p? ap?d?s?? ?a p??pe? ?a e??a? ta µ?d??
  e?att?µata ?a? ??? ??p??a ap?de?t? ep?peda
  p???t?ta?.
• ?? µ?t?? t?? p???t?ta? e??a? t? ??st?? t?? µ?
  s?µµ??f?s?? st?? apa?t?se?? t?? pe?at?? ?a? ???
  ?? d??f???? de??te?.
• ?a? ? Crosby ???s?µ?p??e? ???????a ap? t?? ????
  t?? ??e?a?, ?p?? ? d?????s? t?? p??ß??µat??
  ?aµ???? p???t?ta? ?a? t? eµß???? p???t?ta?.

20
????t?ta

• ??????????
• ??????µ????
• p???t?sµ????
• s?????e?

• ???????a

• ??????µ?a

• p???t?sµ??

21
????t?ta

• ? ßa?µ?? st?? ?p???? ded?µ??? p????? ? ?p??es?a
  a?tap?????eta? st?? a????e? ???sµ???? ???st?.
• Juran , 1988

22
S??e??? ???pt??? ????t?ta?

• ?t?µ???
• e?????
• S????????
• p??sp??e?a

23
????t?ta

• ? s?µµ??f?s? st?? apa?t?se?? t?? pe??t?
  Crosby, 1989

24
????t?ta

• ?? s????? t?? ?a?a?t???st???? µ?a? ??t?t?ta?,
  p?? t?? d????? t? d??at?t?ta ?a ??a??p??e?
  ?a????sµ??e? ? ep?ßeß??µ??e? a????e?
• ISO, 1987

25
????t?ta e??a? t? ??st?? p?? µetaß?ß??e? ??a?
???a??sµ?? st?? ???????a ?ta? de? pet??a??e? t???
st????? t??. ?a????ts? ?? ?p??es?e? ??e?a? p??
as??????ta? µe t?? ?????p?, de? a??e? µ??? ?a
????? a?a???e?se? t?? p???t?ta t?? pa?e??µ????
?p??es??? t??? se ßas??? st???e?? ?e?t?????a?
t??? a??? ?fe????? ?a p??ßa????? se s??e?? ??e???
?a? ße?t??s? t??, p???e?µ???? ?a eµp????? st?
????????? s????? eµp?st?s??? ?a? asf??e?a ??a t??
d?ast????t?t?? t???
26
? Stat??? ?a? ? ???aµ??? ?p??? ??a t?? ????t?ta

• ??????s? ?????? ????t?ta?
• Total Quality Management
• S??e??? ?e?t??s? ????t?ta?
• Continuous Quality Improvement (Development)

27
????t?ta st?? ?p??es?e? ??e?a?

• Good Medicine without Good Care is As Usefull
  as Good Care without Good Medicine
• Paracelsus

28
???S??S ??? ?????S? ??S ????????S S??? ?G???

• ??????ta? t?? p???t?ta
• ?e???t???? p??se???se?? ?a? ?e?t???????? ???sµ??
• ??t??s? t?? p???t?ta?
• ?? ?e???t??? p?a?s??
• ?a ded?µ??a
• ?a st???e?a
• ?a e??a?e?a ?a? ?? te?????? µ?t??s??

29
QUALITY

• High-quality health care can be defined as care
  or service
• with characteristics that meet specified
  requirements and, given the current state of
  knowledge and available resources, fulfill
  expectations for maximizing the risks to the
  health and well-being of the patient.
• (Policy statement, Ottawa, Canadian Hospital
  Association, 1989)

30
?st????? a?ad??µ?

• Ofe??e?? ? µ? ß??pte??
• ?pp????t??, 5?? p.?. a???a?
• ????t???? ??e???? - ?p?????sµ?? ?ep?a?µ????
• Florence Nightingale, 19?? µ. ?. a???a?

31
(No Transcript)
32
???sµ??

• ????t?ta
• ?????? ( ?at???? - ??s??e?t???)
• ????? p?? st????eta? st?? ?e????????? ?p?d?µ?
• ????? p?? st????eta? st? ?????p??? ???aµ???
• ?p??es?e? p?? s???de???? t? p?????
• ?at????? ??s??e?t????
• ?e??d??e?a???
• F?µ? p?? pe??ß???e? t? µ??µa p????? / ?p??es?a

33
? p??s????s? t?? Donabedian

• ?? te????? µ????
• technical, science of medicine
• ?? d?ap??s?p??? µ????
• interpersonal, art of medicine
• ??? ?e??d??e?a?? ?p?d?µ?
• amenities

34
? p??s????s? t?? Donabedian(??ass???? ???sµ??)

• "??t? t? e?d?? f???t?da?, t? ?p??? a?aµ????µe ?a
  µe??st?p???se? t? ?a??? ??e?? t?? as?e??,
  ?aµßa??µ???? ?p??? t?? ?fe?e??? ?a? t?? ap??e???
  p?? eµpe????e? ? d?ad??as?a pe???a????, se ??a
  ta ep?µ????? t?? s?µe?a".

35
?a??µet??? ????t?ta? Donabedian, 1968

• ????
• STRUCTURE
• ???????S??
• PROCESS
• ????S?
• OUTCOME

36
? p?s?t?ta t?? f???t?da? ?a? ? p???t?ta

• p?s?t??? a?ep???e?a t?? f???t?d??

• pe??tt??, µ? a?a??a?e? ?at????? p???e??
  (epeµß?se??, e?et?se?? ??p)

37
?? ??????µ??? ??st?? t?? p???t?ta?

• ? ep?te??? t?? p???t?ta? p???p???te? ep???e?a
  ??????µ???? p????.

• H ep??d?s? a?t? ?a s?µß???e? ap?te?esµat??? st?
  µe??s? t?? ??st??? µe t?? pe?????sµ? pe??tt?? ?a?
  a?ap?te?esµat???? p???e??.

38
?? epa??e?µat?e? ??e?a?, ?? as?e?e??, ?
???????a t?e?? d?af??et???? ???sµ?? t??
p???t?ta?
The social definition ?????????? ???sµ??
The absolutist definition ap???t?? ???sµ??
The individualized definition e?at?µ??e?µ????
???sµ??
???sa?µ??? ap? Donadedian
39
? ap???t?? ???sµ?? t?? p???t?ta? The absolutist
definition

• ?a?????eta? ap? t?? ap??e?? t?? epa??e?µat??? ??a
  t? t? s?µa??e? ep?ped? ??e?a?, µe p?????
  t??p??? s??e?sf????? ?? ?d??? st?? ße?t??s?
  a?t?? t?? ep?p?d?? ?a? p??, t????, ap?t?µ?ta? ?
  s?µß??? t???

40
? e?at?µ??e?µ???? ???sµ?? t?? p???t?ta?The
individualized definition

• ??af??eta? st?? ?p??? ?a?e??? ap? t??? as?e?e??,
  ded?µ???? ?t? ?? as?e?e?? d?af????? µeta?? t???,
  ??? µ??? ?? p??? t?? d?????s? ?a? t?? ßa??t?ta
  t?? ??s?? a??? ?a? ?? p??? t?? f???, t??
  ???s?e?t???? ?a? f???s?f???? a??e?, t??
  ???????????????µ??? p????e?s?, t?? a????e? ?a?
  t?? p??sd???e? t???.

41
? ?????????? ???sµ?? t?? p???t?ta? The social
definition

• ?d? ? ?µfas? d??eta? st?? ap?t?µ?s? µe ß?s? t?
  ?fe??? ??a t? s????? t?? ep?p?d?? ??e?a? t??
  p????sµ?? ?a? ??? e??? µeµ???µ???? as?e??.

S????e?a
42
? ?????????? ???sµ?? t?? p???t?ta? The social
definition

• ??t??s? p???t?ta? ?a? a???????s? p????aµµ?t??
  ??e?a?
• ???sßas?
• S????e?a ?a? S??t???sµ?? st?? pa?e??µe?e?
  f???t?de?
• ?? pe??te? ?a? ? ???sµ?? t?? p???t?ta?
• ??a??p???s? t?? epa??e?µat???.

43

• ????t?ta

t? ?fe??? ??a t?? s???????p? µa? (t?? as?e??)
t? ?p??? se ???e pe??pt?s? p??pe? ?a e??a?
µe?a??te?? ap? t?? p??a??? a???t????
s???pe?e? Donabedian 1968
44
S??e??? p??sp??e?a ap? ??a ta µ??? e???
???a??sµ??, µe s??p? t?? ??a??p???s? t?? a?a????
?a? t?? p??sd????? t?? as?e??? ? ???st?? a???
?a? t?? ????? pe?at?? Laffel and Blumenthal,
1989
45

• ? ße?t??s? st? ep?ped? ??e?a? e??? ded?µ????
  p????sµ??, ?aµßa??µ???? ?p??? t?s? t??
  pe?????sµ?? st??? d?a??s?µ??? p????? ?a? t??
  te???????a ?s? ?a? t?? ep?ß????s?? t?? p????sµ??
  ap? t? ??s?
• Palmer, 1992

46
???te?a??t?te? S?st?µ?t?? ??e?a? ????? µe???
??S? ? ?e?t??s? t?? ?p?p?d?? ??e?a? ??a t?
s????? t?? p????sµ?? ? a???s? t?? ????????
ap?te?esµat???t?ta? ???????? ap?f?se?? p??
ßas????ta? st?? ?a??te?? d??at? p?a?t??? (ap?f???
pe??tt?? p???e?? ? e?et?se?? ?a??? ?a? ap?f???
pa???e???? d?e????e?a? apa?a?t?t?? p???e??)
47
???te?a??t?te? S?st?µ?t?? ??e?a? ????? µe???
??S? ? a???s? t?? asf??e?a? ??a t?? as?e?? ?a? ?
pe?????sµ?? t?? ?at????? sfa?µ?t?? ???pt???
???a??sµ?? pa????? f???t?d?? ??e?a?, ?? ?p????
e??a? ??a??? ?a e?t?p????? ?µesa ?at???? sf??µata
? a?ep???µ?ta s?µß??ta st??? as?e?e??, ?a? ??
?p???? e??a? ??a??? ?a d???? ap?te?esµat??? ?ste
?a p???aµß????? µe????t???? s???pe?e?. ? a???s?
t?? ?pe?????t?ta? ?a???? ?p??es??? st??
?at?????? ????? (µe??s? a?ep???µ?t?? ??????
a?aµ????) ?a? ep?p???? est?as? st?? as?e??,
seßasµ?? t?? p??t?µ?se??, apa?t?se?? ?a? a????
t??.
48
???te?a??t?te? S?st?µ?t?? ??e?a? ????? µe???
??S? ? ße?t??s? t?? ap?d?t???t?ta? ?a? ?
pe?????sµ?? t?? ??st??? ?a???? t?? ?at???????
?p??es??? st??? as?e?e??, t??? p??µ??e?t?? ?a?
t??? p????t?? t?? f???t?d?? ?ste ?a d?asfa???eta?
? µ???st? d??at? a??a ??a t?? a?t?st????
dap???. ? d?asf???s? t?? ?s?t?ta? ??asf???s? ?t?
? ?d?a p???t??? f???t?da, p??sf??eta? se ?????
t??? p???te?, a?e???t?ta ap? t? f???, t? f???,
t?? t?p? ?at????a? ? t?? d??at?t?ta p????µ??.
?p?s?? µe??s? t?? pa?at????µ???? a??s?t?t??
a??µesa se d?af??et???? ?e???af???? pe??f??e?e?
?a? ?????????-??????µ???? ? e?????? ?µ?de?.
49
? ßa?µ?? st?? ?p??? ?? pa?e??µe?e? ?p??es?e?
f???t?da? ??e?a?, se ?t?µa ?a? p????sµ???,
a??????? t?? p??a??t?ta ep?te???? t?? ep???µ?t??
ap?te?esµ?t??, ?a? pa?????ta? µe ß?s? t??
t?????sa ep?st?µ????? ???s? ??st?t??t? ?at?????
???
50
??ast?se?? p???t???? f???t?da? ? asf??e?a t??
pe??ß?????t?? st? ?p??? pa???eta? ? f???t?da ?
p??sßas?µ?t?ta ? ?ata?????t?ta ? s????e?a ?
ap?te?esµat???t?ta ? ap?d?t???t?ta ? ???a???
pa???? JCA?O
51
? Donabedian (1990), ?pt? p????e? t??
p???t?ta? ?p?te?esµat???t?ta (Efficacy) ?
ße?t??s? t?? ep?p?d?? ??e?a? ?a? e?e??a? t??
as?e??, ?? ap?t??esµa t?? pa?e??µe???
f???t?da? ?p?d?t???t?ta (Efficiency) ? ep?te???
t?? µe?a??te??? d??at?? ?f????? µe t?
µ????te?? ??st??. ?e?t?st?p???s? (Optimality)
? e??s????p?s? a??µesa st? ??st?? ??a t?? pa????
??p??a? f???t?da? ?a? st? ?fe??? p?? ?a
p?????e?. ?p?d??? (Acceptability) ? seßasµ??
st?? a????e?, p??sd???e? ?a? ep???µ?e? t??
as?e??. ??µ?µ?t?ta (Legitimacy) ? pa????
f???t?d?? ?? ?p??e? ?a e??a? ap?de?t?? ap? t?
????????? s?????. ?s?t?ta (Equity) ?s?t?µ?
d?a??µ? t?? p??sfe??µ???? ?p??es???
??e?a?. ??st?? (Cost) ??a???? p??sp??e?a ??a
t?? ???? a???p???s? t?? p???? ?ste ?a
ep?t?????eta? ? µe??st?p???s? t?? ?????
??st??/?fe???.
52
Maxwell (1984)

• ???sßas? ?pe?p?d?s? p?s?? f?se?? eµp?d???
  (?e???af????, ??????µ????, ???ss????) p???e?µ????
  ?a d?asfa??ste? ? ???s? t?? ?p??es??? ??e?a?
• ?s?t?ta ? pa???? ?p??es??? p?? e??p??et??? t??
  a????e? ??a ??a a?e?a???t?? ta ????????? st??µata
• ????????? ap?d??? ? ?p??? t?? pe??t? s?et??? µe
  t?? t??p? pa????? t?? ?p??es???, ? ???t??? t??, ?
  a???????s? t?? ?p??es?a? p?? t?? p??sf??eta?
• S?et???t?ta ?? p??? t?? a????e? s?µf???a a??µesa
  st?? a????e? t?? at?µ??, st?? ?????a t??
  a???st?a? ?a? t?? a?ap???a? p?? a?apt?sseta? ?a?
  ???eta? de?t? se s???e???µ??? ????????? s?????
  ?a? st?? ?p??es?a p?? pa???eta? ??a t??
  a?t?µet?p?s? t??
• ?p?d?t???t?ta t? ?aµ???te?? d??at? ??st?? ??a t?
  s???e???µ??? ?at???? p????
• ?e????? ap?te?esµat???t?ta ? ep?te??? t??
  ?a??te??? te?????? ap?te??sµat??

53
?????????S???? S?S?????O? ?G???S

• ??dede??µ??? pa???? ?p??es???
• ???a??µa st?? pa???? f???t?d?? ??e?a?
• ????? f???t?da
• S?µas?a
• ???a?? ?ata??µ?
• ???at?t?ta ???sßas??
• S????e?a ?a? ??????s?
• ????????? ?p?de?t?? ???p??
• Hopkins, 1990

54
? p???t?ta p??pe? ?a ????eta? p??ta se s??s? µe

• ???? ep???µ?t??? st?????
• ???? e??p?????ta? ???d????? st? d?ad??as?a
  pa????? f???t?d?? ??e?a?
• ???? d?at???µe???? p?????
• Povar, 1992

55
?a?a?t???st??? p???t???? f???t?da?

• ????? ep?ped? epa??e?µat?sµ?? (epa??e?µat????
  ?pe?????).
• ?p?te?esµat???t?ta st? ???s? t?? d?a?es?µ??
  p????.
• ?e??s? t?? ???d???? ??a t??? as?e?e??.
• ??a??p???s? t?? as?e??.
• ?e???? ?et??? ep?d?as? st? ep?ped? ??e?a? t??
  as?e??.
• (WHO, 1993).

56

• ? ???e ???sµ?? t?p??ete?ta? - ?a? µe a?t? t??
  ?????a e??a? ????? - sta p?a?s?a s???e???µ????
  ??e????µ???? s?st?µat??.

57

• ? ???e ???sµ??, µe ß?se? t?? pa?aµ?t???? p?? t??
  p??sd????????, a?ta?a??? t?? a??e? ?a? t???
  p??ß??µat?sµ??? t?? ??e????µ???? s?st?µat?? sta
  p?a?s?a t?? ?p???? d?aµ??f??eta?.

58

• ???? ?? ???sµ?? ep??e?t?????ta? st? ?fe??? t?
  ?p??? p????pte? ??a t?? as?e?? ?a? t? ?p??? se
  ???e pe??pt?s? p??pe? ?a e??a? µe?a??te?? ap? t??
  p??a?? ß??ß?.

59

• T? s??????? ?fe??? ??a t? ????????? s????? ?a? ?
  ap?te?esµat??? ???s? t?? d?at???µe??? p????
  ?pe?s?????ta? st??? pe??ss?te???? ap? t???
  ???sµ??? t?? p???t?ta?.

60
???????S?? ?????S?S

• ?ed?µ??a (data)
• ??µ? ??ad??as?a ??ßas?
• ???t?pa (standards)
• ???t???a (criteria)

61

• Numbers are properly used to raise questions
  about the quality of care.

62
???????S?? ?????S?S

• ???t?pa (standards).
• ? ap?de?t?? ßa?µ?? ap????s?? ap? ??a ?a???a ?
  ???t????, ?p?? ??e? ?a????ste? ap? a?t?st???e?
  epa??e?µat???? ep?st?µ?????? e??se??.

63
???????S?? ?????S?S

• ???t???a (criteria).
• ????a????sµ??a st???e?a, s?stat??? t?? p???t?ta?
  p??? ta ?p??a µp????µe ?a s????????µe d??f??e?
  ??e?? t?? p???t?ta? µ?a? ?at????? ?p??es?a?.
• ??t?? ?a????sµ??a (explicit) ???t???a ?????
  ???s?e? epa???ß?? ?a? de? pe??????? pe??????a
  p??s?p???? ???se?? st?? e??st?te ???t?.
• ?? ??t?? ?a????sµ??a (implicit) ???t???a ?ta?
  de? ??????ta? epa???ß?? ? ?p??????ta? ?p?te
  af????ta? st?? p??s?p??? ???s? t?? e??st?te
  e?t?µ?t? ? ?p???? d?a??te?, ???? pe??a? ?a?
  e?e?d??e?s??, ??a??t?ta a?t??e?µe????? ???s??.
• S?????t??? ? eµpe????? (comparative empirical)
  ???t???a ?ta? s????????µe ap?te??sµata ap? d??
  d?af??et??? ??s???µe?a ? ????????.

64
? ???t??? e??a? e?????, s???? ?µ?? ?st??? a? de?
st????eta? se te?µ????µ??? ?a? µet??s?µ? ap?de???
t?? p?a?t????
65
???t?pa ??af????
66
???t?pa ??af????p??t?pa t?? se???? ISO9000 ??a
s?st?µata p???t?ta?
67
???t?pa ??af????p??t?pa t?? se???? ??45000
68
?????? ??a ?µad??? ???as?a

• ???sµ?? ?µ?d??
• ?pe?????? ?µ?d??
• ???pt??? ?µ?d??
• ?ata???sµ?? ?de??
• ?e?????s?
• ?????? ??a ???a?e?a

69
?a ???a?e?a t?? ????t?ta?

• ?a 7 p??ta ( ???????)
• ?a 7 de?te?a ( ??????s??)
• ??st?? ????t?ta?
• QFD
• Benchmarking
• Capability
• Repeatability Reproducibility

70
?et??se??

• ?ed?µ??a
• ?? e?d???
• ?etaß??t?t?ta
• ???sµ?? t?? ?e??t?
• ???te?????
• ?s?te?????

71
S?st?µata ????t?ta?

• ISO 9000
• KFOA ( Kings Fund Organisation Audit)
• HQS ( Health Quality Service)
• JCAHO ( Joint Commision on Accreditation of
  Health Care Organization)
• ????pa??? ??aße?? ????t?ta?
• ?µe???????? ??aße?? ????t?ta?
• S?st?µata ??a????? ?e?t??s??

72
?a ???ta 7 ???a?e?a

• ?????aµµa ????
• F???a ???????
• ?st????µµata
• ??a???µµata Pareto
• ??a???µµata ??t?a? ?p?te??sµat??
• ??a???µµata ??asp????
• ??a???µµata ???????

73
?? e??a? ta ???a?e?a

• ?p??? ????d??
• ?ata??af?? p??ß??µ?t??
• ???es?? d??at?? ße?t??se??
• ??as??p?s?? a?t???
• ?p??? ?e??e?t???? ?p????????a?
• ?e?????s?? ???ß??µ?t??
• S?µf???a?
• Teµ???a t?? ??a????? ?e?t??s??

74
G?at? ???s? ???a?e???

• ??a??a??t?ta
• ????te??? S??a??es??
• ?µad???? ???as?a?
• ?a?t??????? ??????s?? ?e?t??se??
• ?p?? ?e??e?t??? ?pe?????s?
• ?????a ?ata???t? ap? ?????
• S??s? µe 90 t?? d??at?? ße?t??se??

75
??? ???s?µ?p?????ta?

• ?e?t??s? d??at? µ??? ap? es??
• ?a?e?? de? ???e? / µp??e? ?a ???e? t? d???e??
  ?a??te?a ap? es??
• ?µfas? st?? ?µad??? ???as?a
• ?µp?st?s??? st?? d???µe?? µa?
• ??st? st??? s??e???te? µa? ?a? st?? ????? µa?
  p??e?a µ?????

76
??? ???s?µ?p?????ta?

• ?at? p??s?p? , Se ß???? e??tas?
• t?? t? s?µßa??e?
• ??at? ?ts? ?a? ??? a?????
• p?? ?a??te?? ap?t??esµa
• p??a µ?sa / p????
• ??t?µet?p?s? t?? p??t?? s?ept?µe??? ?? pe??te?

77
??a???µµata ????

• ?? e??a?
• G?af??? ?pe?????s? t?? ???? µ?a? ??e??as?a? /
  ??ad??as?a?
• G?at?
• ?e??t?, a????s? ?a? ?ata???s? t?? ????
• ??t?p?sµ?? d?s?e?t??????? d??at?t?t?? ??a
  ße?t??s?

78
??a???µµata ????

• G?at?
• ?e??t?, a????s? ?a? ?ata???s? t?? ????
• ??t?p?sµ?? d?s?e?t??????? d??at?t?t?? ??a
  ße?t??s?
• ??a???? ?pa?e??tas?
• µa ??at? ?ts? ?a? ??? a?????
• µa µ??? a?t? t? ap?t??esµa ?a? ??? ?a? t? ????

79
??a???µµata ????

• ???
• ?p?t?p?s? ß?µa p??? ß?µa ???e s?µa?t???? stad???
• ???s? t?p?p???µ???? s?µß????
• ??a???? ?pa?e??tas?
• µa ??at? ?ts? ?a? ??? a?????
• µa ??at? µ??? a?t? t? ap?t??esµa ?a? ??? ?a?
  t? ????

80
F???a ???????

• ???a?e?a ?ata??af??
• ??d??? ???ß??µat??
• S????t?ta?
• G?at?
• ??a??a?a s?????? ded?µ????
• ??s? (µet??se??) ??a ???? ap?f?se??
• ?ata???s? e?d??? / e???t?ta? p??ß??µat??
• ?at??????p???s?

81
F???a ???????

• ???
• ?ata???sµ?? ?de?? ??a t?? a????? apa???µ?s?
  p??ß??µ?t?? / a?t???
• Stad?a??? eµp???t?sµ??

82
?st????µµata

• ?? e??a?
• G??f?µa t?? f????? e??????
• ?ata??µ? t?? a?t???
• G?at?
• ?pe?????st??? / ?p????????a?? ?s?? t?? e????a?
• ???
• Bar Chart st? Excel

83
??a???µµata Pareto

• ?? e??a?
• ?? ?st???aµµa µe ta a?t?a se se??? f?????sa?
  s????t?ta?
• ?e?????s? p?? s?µa?t???? / dapa????? a?t???
• G?at?
• ?a???a? 80 - 20
• ???a p??ß??µata ße?t??se?? p??ta

84
??a???µµata Pareto

• ???
• ?at?ta?? µe f?????sa s????t?ta
• ?e?????s? s?µa?t???t?ta? / ep?pt?se??
• ?????? ??a s?µf???a st?? t?µ? t?? µ?s??
  ??st???

85
??a???µµata ??t?a? - ?p?te??sµat??

• G?at?
• ????????µ??? / ????? e????a ??a
• ??at? ?ts? ?a? ??? a?????
• ep?te??? p???? ap?te?esµ?t??
• µe??d?? ?a? p???? p?? ???s?µ?p?????ta?
• ???at?t?ta e?????? ep????????a? te?µ????s??

86
??a???µµata ??t?a? - ?p?te??sµat??

• ???
• ??a?????s? p??ß??µat??
• ?ata??af? a?t???
• ??e??es? / S?µf???a d?????t???? ????se??

87
??a???µµata ??t?a? - ?p?te??sµat??

• G?at?
• ?pe?????st??? ?s???
• S?s??t?s? ??t??? - ?p?te??sµat??
• ?????ep?d?as? ??t???
• ??e??es? ??se??

88
?T???? ???????? ????????S

• ? d?µ??????a t?? ?at??????? ??????µ????,
  te??????, ???a??t???? ?a? p???t?st????
  pe??ß?????t?? ??a t?? a??pt??? e? µ????? t??
  ep??e???se?? ?a? t?? ???a??sµ?? t?? p???t?ta? p??
  ?a ße?t??se? t?? ap?d?s? t???, ?a e??s??se? t??
  a?ta????st???t?ta t?? e?????? ??????µ?a? ?a? ?a
  s?µß???e? st?? p???t?ta t?? ???? t?? p???t??.

• ?? ?p?d?µ?? ?? ?p??e? ?e?????ta? apa?a?t?te? ??a
  t?? d?asf???s? t?? p???t?ta? e??a?
• ? d?µ??????a p??d?a??af??, p??t?p?? ?a?
  s?st?µ?t?? t?p?p???s??.
• ? d?µ??????a s?st?µat?? ?et??????a? ??a d?a???
  a?a??t?s? t?? ?a??te??? d??at?? p??s????s?? e???
  f?s???? µe?????? ?a? s??d?eta? µe t?? ??s?ast???
  ???s? t?? te?????? µet??se??.
• ? d?µ??????a s?st?µat?? d?ap?ste?s?? ? ?p??a
  e??a? ? ep?s?µ? a?a?????s? t?? ??a??t?ta? e???
  e??ast????? ?a e?te?e? s???e???µ??e? d???µ?? ?
  s???e???µ????? t?p??? d???µ??.

89
???????T??S? S??? ?G????. 2889/2001

• ?p????t??s? t?? ?p??es??? ??e?a?
• ??????t???-d?a?e???st??? a?t???µ?a t??
  ??s???µe???
• ?p?st?µ????? te?µ????µ??? pa???? ?at?????
  ?p??es???
• ??asf???s? ?a? s??e??? ße?t??s? t?? p???t?ta?

90
??µ?? 3172, F?? 197/6-8-03??????s? ?a?
e?s???????sµ?? ?p??es??? ??µ?s?a? ??e?a? ?a?
???e? d?at??e??

• St? p??t? ????? ????eta? ? ?????a t?? d?µ?s?a?
  ??e?a ?? ??a s????? s??t???sµ???? d??se??.
• ? p???t?µea?? d??s? t?? d?µ?s?a? ??e?a?
  p??sß??pe? st? ße?t??s? t?? ??e?a? ?a? p???t?ta?
  ???? t?? p???t??, ?? ßas????? st????? e???
  ???t??? p?????a?.

91
??µ?? 3172, F?? 197/6-8-03??????s? ?a?
e?s???????sµ?? ?p??es??? ??µ?s?a? ??e?a? ?a?
???e? d?at??e??

• St? d??at? ??d?? ????? a?a??eta? ? s??ta?? t??
  ??e????µ???? ???t? t?? ???a?, ?? ??a s?st?µa
  ded?µ???? ?a? de??t?? d?a???????? ß?s??.
  ??µ???af???, ep?d?µ???????? st???e?a, st???e?a
  ??st???, de??te? p???t?ta? ?a? ??a??p???s?? t??
  p????sµ?? ap? t?? ?p??es?e? ??e?a? e??a?
  ???sµ??e? ap? t?? p????f???e? ?a? ded?µ??a p??
  ?ata???f??ta? st?? ???t? ??e?a? t?? ???a?.

92
S?S???? ?G???S

• S??p?? ? d?asf???s? ?a? ße?t??s? t?? ep?p?d??
  ??e?a? t?? p????sµ?? µe ap?te?? s??p? t? s?µß???
  t??, ?? ßas???? ?esµ?? t?? ?????????? ???t???,
  st? d?asf???s? ?a? ße?t??s? t?? ep?p?d??
  e??µe??a? ?a? p???t?ta? ???? t?? p????sµ??.

93
?????S??S ?G???S

• ????? e??a? ? pe??t??
• ???? e??a? t? p?????
• ????? p??sf????? t?? ?p??es?e?
• Se t? pe??ß?????/s?????e? p??sf????ta? ??
  ?p??es?e?

94
? pe??t?? e??a? t? ?t?µ? ? ta ?t?µa ??a t??
e??p???t?s? t?? ?p???? ?p???e? ??a? ???a??sµ??

• ? ??????S e??a? ? p??ta?????? pe??t?? t??
  S?st?µat?? ??e?a?

• ? ?ST???S e??a? ? p??ta?????? pe??t?? t??
  ??s???µe???

95

• ?S???S? S??? ?ST???, ??S? T? ?????S??S ?? ???
  ?????????S??S
• H. Stamatis

96
????? e??a? ? pe??t?? ?

• ?????a
• F???
• ?sfa??st???? F???a?
• ??????µ???? d??at?t?te?
• ???f?t???/????????? ep?ped?
• F???/??????t?ta/?p????t?ta
• ?? e?d?? t?? as???e?a?
• ?? ?????e?e?a?? pe??ß?????

97
? pe??t?? t?? S?st?µat?? ??e?a?

• ???s?µ?p??e? t?? ?p??es?e? ap? a????? ?a? ??? ap?
  ep?????.
• ??e? p??? µ???? d??at?t?ta ep??????.
• ? ??at??? ap?fas??e? s?et??? µe t??
  a????????µe?? a????/a?t?µet?p?s?.

98
????S?G???S??S ?O? S?S?????O? ?G???S

• ?SS?????? ?????F???S?
• ?T??? ???????OS? ?O? ??????O?
• ????????S ??????G?S? ???SF??????O? ?????S?O?
• ??O??????S ?????????S
• ?????O?????S ??S??S
• ???S?????S

99
?SS?????? ?????F???S?

• ? G?at??? de? a?t?p??s?pe?e? µ??? t?? p??sf???
  a??? ?a?????e? ?a? t? ??t?s? ?? e?p??s?p??
  (agent) t?? as?e??- ??a ?p??es?e? ?a? p?????ta.
• ?at??? f??a?e? (gatekeepers) t?? s?st?µat??
  ??e?a?.

100
?a?????te? p?? ep??e????? t?? as?µµet??
p????f???s?

• ???f?t??? ep?ped? p????sµ??
• ?pa??? p????aµµ?t?? a????? ??e?a?
• ????µ?? ?at??? (p?????t? ??t?s?)
• ?ap??e? ??s?t?ta ?p??es??? ? ??st?? ?p??es???
• ? Q ? C
• ?ap??e? ?pas????s? e?s???? ? ??µ? e?s????
• ? N ? P
• Q ? C E N ? P
• ???f? s?st?µat?? ??e?a? (d?µ?s??/?d??t???)

101
??????? ??S??S

• ?????S ???????S S? ??O?????? ???????

• ?????S ???????S S? ??S??S ???????S
• ??S????? ? ??????S? ? ??????G??? ?????S?O?
• ????????????? (F?????????)
• ??????S??S (???S????????? ??G??)
• ????OS? ?S?????S

102
???? e??a? t? p?????

• ?? ap?t??esµa (output-outcome) µ?a? ??s??e?a?
• ? µ?a? ?at????? p????? (multi-product)

103
We work together but we do not learn together

• ???a??µaste µa??,
• e?pa?de??µaste ?e????st?,
• s?eft?µaste d?af??et???,
• a??? ????µe t?? ?d?a ap?st???
• ?e?t??s? t?? ??e?a? t?? ????t??

104
???? e??a? t? p????? ?

• ???????S? ?????? ????????
• ???S????????? OF?????S
• ?????????????
• ???????S??????-????
• ???????G???? ?????? F???????S

105

• ??S???S ???????S?? ?????S
• INPUTS PROCESS OUTPUTS
• ?????p???? p???? -??e???? -?????e?a
• ??????µ???? p???? -??????s? ??s??e?a?
• ?????te????? ?p?d?µ? -Te?ape?a -????µ?? ?a?
• ?a? e??p??sµ?? -?p??at?stas? e?d?? epeµß?se??
• 
  ???ast???a???
• e?et?se??

???????S???? --?e?t??s? ?p?p?d??
??e?a? -?e?t??s? ?p?p?d?? e??µe??a? ?a?
p???t?ta? ????
??????S??S IMPACTS -?e??s? ???s?µ?t?ta? -?e??s? ?
?s???t?ta?
??ad??as?a a?at??f?d?t?s??
??ad??as?a a?at??f?d?t?s??
?? S?st?µa ??e?a? ?? pa?a?????? d?ad??as?a
???? Te?d???? ?a? s??. 1995
106
????? p??sf????? t?? ?p??es?e?

• G??se??
• ?e???t?te?
• ???sd???e?
• ?????? a??e?
• ?e??t?????a
• S?????e? ?s??s?? epa????µat??
• ?µ??ß??

107
Succesful Teamwork

• ?a?? e??as?a?? ???µa
• ??sµe?s? st??? st????? t?? p???t?ta?
• ??a?????s? ?a? seßasµ?? µeta?? t?? d?af????
  ?at??????? e??a??µ????
• ??e????a d?µ??
• ?????µ?a
• ?a?? ep????????a

Good Medicine without Good Care is as Usefull as
Good Care without Good Medicine Paracelsus
108
???????

• ? ?at???? e??a? a????p?st??? (humane) ?a?
  ????????? (social) ep?st?µ? pa?? t? ?e????? ?t?
  e?a?t?ta? ?µesa ap? t?? te?????????? a?a?a???e??
  ?a? t?? e?e???t???? efe???se?? t?? f?s????
  ep?st?µ?? (natural sciences).
• ? ??at??? ??e? ?? ???? ?a? ap?st??? t?? ?a
  ?e?ape?se? t?? ?????p?, d??ad? ??a ?? st??
  ???t?t? t??.
• ? ???e as?e??? p??pe? ?a ?e?ape?eta? ?? ??a
  a???a??, a?a?t??at?stat?, µ??ad??? ?a? ??t?µ?
  ?t?µ?.
• ?ts?, ? as?e???, ??? ?? pe??stat??? a??? ??
  ?t?µ? µe d??a??µata, ?a??stata? e??µe??µ???? ?a?
  ?pe????a p???? s??e????eta? ?a? s?µµet??e? st??
  p??sp??e?a ??a t?? ße?t??s? t?? ??e?a? t??.

109

• ????????S? ?? ????? ?O? S????G??O? S??, ??S? T?
  ?????S??S ?? ????????S??S ?? S????G???
• H. Stamatis

110
?T?S ????????SQuality Ethos t? ?a p??tte? ?
?a???a? t? ?a??te?? ??ta? p??? ap? ????? ? ?d???
???t?? t?? p???e?? t?? ?a? p??spa???ta? d?a????
?a ???e? ?a??te??? e??a? ?? ßas???? a???? t??
epa??e?µat?sµ?? ?a? ? p???t?ta ßas??eta? ?at?
????? ???? se ?????? a??e? p?? ????? ?a ??????
,µe t?? pa?ad??? t?? ?pe?????t?t?? µa? ap??a?t?
st??? ?????? ?a? t? d?a??? d???es? ??a ??s?ast???
p??sf???Donadedian
111
Se t? pe??ß?????/s?????e? p??sf????ta? ??
?p??es?e?

• ????
• STUCTURE
• ???????S??
• PROCESS
• ????S?
• OUTCOMES
• Donabedian, 1968

112
?d?a?te??t?te? ??s???µe???

• ?e???? µ??e???.
• ?e??st?e? ?a? s???ete? e??atast?se??.
• ?????? p?????t?? ?a? ?p??es??? p?? pa?????ta?
  ta?t?????a.
• ??????ta ?a? ?p??es?e? µe????? a??a?.
• ????p????? ?a? a??µ????e??? ?? p??? t??
  p????e?s?, t?? ???se??, t?? ap?d????, t??
  p??sd???e? ?a? t?? f???d???e? p??s?p???.

113
??s???µe??

• ???te???? p?a?µat???t?ta
• ????t??? s?st?µa
• ??????µ?a
• ?e???????a
• ???????a
• ?a???sµ??p???s?
• aßeßa??t?ta
• p???p????t?ta
• a????e???t?s?

• ?SO?????? ?????????????
• pe????af?
• ?ata???s?
• a??a???
• ??????????
• ?µp?d?a st?? e??????
• ??af???e? st?? a?a??t?s? apa?t?se??
• ??s????e? ep?????? µeta?? e?a??a?t???? p??t?se??
• ??T?O???
• G??s?
• S?st?µat???t?ta
• S??es?
• ????

114
???ß??µata St? ??????s? ?a? ??????s? ???
????????? ??s???µe???

• ???e??? ?at??????? ste?e??? d?????s??
• ?p??s?a d?µ?? µ??at?µe?t
• ?p??s?a saf?? p????aµµat???? st????
• G?afe????at??? s?st?µa ????? ap?f?se??
• ???e??? ?pe?????t?ta?
• ??s?aµpt? ????st??? s?st?µa

• ???e??? f?????t?ta? p??? t?? p???t?
• ?d??aµ?a ep????????a? ?a? s??t???sµ??
• ??µ???a t?? ??s???µe??? p?? d????ta? µe?a??te??
  ???? as?e???
• ???e??? ep??e???s?a??? ????t???a? t?? e??a??µ????
  

115
???????? ??? ????S?? ??????S?

• T?S????S ???????G???S ????????S
•  
• ??µ?? p?? ??f????ta? ap? t? ????? ?a? de?
  efa?µ????ta?
•  ?p?f?se?? ????? t?? ?at?????? ?p?st????? ap?
  d?????t???? e????e?e? ?at? t?? p??et??µas?a ?a?
  t?? efa?µ??? t???
•  ?p??e???se?? p?? ep?ßa?????ta? ap? t??? a?????
  ???µ??? t?? d?µ?s??? ?p??es???
•  ????te? p?? ? p???t?ta ???? t??? ?p?ßa?µ??eta?
  ap? t?? ta?a?p???a ?at? t? d????e?a t??
  s??a??a??? t?? µe t? d?µ?s??
•  ??sp?st?a ?a? ?a??p???a p??? t? d?µ?s??
•  ?st????? ???????µ?? ap? pe?ate?a??? s??se??
•  ?es????te? p??sp????µe??? ?t? ep??e?????
  ap?f?se?? .
•  

116
???????? ??? ????S?? ??????S?T?S????S
???????G???S ????????S

• ??µ?s???pa??????? ???t??p?a
•  
• ?et???t?ta
• ??????f?ß?a
• ??p??at??aAd?af???a

117
?d?a?te??t?te? t?? ??µ?a ??e?a?

• ? µ??ad???t?ta t?? as?e??
• ?????? f?a?µ??-?e??t???????? ?a???e?
• ? f?s? t?? a?a??? ??e?a
• ? ?d??µ??f?a t?? ape???? t?? as???e?a?
• ?? ?a?da?e? µetaß???? st? pe??ß????? t??
  s?st?µat??
• ? ste??t?ta t?? p????

118
?d?a?te??t?te? t?? ??µ?a ??e?a?

• ???s?µ?t?ta pe??pt?se??
• ?pe???? ?atast?se??
• G?afe????at???? µ??a??sµ??
• ???e??? e?e????a?
• ?µp???? p????? at?µ??
• ???te????? ep??????

119
?????OS? ??S ????????S S??S ?????S??S ?G???S

• ??????
• ?p????????a?
• ??????s??
• ???a???

120
?????OS? ??S ????????S S??S ?????S??S ?G???S

• ??????
• ??????s??

121
?????????S ??????????
G?OS??S ??????????
MANATZEMENT
????????? F???S?F?? ??????????
S?S?????? ??????????
122
?????? ??G??OS?S

• G??s? ??a t?? ????t?ta
• ?e???t?te? ??a t?? ????t?ta
• S?st?µata ????t?ta?

• 3 ???S??S??S

123
??????T?S??S G?? ??? ????????

• ?p?d?µ?
• ??ad??as?e? ??a ße?t??s?
• ?a?a????s?
• ????????s?
• ????t???a µ???s?? ?a? ße?t??s??
• ??sµe?s? t?? ??????s??
• ??sµe?s? t?? e??a??µ????
• ??d???µ?s? t?? e??a??µ????
• S??e??? e?pa?de?s?

124
??? µp????µe ?a ße?t??s??µe t?? p???t?ta

• ?????????ta? t?? ?p?????sa ?at?stas? (µ?t??s?)
• S????????ta? µe ta ap?de?t? standards
• ?????ta? d?????t???? pa?eµß?se??

• ?SO??????S ???G??S
• ??O?????? E???????OS?
• ??????s?-??st?p???s?-??ap?ste?s?

125
? ?????? t?? ????t?ta?
ACT
CHECK
PLAN
DO
126
Models of QualityDonabedian, 1966
STUCTURE
PROCESS
OUTCOME
Resources Organisation Environment
Morbidity Mortality Well being
Diagnosis Treatment Communication
127
?SO??????S ???G??S

• Clinical Audit
• Nursing Audit
• Medical Audit

128
Audit Cycle

• ?a????sµ?? p??t?p??
• ??e????-?ata??af? a????????µe??? p?a?t????
• S?????s? ap?te?esµ?t??/standards
• ???a??

129
Models of Accreditation

• European Model for Business Excellence (EFQM)
• Pomotes quality management
• ISO 9000 - for quality systems
• Standards for certification
• Baldridge Excellence Model
• Standards for self-assessment

130

• ?????S? ??? ????????, ??S? ??????S ?? ???
  ????????S???S
• H. Stamatis

131
??????? S?? ?????OS? ??S ????????S

• ?? p??s?p??? µp??e? ?a µ?? ??e? ?ata???se?
  epa???? t? ep?ped? p???t?ta? t?? ?p??es??? p??
  p??pe? ?a p??sf??e? (quality standards)

132
??????? S?? ?????OS? ??S ????????S

• ?? ?d???e?, (guidelines), µp??e? ?a e??a?
  pe?????sµ??e?, asafe?? ?a? ? e?pa?de?s? t??
  p??s?p???? a?epa????.

133
??????? S?? ?????OS? ??S ????????S

• ?? p??s?p??? pa?? t?? ???? e?pa?de?s? t?? ?a? t??
  ?ata???s? t?? ?d????? se ?e???t??? ep?ped? µp??e?
  ?a d?s???e?eta? ?a ta efa?µ?se? st? ???? t??
  e??as?a? t??, ???? ????? pa?a???t??.

134
Path dependency

• ?p? t? st??µ? p?? ??a s?st?µa a???se? ?a
  ?e?t????e? µe ??a t??p?, t?te t?s? ?? ?e?t??????
  ?s? ?a? ?? ???ste?, ep?fe???µe??? ap? a?t?,
  s?????t??? se at?µ??? ?a? s???????? ep?ped?
  a??a??? p?? s???d??? µe t?? a????? d?µ? ?a?
  ?????? t?? a??a??? d?s???e?.

135
???????T??S? S??? ?G??? - ?. 2889/2001

• ?a ?e??fe?e?a?? S?st?µata ??e?a? ?a ß????s???
  ?ste
• ?a as???µe ap?te?esµat??? d?????s? ?a?
  p?a?µat????? e??????? st?? ?p??es?e? ??e?a?
• ?a ????????µe ap? ???t? ?a? ?a ap?t?p?s??µe
  p????ste?a t?? p?a?µat???? a????e? ??e?a? t??
  p????sµ??
• ?a s?ed?????µe ?a? ?a ???????????µe p????ste?a
  t?? ?p??es?e? ??e?a? se pe??fe?e?a?? ep?ped?
• ?e ???a ????a ?a ?????µe ???t? st?? a????e? t??
  ?????a p???t?
• ? ?p?????? ??e?a? ?a? ??????a?
• ?. ?apad?p?????

136
????????? ?????G?? 357/2001???a??sµ?? ?e?t?????
?p??es?a? t?? ?e.S.?.
??T?? 1 S????S ??? G????? ???S???? ?O?
?e.S.?. 1. ??µ??????a ????????µ???? s?st?µ?t??
pa????? ?p??es??? ??e?a? st? ep?ped? t??
pe??f??e??? t??, p?? ?a e?????ta? µ?a p???? d?sµ?
?p??es??? ??e?a? ?????? p???t?ta?, ap? t??
p??t?ß??µ?a ?a? ??s???µe?a?? pe???a??? µ???? t?
µeta??s???µe?a?? f???t?da, t?? ap??at?stas? ?a?
t?? ?at ????? ??s??e?a ?a??? ?a? t?? p?????? t??
as?e?e??? ?a? t?? p??stas?a t?? ??e?a? 3. ???
e??µ???s? t?? ?????????? s?????? t?? ?e??f??e???
t?? ??a t?? p?????? t?? as?e?e??? ?a? t??
p??stas?a t?? ??e?a?.
137
????????? ?????G?? 357/2001???a??sµ?? ?e?t?????
?p??es?a? t?? ?e.S.?.
??T?? 1 S????S G????? ???S???? ?O? ?e.S.?. 2. ??
s??t???sµ? t?? d??se?? ?a? p???t???? pa?????
??e?a? st? ep?ped? t?? ?e??f??e??? t?? ?a? t?
d?asf???s? t?? ap?te?esµat???? ??????s?? ?a?
d?????s?? ???? t?? µ???d?? ??e?a? t?? ?S?, p??
a?????? st?? a?µ?d??t?t? t??, µe st??? t??
?????te?? d??at? ?e?t??????? ?a? ??????µ???
ap?d?t???t?ta. 4. ?? d?a??? a???????s? ?a? ??e???
t?? ap?d?t???t?ta? ?a? ap?te?esµat???t?ta? t??
?p??es??? ??e?a? t?? pe??f??e??? t?? ?a? t?
s?????? ???? t?? apa?a?t?t?? st???e???.
138
??G???G????? ??S?
?????????? S????????
??????? S????????
???S???????? S????????
???????S ?.S. G??. ????T????S
G??F??? ???????? (G5)
??S???????? S????????
?????? G??F??? (G6)
???????O??S G?????S ????T????S
??t?te??? ?µ?µa ??????s?? (?4)
G????? ????T??S? ??S?
??e????s? ?????aµµat?sµ?? ?a? ???pt????
????t???? ?a????? ?p??es??? ??e?a? (?1)
??e????s? ???pt???? ?????p???? ???aµ????
????d?? (?3)
??e????s? ??????s?? ?a? ??????t????
?p?st?????? (?2)
?µ?µa ???a??t???? ???pt????, ???a???????s??
?a? ???p??sµ??
?µ?µa ??a?e???s?? ?????p???? ?????
?µ?µa ?e??fe?e?a??? ???t? ??e?a?
?µ?µa S??e????µe??? ??pa?de?s?? ?a? ??e????
S??e??as???
?µ?µa ?e?t??s?? ?a? e?????? p???t?ta?
?µ?µa ??????µ???? ??a?e???s?? ????d?? ??e?a?
G?afe?? ??????t???? ?a? ???a??t???? ??pa?de?s??
?µ?µa ??e??a? ?a? ???pt????
?µ?µa ???µ??e???
G?afe?? ?at????? ?a? ??s??e?t???? ??pa?de?s??
139
?. 2889/2001

• ???? ???a??sµ?? ?e?t?????a? t?? ??s???µe???.
• ?e??d??e?a?? - ?e????? ?p??es?a.
• ?µ?µa ??????s?? ?a? ?????f??????.
• ?µ?µa ??????? ????t?ta?, ??e??a? ?a?
  S??e????µe??? ??pa?de?s??.
• ??d???? ??se?? ?e??d??e?a??? ??aß??µ?s?? (??? 20
  t?? d??aµ???t?ta? t?? ?????? t?? ??s???µe???).
• G?afe?? ?p?d???? as?e???.
• ??t?te??? ?µ?µa epe????t?? pe??stat???? (???).

140
?? ????????S???? S????? ?O? ??S??????O?

• ??????µµata p????f???s?? p???t??
• ??????s? ste????s? t?? G?afe??? ?p?d????
  as?e???
• ????t??? ?a? µ?t?a ??a t?? ???e??? asf??e?a
• ??????µµata ?at??t?s?? e?pa?de?s??

141
G??F??? ???????S ?ST??O?

• Se ???e ??s???µe?? s???sta?ta? ??d??? G?afe?? µe
  t?t?? G?afe?? ?p?d???? ?s?e???.
• ??aµe??µe?a ?f???
• ?e??s? t?? ?????? t?? as?e???.
• ????s? t?? a?t?pep????s?? t???.
• ??s??µa asf??e?a?.

142
?????S ?G???S ??? ???????S

• ??a ???a??t???, ?esµ??? ?a? p????f???a?? s?st?µa
  ??a t? s?????? ?a? d???es? a???p?st?? ?a? ???????
  p????f?????, ß?s? e??a?a? ?ata??af??,
  epe?e??as?a? ?a? a????s?? st???e??? t?? d?µ?s???
  ?a? ?d??t???? t?µ?a ??e?a? ?a? p?????a?.

143
?????S ?G???S ??? ???????S

• S??e??? ?ata??af? ?a? ap?t?p?s? st???e??? ??a t??
  ?at?stas? t?? ?p?d?µ??, t?? a????p???? d??aµ????,
  t?? e??p??sµ??, t?? pa????? ?p??es???, t??
  ??????µ????, e?pa?de?t???? ?a? e?e???t????
  d?ast????t?ta? st??? t?µe?? ??e?a? ?a? p?????a?
  t?? ????d?? t?? ?e.S.?.
• Se ?e?t???? ep?ped? e??a?e?? s?????s??, a????s??
  ?a? a???????s?? ???? t?? ?p??es??? ??e?a? ?a?
  p?????a? ??a t?? ????t?.
• ???a?e?? ??a ?n-line p????f???s? a?? ?e???af???
  pe????? ??a t??? f??e?? ??e?a? ?a? p?????a?.

144
? ?????? p???t?ta? ?at???? f???t?da de?
ap?te?e?ta? ap? ??a ep?st?µ????? ? te????? µ????
a??? ?????? ap? ??a d?ap??s?p???, ta ?p??a µa??,
?a??st??? ??a?? t?? as?e?? ?a ep?t??e? t?
?????te?? d??at? ?e?t??????? ep?ped? (se
s?µat??? ep?ped?) ?a? f????µa (?????) se ?t?
af??? t? ?????????? µ????.
145
?aµµ?a ße?t??s? de? µp??e? ?a ep???e? se ??a
s?st?µa ??e?a?, e??

• de? ??ße? ?p??? t?? t?? a????e? ?a? t??
  p??sd???e? t?? ??????.
• de? e??a? se ??s? ?a e?e??e??se? t? µe?a?e?? p??
  ?p???e? µ?sa st??? a????p??? ?? ?p???? ?p??et???
  s' a?t?.

146
Q
???µe???e?te ??a t?? ????t?ta ???????? sites
?p????e?? ???pt???? www.ypan.gr ??????
S?µß????? ??ap?ste?s?? (?S??) www.
esyd.gr ??????? ???a??sµ?? ??p?p???s?? (????)
www.elot.gr ???????? ?ta??e?a ??????s??
?p??e???se?? (????) www.eede.gr ??a, e?d?se??,
????a ??p ??a t?? p???t?ta www.qualitynet.gr
147
Q
???µe???e?te ??a t?? ????t?ta ? p???t?ta st?
d?ad??t?? www.jcaho.org www.efqm.org www.esoe.o
rg www.anaes.fr www.isqua.org www.iqa.org www.who.
org www.iso.org
148
What is the secret of quality, you, will
ask. Very simple, it is love. Love of
Knowledge, love of Man and love of God. Let us
live and work accordingly. Avedis Donabedian