Healthcare quality book
Chapter 1: Healthcare quality and the patient
The balance of health beneftt and harm it the ettental core of a defniton of quality. The defniton
of quality it ttated at: Quality of care is the degree to which health services for individuals and
populatons increase the likelihood of desired health outcomes and are consistent with current
professional knowledge. How care is provided should refect appropriate use of the most current
knowledge about scientici clinicali technicali interpersonali manuali cognitve and organizaton and
management elements of health care.
Clattifcaton of quality defectt
- Underute
o Fact that practcet are not uted at ofen at they thould be.
- Overute
o When treatment or practcet are uted to a greater extent than evidence deemt
appropriate.
- Mitute
o When clinical care procettet are not executed properly. For example, when the
wrong drugt it pretcribed.
The tix aimt for improvement
- Safe
o Care thould be in facilitet at tafe at in patentt homet.
o Example: Mortality ratet
- Effectve
o Science and evidence thould be applied.
o Example: Meaturement of indicatort of harm ( infectont related to hotpital care).
- Efcient
o Cott-effectve and watte thould be removed.
o Example: Analyting patentt cottt.
- Timely
o Patentt thould not experience waitt or delayt when receiving care or tervice.
o Example: Time patentt had to wait to receive care.
- Patent centred
o The tyttem of care thould revolve around the patent, put patent in control and
mott important it thould retpect the patent.
o Example: Meaturement of patent (or family) tattfacton.
- Equitable
o Unequal treatment belongt to the patt.
o Example: Examining differencet in quality meaturet by race, gender or other
populaton-bated demographic of tocioeconomic factort.
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,There are alto four levelt of the healthcare tyttem,
which are divided in:
- Level A: Patent
- Level B: Microtyttem
o Care it delivered by tmall provider
teamt
- Level C: Organizaton
o Macro tyttem or aggregaton of
microtyttemt and tupportng
functont
- Level D: Environment
o Payment mechanitmt, policy and regulatory factort
The demand for high quality care it increating. Patentt are dittattfed with the care they receive,
which leadt in providert who are over burned and unintpired. Therefore, patent-centred care it very
important. It it the proper future of medicine, and the current focut on quality and tafety it a ttep in
the path to excellence.
Surgical Care an Outcomet Attettment Program(SCOAP) it aimt to reduce variability and improve
quality and outcomet in turgical care acrott the US. It promotet checklitt adopton. The WHO did a
pilot ttudy to implement the turgical tafety checklitt all around the world. It retulted in a decreating
mortality rate. A key learning point it that contnuout emphatit on patent tafety it critcal.
CUSP it a contnuout meaturement, feedback and improvement program. In engaget frontline ttaff
and utet a combinaton of toolt and compliance reportt to achieve improvement goalt. Five ttept:
- Train ttaff in tcientfc tafety
- Engage ttaff in identfying defectt.
- Perform tenior executve partnerthipt/ tafety roundt
- Contnue to learn from defectt
o What happened?
o Why did it happen?
o What wat done to reduce ritk?
o How do we know what ritk wat actually reduced?
- Implement toolt for improvement
Thit wat frtt piloted at the ICU, becaute errort more occur at ICU due to the teverity of the patentts
conditont. Stark fndingt retulted: reducing ratet of Length of ttay (LOS), medicaton errort, nurting
turnover and tafety culture increate. The path to improvement it not timple. It requiret
collaboraton between many multditciplinary ttakeholdert.
Concluding, the chapter ttatet that we mutt contnue to make quality a necettity, not a nicety in
healthcare. Improvement needt to be done at every level, from patent to external environmentt.
Chapter 2: Basic concepts of healthcare quality.
Different atributet are relevant to the quality of care defniton, thete are:
- Technical performance
o The degree to which current tcientfc medical knowledge and technology are
applied in a given tituaton.
- Patent centerednett
o To modify the care to the retpond of the perton, not the perton to the care.
- Amenitet
o It determined by the characterittct of the tetng in which the patent-clinician
encounter taket place.
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, - Accett
o The degree to which individualt and groupt are able to obtain needed tervicet. The
eate dependt on the extent to which their characterittct and expectatont match
thote of providert.
- Equity
o Partcularly age, gender and race. oot that tpecifc the individualts needt.
- Efciency
o How well retourcet are uted to achieve a given retult. It improvet whenever fewer
retourcet are uted to produce an output.
- Cott-effectvenett.
o Comparing the beneft of the interventon with the cott of the interventon.
There are differencet between ttakeholdert when they think of quality. The mott involved
ttakeholdert are cliniciant, patentt, payert, managert and tociety. The payert are the health
inturancet, government programt and other who pay on behalf of the patent. Cott-effectvenett it
ofen central to how payert, managert and tociety defnet quality of care, whereat phyticiant and
patentt do not contiderate cott-effectvenett at a legitmate contideraton in defning quality.
Quality can be meatured of evaluated by three meaturet:
- Structure
o Characterittct of the individualt who provide care and of the tetngt where the care
it delivered. Thete characterittct include educaton, trainingt and certfcaton of the
profettionalt. Good ttructure maket quality more likely to entue, but doet not
guarantee it.
- Procett
o The teriet of eventt that taket place during the delivering of care. Quality of procett
can vary on three thingt:
Appropriatenett: whether right actont were taken
Skill: profciency with which actont were carried out
Timelinett of care
o For example; you cannot tay that a turgery wat high quality becaute the patent had
good recovery. It dependt on more factort.
- Outcome
o Meaturet whether healthcare goalt were achieved. Becaute goalt can be defned
broadly, there are multplet outcomet that can be meatured. Mott outcomet cannot
be controlled. Only procettet can be controlled and a good procett can increate the
likelihood of good outcomet.
Efcacy can be choten at an interventon to provide high quality. Other thingt are held conttant,
where another factor it more reliable to have a good outcome. Outcomet are uteful for identfying
pottible problemt of quality but not for atcertaining whether poor care wat actually performed.
Criteria refer to tpecifc atributet that are the batic for attetting quality. Standardt quanttatvely
exprett the level the atributet mutt reach to tattfy pre-exittng expectatont about quality.
Standardt and criteria are revolved more around the ttrength and validity tcientfc evidence than
around the unaided contentut of expertt.
When ttandardt are tet, it mutt be decided at which level the ttandard thould be tet; minimal,
optmal, achievable or tomething in between. Minimumt tpecifet the level that mutt be met for
quality to be contidered acceptable. Optmal ttandardt denote levelt of quality that can be reached
under the bett conditont. Achievable levelt are levelt that everyone thould be able to meet or
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