7.6 Quality Data Come from Quality Processes

A key insight in quality assessment and quality improvement is that the quality of any product generated by a system is the consequence of the quality of the processes that make up that system. A high-quality product can come only when quality is embedded in the processes that make it.

In public health surveillance, the“product” is the information generated by the surveillance system. This product is generated by the processes of the system, including ascertainment, description, coding, classification, and so on. To have high-quality information, programme staff should understand these specific processes (what they do and who does what) and how they interact, and then embed tools to ensure quality, such as checklists and specific indicators.

This insight highlights a key concept. Quality assessment evaluates the end product (the completeness, accuracy and timeliness of the information) – it can detect the problem, but does not fix it or provide information on how to fix it. To fix the problem, the root cause of the issue, such as incomplete, inaccurate or delayed data, should be determined. To address the root cause(s), an understanding of the processes is needed. For this reason, the next step is to understand in detail the processes of the surveillance programme.