Quality in Healthcare Management

Importance of Quality in Healthcare

• Proper use of limited resources and appropriate costs of services
• Decreasing variation in medical performance and outcomes across different health organizations
• Encouraging competition between organizations, meeting customer needs and expectations
• Inspection for identifying and fixing problems at the end-point of the product

Control Quality

• Reactive approach focused on detecting defects in the product itself

Quality Assurance

• Proactive approach focused on preventing defects at the process level

Total Quality Management

• (Not detailed in the document)

Continuous Quality Improvement

• (Not detailed in the document)

Perspective of Quality

• HC Manager: best services, lowest cost, best outcome
• Community: available, accessible, comfortable, humanity, relieve symptoms, prevent illness
• HC Services Triad: health team, technical skills, resources, work environment, achieving target

Dimensions of Quality

• Appropriateness: The extent to which care is relevant to the patient's clinical needs
• Access to Service: Unrestricted access to healthcare services
• Competency: Adherence to professional care and practice standards
• Continuity: Providing complete health services without interruption
• Effectiveness: Providing care in the correct manner for desired outcomes
• Efficiency: Providing the greatest benefit with available resources
• Efficacy: The power of a procedure or treatment to improve health
• Respect and Caring: Patient involvement in decisions and provider responsiveness to needs and expectations

Safety

• The organization's environment being hazard-free.
• Minimizing adverse outcomes for patients and providers due to healthcare interventions.

Timeliness

• Providing care and services at the most beneficial or necessary time

Measuring Quality of Care

• Inputs (Structure): People and skills (physicians, support staff), equipment, facilities, organizational structure, information systems
• Process: Interpersonal interaction, access to care, appropriateness of care
• Outcome: Death rate, disease, disability, discomfort, dissatisfaction rate

Seven Basic Quality Tools

• Cause-and-effect diagram (Ishikawa/fishbone): Identifying and categorizing potential causes of a problem
• Check sheet: Gathering data on how often a problem occurs
• Control chart: Studying how a process changes over time through graphs
• Histogram: Displaying the distribution of continuous data (like time, weight, size)
• Pareto chart: Identifying the most significant factors contributing to a problem using a bar graph (80/20 principle)
• Scatter diagram: Analyzing the strength and relationship between two variables
• Flowchart: Visually representing the steps of a process in a sequential order

Sentinel Event

• Unexpected occurrences resulting in severe physical or psychological injury or death

Near Miss

• Potential medical errors caught before patient administration

Accreditation

• Typically a voluntary process where a government or agency grants recognition to healthcare institutions that meet standards

Hospital Provisional Accreditation Requirements

• Basic requirements (e.g., licensure)

National Safety Requirements (NSR)

• (A comprehensive list of numerous safety requirements for healthcare facilities) including:
  • Accurate patient identification
  • Effective verbal/telephone communication
  • Hand hygiene
  • Prevention of catheter/tubing misconnections
  • Fall/pressure ulcer risk assessment and management
  • Critical alarm recognition, response
  • Venous thromboembolism prevention and management
  • Timely and accurate communication of critical results
  • Standardized codes/terminology
  • Medication reconciliation within the hospital
  • Safe storage of medications and hazardous materials
  • Minimization of risk with high-alert medications and electrolytes
  • Avoiding look-alike/sound-alike medication errors
  • Marking surgical sites
  • Proper verification of patient, procedure, and body part -Accurate counting of instruments
  • Fire/smoke safety plans, and drills
  • Safe work environment for high-risk situations
  • Radiation and laboratory safety programs, etc.

Essential Quality Requirements

• (Detailed list of specific requirements like patient rights, waiting spaces, complaint processes, special care unit access, medical imaging quality assurance, operative reports, medication procurement, isolation/disinfection practices, hospital governing body & structure)