Quality in Healthcare PDF

Quality in HealthCare Course code: 610 Quality Assurance & Accreditation Learning Objectives By the end of this session, you will be able to: 1. Describe the definition of quality in healthcare. 2. Discuss the history of quality in healthcare. 3. Understand why quality healthcare matters. 4. Ap...

Quality in HealthCare Course code: 610 Quality Assurance & Accreditation Learning Objectives By the end of this session, you will be able to: 1. Describe the definition of quality in healthcare. 2. Discuss the history of quality in healthcare. 3. Understand why quality healthcare matters. 4. Appraise the value of the dimensions of quality. 5. Identify the role of quality in health systems. 6. Recognise the different perspectives on quality. 7. Describe Donabedian’s framework for quality assessment. 8. Identify the main quality improvement models. 9. Understand the components of a culture of quality. 2 What is Quality? 1980 ‘Quality of care is the kind of care which is expected to maximize an inclusive measure of patient welfare…’ (Donabedian) 1990 ‘The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge…’ (IOM) 1994 ‘The degree to which care services influence the probability of optimal patient outcomes…’ (AMA) 2008 ‘Doing the right things, for the right patient, at the right time, in the right way to achieve the best possible results.’ (AHRQ) 2018 ‘Is health care that is effective, safe and responds to the needs and preference of patients.’… (WHO) 3 History of Quality The National Roundtable on Health Care Quality’s ‘The Urgent Need to Improve Health Care Quality’ (1998) The Institute of Medicine’s (IOM) ‘To Err Is Human’ (2000) IOM’s ‘Crossing the Quality Chasm’ (2001) The Agency for Healthcare Research and Quality’s (AHRQ) ‘National Healthcare Quality Report’ (2003–2011) National Academies of Sciences, Engineering, and Medicine’s report on ‘Improving Diagnosis in Health Care’ (2016) 4 Progress in Healthcare So Far To Err Is Human: Building a Safer Health System (2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001): Catalysts for change in healthcare. Patient safety became a unifying cause for regulators, providers, and consumers Increased reporting of medical errors Improved accountability Identified the quality dimensions More than 15 years after: 250,000 deaths annually in the United States 5 Why Healthcare Matters: Evidence of a Problem Patient harm is the 14th leading cause of the global disease burden. Patient safety incidents occur in 6% of patient cases acutely admitted to hospitals. 12% of safety incidents result in severe or fatal outcomes. 1 in 10 patients experiencing a patient safety incident die. While in hospital, 1 in every 10 patients is harmed. Hospital infections affect 14 out of every 100 patients admitted. More than one million patients die annually from surgical complications. 134 million adverse events due to unsafe care occur in hospitals in low- and middle-income countries, contributing to around 2.6 million deaths every year. 15% of health spending is wasted dealing with adverse events. Cost of patient harm can be valued at US$ 1–2 trillion a year. 46% of medication charts contain errors. Administrative errors account for up to 50 % medical errors. 6 Quality Dimensions 7 Overview 8 Quality Dimensions Safe Timely Delivering health care that minimises Reducing delays in providing and risks and harm to service users, receiving health care. including avoiding preventable injuries and reducing medical errors. 9 Quality Dimensions Effective Efficient Providing services based on scientific Delivering health care in a manner knowledge and evidence-based that maximises resource use and guidelines. avoids waste. 10 Quality Dimensions Equitable People Centred Delivering health care that does not Providing care that takes into account differ in quality in accordance with the preferences and aspirations of personal characteristics such as individual service users and the gender, race, ethnicity, geographical culture of their community. location, or socio-economic status. 11 Role of Quality 12 Improvement at the Four Levels 13 Stakeholders: Different Perspective on Quality Patient/client: safe care, timeliness, and effective treatment Care providers: clinical effectiveness, improved outcomes, available technologies, and medications Regulators/government: efficiency of services, cost-effectiveness, good management, and reputation Community: lifestyle, well-being, equity, access, and cost-effectiveness Administrators: efficiency, cost-effectiveness, and distribution of resources Payers: cost-effectiveness and efficiency 14 Revolutions Florence Nightingale – 1854 Avedis Donabedian – 1966 IOM Reports To Err Is Human: Building a Safer Health System (2000) Crossing the Quality Chasm: A New Health System for the 21st Century (2001) Don Berwick – 1991 Value Based Care – 2010 15 Models PDSA Model for Improvement LEAN Six Sigma 16 Plan-Do-Study-Act Cycle 17 Effective System of Care 18 Donabedian’s Structure-Process-Outcome Framework Structure Setting Material, intellectual, and human resources Facilities, professionals, and knowledge Process Activities Clinical and organisational processes Prescription patterns and supplies management Outcome Health status Intermediate or final outcomes Blood pressure, well-being, quality of life, and mortality 19 Poor Quality Cost https://www.youtube.com/watch?v=jYj_R4 oCTPI&t=11s Impact Medical errors Patient harm Bad reputation Loss of trust Waste of resources Redoing 20 Reasons for Struggle to Improve Quality Poor organisational culture Inadequate infrastructure Lack of cohesive mission and vision System shocks Dysfunctional external relations 21 Culture of Quality 22 23 Overview Vision of High-Quality Care Clear Objectives in Health Services People Management Culture of Engagement Health Service Teamwork 24 Healthcare Delivery System All the right care, but only the right care; without defect or injury; at the lowest necessary cost; under the full knowledge and control of the patient, while learning from every case. 25 References AMA: American Medical Association. (1994). Attributes to guide the development of practice parameters. http://www.acmq.org/policies/policies1and2.pdf. AHRQ: Agency for Healthcare Research and Quality. (2012). Understanding quality management: Child health care quality toolbox. https://www.ahrq.gov/patient-safety/quality- resources/tools/chtoolbx/index.html AHRQ safety program for enhanced recovery after surgery. (n.d.). AHRQ. Retrieved from https://www.ahrq.gov/hai/tools/enhanced-recovery/index.html Ball, J. R., Balogh, E. P., & Miller, B. T. (Ed.). (2015). Improving diagnosis in health care. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK338596/ Berwick, D. M. (2002). A user’s manual for the IOM’s ‘quality chasm’ report. Health Affairs, 21(3), 80–90. https://doi.org/10.1377/hlthaff.21.3.80 Campanella, J. (1999). Principles of quality costs: Principles, implementation, and use (3rd ed.). ASQ Quality Press. Corrigan, J. M., & Kohn, L. T. (2000). To err is human: Building a safer health system. National Academies Press. https://pubmed.ncbi.nlm.nih.gov/25077248/ 26 References Crosby, P. (1984). Quality is free. Health Affairs (Spring), 7, 49–60. Ferlie, E. B., & Shortell, S. M. (2001). Improving the quality of health care in the United Kingdom and the United States: A framework for change. The Milbank Quarterly, 79(2), 281–315. https://doi.org/10.1111/1468-0009.00206 Harteloh, P. (2003). The meaning of quality in health care: A concept analysis. Health Care Analysis, 11(3), 259–267. Kronick, S. L. (2015). Part 4: Systems of care and continuous quality improvement. Circulation, 132(18), S397–S413. https://doi.org/10.1161/CIR.0000000000000258 Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass. Makary, M. A., & Daniel, M. (2016). Medical error—The third leading cause of death in the US. BMJ, 353, i2139. https://doi.org/10.1136/bmj.i2139 Urquhart, A., Yardley, S., Thomas, E., Donaldson, L., & Carson-Stevens, A. (2021). Learning from patient safety incidents involving acutely sick adults in hospital assessment units in England and Wales: A mixed methods analysis for quality improvement. Journal of the Royal Society of Medicine, 114(12), 563–574. https://doi.org/10.1177/01410768211032589 27 References Vaughn, V. M., Saint, S., Krein, S. L., Forman, J. H., Meddings, J., Ameling, J., Winter, S., Townsend, W., & Chopra, V. (2018). Characteristics of healthcare organisations struggling to improve quality: Results from a systematic review of qualitative studies. BMJ Quality & Safety, 28(1), 74–84. https://doi.org/10.1136/bmjqs-2017-007573 West, M. A. (2013). Creating a culture of high-quality care in health services. Global Economics and Management Review, 18(2), 40–44. https://doi.org/10.1016/S2340- 1540(13)70007-0 Wolfe, A. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press. https://pubmed.ncbi.nlm.nih.gov/25057539/ World Health Organization. (2021, October 5). Quality of care for maternal, newborn, child and adolescent health. https://www.who.int/teams/maternal-newborn-child-adolescent-health-and- ageing/quality-of-care World Health Organization & World Health Organization. (2007). Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action. World Health Organization. https://apps.who.int/iris/handle/10665/43918 28 Credits The following faculty is attributed with the slides and ideas of this session: Dr. Alia 29