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Summary BMZ2024 Improving Quality of Care (BMZ2024)
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Summary of all cases in course BMEZ2024 'Improving Quality of Care'. Completed the course with an 8!
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Case 1 – Caring for qualityQuality of care is the degree to which health services for individuals and populations increase the
likelihood of desired health outcomes and are consistent with current professional knowledge.
- Definition of QoC for individual patients:
Whether individuals can access the health structures and processes of care which they need
and whether the care received is effective
- Definition of QoC for populations:
The ability to access effective care on an efficient and equitable basis for the optimisation of
health benefit/well-being for the whole population
Quality of Care has 6 dimensions according to the WHO:
- Effective – delivering health care that is adherent to an evidence base and results in
improved health outcomes for individuals and communities, based on needs
- Efficient – Delivering health care in a manner which maximizes resource use and avoids
waste
- Accessible – Delivering health care that is timely, geographically reasonable, and provided in
a setting where skills and resources are appropriate to medical need
- Patient-centered – delivering health care which takes into account the preferences and
aspirations of individual service users and the cultures of their communities
- Equitable – delivering health care which does not vary in quality because of personal
characteristics such as gender, race, ethnicity, geographical location or SES
- Safe – delivering health care which minimized risks and harm to service users
Donabedian’s framework
The framework consist of a triad of structure process and outcome to evaluate the quality of care
- Structure
Refers to the organizational factors that define the system under which care is provided.
The setting, qualifications of providers, and administrative systems through which care takes
place
- Process
Involves interaction between users and the health care structure; in essence: what is done to
or with users.
The components of care delivered
o Clinical care refers to the application of clinical medicine to a personal health problem
and is based upon a theory of function which can be evaluated for efficacy and
generally standardized
o Interpersonal care describes the interaction of health care professionals and users or
their carers. This includes ‘the management of the social and psychological interaction
between client and practitioner.’
- Outcome
Are consequences of care
Recovery, restoration of function, and survival
Structure as well as processes may influence outcome.
However, the relative importance of each of these
components will vary in different situations and the
relationships between them are not necessarily linear.
Needed skills: communication, the ability to build a
relationship of trust, understanding and empathy with
the patient and to show humanism, sensitivity and
, responsiveness. Patients want explanation and discussion about their symptoms and to be
involved in decisions about their management.
The IOM conceptualised quality as 6 dimensions:
Safety
Causing no harm by care that is intended to help. Reliable standardised care will reduce
error, resulting in safer health care systems
Timeliness
Primarily concerned with the avoidance of unnecessary delays. Reducing unnecessary
waiting or delay within the health care system. In community setting, timeliness was
associated with reliable behaviour of care providers (keeping appointments, attention)
Effectiveness
Matching science to care, this dimension is closely linked to the adaptation in western
healthcare of evidence based medicine
Efficiency
Care that is not wasteful in terms of duplication of effort and unnecessary treatment, but
also includes making full use of all resources (enabling staff to be innovative)
Equity
Closing the gap between justice and healthcare, in which care should not be influenced by
individuals’ personal characteristics
Patient-centeredness
Care that is respectful of an individual’s preferences, needs and values and incorporates the
notion of ‘nothing about me without me’. The patient and practitioner work together to
attain the best health outcome for the patient
Extra domains:
Caring
The relationship between those accessing health care and those providing care. Service users
are aware of whether or not the care was given in a compassionate manner by identifying
characteristics of the care giver’s attitude and body language.
Navigating the system
Accessing and finding ways round complex health care systems. Health care systems need to
be designed to ensure individuals are empowered to access services, and routes through
various health care journeys are seamless
There are 5 main themes which represent the greatest challenge to deliver effective, high quality and
safe care:
Organisational culture
, The complexity of the dynamic systems within care organisations, across care sectors and
between professional domains
Pressure at work
Lack of barriers for what was described as a reactionary system with full/blocked
departments, time pressures, competing priorities and coping strategies including work force
resilience.
The ability to adjust to uncertainties provides resilience within the system to sustain and
balance the goals of safety and efficiency. Adjustments can also be seen as a contributory
factor for an unsafe event, especially where investigations focus on human behaviour rather
than proactive risk management
Risk management culture
Covers a wide range of operational issues including
quality improvement, financial risk and clinical
governance
Communication
The entrenched status culture in healthcare which
contributes to the barriers for integrated working
across sectors and professional boundaries, and
possibly also patient safety events are discussed
Resources
Limited space or environmental limits
The smaller the hole in the cheese, the more easy it will crash into the cheese, so a bigger chance
on an adverse event.
Adverse events are unintended injuries that results in temporary of permanent disability, death or
prolonged hospital stay, and is caused by healthcare management rather than by the patient’s
underlying disease process
Medical error has been defined as an unintended act or one that does not achieve its intended
outcome, the failure of a planned action to be completed as intended, the use of a wrong plan to
achieve an aim, or a deviation from the process of care that may or may not cause harm to the
patient
Strategies to reduce death from medical errors:
1. Making errors more visible when they occur so their effects can be intercepted
2. Having remedies at hand to rescue patients
3. Making errors less frequent by following principles that take human limitations into account
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