Quality assessment is the measurement of the quality of healthcare services: it measures the difference between expected and actual performance. Information gained from an assessment can be used to identify opportunities for improvement. Performance standards can be established for most dimensions of quality, such as technical competence, effectiveness, efficiency, safety, and coverage. Where standards are established, a quality assessment measures the level of compliance with standards. Where standards are more difficult to articulate, such as the quality dimensions of continuity of care and accessibility, a quality assessment describes the current level of performance with the objective of improving it. A quality assessment can use various data collection methods to overcome the intrinsic biases of any method alone. These methods include direct observation of patient-provider encounters, staff interviews, patient focus groups, record reviews, and facility inspections. The assessment is often the initial step in a larger process that may include providing feedback to health workers on performance, training and motivating staff to undertake quality improvements, and designing solutions to bridge the quality gap. Quality improvement is a systematic process of addressing the gaps between current practices and desired standards. Effective approaches to quality improvement include individual problem solving, rapid team problem solving, systematic team problem solving, and process improvement. These methods vary in the time and resources required and the number of people who participate. Regardless of the rigor and intensity of the method used, quality improvement approaches usually share four basic steps: identification of opportunity for quality improvement, analysis of improvement area, development of possible interventions to address a need for improvement, and testing and implementing interventions. Sometimes, when the potential solutions to a problem are clearly defined, a shorter quality improvement activity focused on testing the alternatives is used. This case study describes how healthcare providers in Nicaragua worked together to improve the quality of obstetric care at their health centers and posts. They began by measuring the extent to which staff performed according to standards. Once aware of the quality gaps, they formed QI teams and used rapid team problem solving to implement quality improvements so that healthcare providers could perform according to obstetric standards. Continuous monitoring shows their success in meeting the standards and improving health outcomes. (excerpt)

In 1999, the Guatemala Ministry of Health and the Quality Assurance Project undertook a joint initiative, which applied quality design methodology at seven hospitals in the highlands of Guatemala. The goal of the quality design effort was to create client-driven obstetric care services that would improve quality of maternal care, with the longer-term vision of decreasing maternal mortality. This case study describes the quality design experience of seven hospitals in Guatemala, using the Solola Hospital to illustrate some of the specific steps in the process. It is noted that quality design teams were formed and trained in each hospital. Each team identified a particular area of concern for its facility, such as the reception and triage of patients in labor, postpartum care, or regional surgical care. Overall, facilitators were able to guide the teams over several months to redesign and implement improved processes of obstetrical care.