Quality Management in Healthcare System; where we stand?


  • Ghulam Mustafa Sheikh Zayed Medical College, Rahim Yar Khan
  • Muhammad Zahid Latif Professor of Community Medicine and Director of Medical Education, Azra Naheed Medical College, Superior University Lahore, Pakistan.




Quality management in healthcare, health system performance, resource generation


Quality management in healthcare can significantly and efficiently change the health system performance and patient satisfaction. It improves every aspect of the health system such as system or process, its functions, and goals, in a systematic evidence-based manner. A health system is anorganization of persons, institutions, and the resources which deliver health care services to fulfill health needs of the populations.1 A health system includes public sector facilities and private facilities, which deliver preventive, curative, and the personal health services. It also includes in it, theprograms which focus on behavior change, and vector-control program, financing methods like health insurance systems, inter-sectoral coordination, and legislation. The goals for the health system include; providing good health for its citizens, being responsive to the expectations of population it serves, and fair financing services. The achievements towards these goals is based on how effectively and efficiently, a health system carries out the following key functions including, provision of quality health care services, resource generation, financing, and overall stewardship.1

The outcome of the health system is not based on these factors only, in fact, it is based on multiple interrelated factors, which in turn are governed by the concepts, and principles of quality management in healthcare. There are many established quality standards that may work as a yardstick in a journey to achieve the goals of the healthcare system in a country. There are multiple key concepts in quality management of healthcare system such as healthcare services are very specific and unique, because of continuous physical and mental interaction of the patients and healthcare providers (HCP) in the process of health services provision, and patients usually have little knowledge of medical services. As in the input, process, and output model of a system, this interaction of the patient with HCP shall define the process and output of the system. So whether it is effective interaction or not will be the deciding the quality of healthcare and thus a satisfied patient at the end. Additionally, these interactions are not the only thing important in an effective treatment and quality of healthcare. The related factors which are also very pertinent to mention like payments type and sources, suppliers of the medical and non-medical equipment, materials and resources, healthcare financing in the form of insurance, legislative and other regulatory bodies, so emphasizing the complex nature of the healthcare quality management.

Quality management principles are widely followed in a diverse range of systems and disciplines and the healthcare system is not an exception. The key principles of quality management in healthcare include; it should be patient-centered, all the stakeholders should have the say, including not only patients and HCPs, but paramedical staff, managers, political and financers. Leadership skills for quality, shared vision of care, process orientation by staff, partnership, third party services, continuous improvement, and use of modern technologies.2,3In the light of the concepts, principles, and standards, of the quality management system in the healthcare organizations brings a revolutionary change in the healthcare systems. Quality management affects every aspect of a health system from ownership to structure, and patient-doctor relationships so positively affect the goals of the health system and patient satisfaction. The health system comprises mainly private healthcare services to about seventy percent of patients and public healthcare services to remaining patients.4 Healthcare system in Pakistan is facing scarcity of financial resources, coupled with the double burden of communicable and non-communicable diseases. Although Pakistan has an adequate qualified human resources for healthcare service delivery, there are serious gaps in the planning, resulting in the poor quality of healthcare services. Still, the vast majority of the public and private hospitals in the country, are not certified with ISO 9001:2015, which specifically focuses on performance in a healthcare setting.5 Although international organizations like World Health Organization, continue to emphasize its importance for our health system, healthcare quality management is a neglected academic specialty in the country. Recently there has been an increasing emphasis seen on this relatively new concept of quality in healthcare, after more and more qualified people joining this discipline. The development of healthcare quality management mainly depends on the value and priority given by the leadership at all levels, to integrate and implement quality management with in the healthcare delivery system in a country. Although some progress has been made recently by Healthcare commissions in provinces there is a lack of a comprehensive national healthcare accreditation system and national guidelines, on healthcare quality and patient safety. Additionally, we still don,t have established national quality care indicators. In both private and public sector healthcare establishments, organizational culture is absent, and leadership, to prioritize quality management in healthcare. The ambiguity in the regulatory role of PMC (Former PM&DC), Healthcare commissions at federal and provincial levels was another hurdle at the legislative and policy level.6 It is suggested that healthcare policymakers and planners in the country start realizing the importance of quality management in healthcare and devise a system to integrate quality improvement initiatives at the planning stage of the healthcare system. This would make our health system efficient and thus maximum benefit could be gained from the resource-constrained healthcare system and would restore the much-needed patient trust in the healthcare system of our country.