A major challenge in health systems around the world is the wish to provide high quality health services. Organizations which supply health services are seeking ways to improve their quality and their care outcomes. This study examines several methods to improve quality and focuses on one — quality assurance programs, which are structured programs comprised of several stages: data collection on processes or outcomes of care or services; data analysis, and determining means of improvement; intervention aimed at improvement; and re-collecting data to assess the effect of the intervention.
One of the main issues in implementing quality assurance programs today is the need to better understand the organizational and environmental factors that contribute to a program’s effectiveness. In light of this, the following three goals were set for this study:
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To examine the role of quality assurance programs in Israel’s health plans’ overall strategy to improve the quality of care and services
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To map existing programs
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To examine the need for additional programs, and obstacles to their implementation
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To identify factors which contribute to the success or failure of quality assurance programs.
The study is based on a series of in-depth interviews conducted in 2001 with 71 staff at the headquarters and regional offices of Israel’s four health plans; and on an additional series of interviews conducted in 2003 with 42 staff who implement quality assurance programs, some of them successful and some of them unsuccessful.
The findings of the study indicate that all of the health plans profess a commitment to quality, and implement various quality improvement programs, but quality assurance programs do not constitute the principal strategy. Many factors contribute to the success of quality assurance programs; no one factor is solely responsible for a program’s success or failure. Nevertheless, respondents stressed two main factors associated with a program’s success: steady support from management, and strong and effective leadership, which propels the program forward.
Based on the study’s findings, several directions were suggested for expanding the successful implementation of quality assurance programs. These included developing information systems to continuously monitor quality measurements; considering all of the factors that affect program implementation, beginning at the planning stage; considering offering the health plans incentives to spur their investment in quality assurance programs; and continuing to develop data bases on the factors that influence program success.
This study was funded by the National Institute for Health Policy and Health Services Research.