Quality in Health Care PDF

Quality in Health Care Dr. Mais Alkhalili Community medicine How would you define “Quality”? Definition of(quality Ra $ &Hi &Jim is sidT The degree to which health ser...

Quality in Health Care Dr. Mais Alkhalili Community medicine How would you define “Quality”? Definition of(quality Ra $ &Hi &Jim is sidT The degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are ( consistent with the current professional knowledge. Lie = 125 (Board of commissioners, Joint commission)  Two publications from the Institute of Medicine NISADy (IOM): : *Dis A * D - first brought public attention to the issue of medical errors, G concluding the fact that between 44,000 and 98,000 people To Err Is die every year from medical mistakes. It also diagnosed the quality problem as not one of poorly performing people, but Human of people struggling to perform within a system that is riddled with opportunities for mistakes to happen, i.e., system failures. Crossing the outlined a number of goals for improving the quality and Quality performance of the U.S. healthcare system, as well as some of the methods for achieving those goals. Chasm Quality Through Different Eyes PerspectivesonQuality Client / Family Provider Health Care Administration Community & Management  $9 Defining Quality in Health Care &, 1, 8 is Quality 1 Celements)  Avedis Donabedian (1966) defined quality in terms of structure, process, and ↳ outcome. - (input) 1) The structural elements of quality involve the material and human resources of an organization and the facility itself. The quality of personnel is documented in their numbers (nurse staffing), skill level (e.g., certified nursing assistant), and various certifications (e.g., board-certified physician), while the quality of facilities lies in accreditation (in hospitals through The Joint Commission) and/or certification (e.g., Magnet Hospital certification). - technology equipment Machines Tools ↳ , , , s - I & ji) standard , s /I  s - &s 2) The process involves the actual delivery of care as well as its management (e.g., the quality of basic care including cleanliness, feeding, hydration, delivery of treatments, and keeping patients safe from falls and errors). 3) The outcome is the resulting health status of the patient (e.g., mortality, E morbidity, length of stay, and functional status) and organizational issues (e.g., turnover of staff, cost outcomes, etc.). As a physician, Donabedian championed the development of best practices, i.e., “the ideal to which organizations should aspire” to improve care (Cooper, 2004, p. 827), linking structure, process, and outcome with a feedback loop, i.e., information given back to providers to achieve better ~ care. i li patient satisfaction structureii process + life expectancy outcome to provid better care Moreover, he defined quality as having at least four components (Donabedian, 1986): - 1. The technical management of health and illness. careprovider - 2. The management of the interpersonal relationship between the providers of care and their clients. Neig " > - - 3. The amenities of care.- is wis 4. The ethical principles that govern the conduct of affairs in general and the health care enterprise in particular. disI > - The four parts of this definition highlight the need to incorporate multiple stakeholder perspectives to understand healthcare quality. Goddes  ↓ 1) The technical management of health focuses on the clinical performance of healthcare providers. 2) the management of interpersonal relationships underscores the co-production of care by both providers and patients. In other words, at the patient–provider encounter level, health service quality is driven both by clinical and non-clinical * processes. It should be noted that in 1986 when Donabedian was writing about quality, basic delivery of medical care was increasing in complexity. This is ~ lo important because today caregivers are working in a significantly more complex environment with an associated increased risk of error and system failure—and the consequences of error are more severe (Guarinoni, Petrucci, Lancia, & Motta, 2015). Medical * clinical - error > mi & * Non-clinical- > 51 1 g. 1 (emotional support)  -1619-0 - J speak to the patient’s interest in being treated 3) [The amenities of care in comfortable, clean surroundings > " R IEI9s - , E 4) The ethical principles speak to the provider’s ethical conduct in delivering care and his/her interest in furthering societal and organizational well-being (or effectiveness). &31 - 91 4515 olS's  A related, but more focused, view of quality represents two fundamental questions about any clinical service, procedure, or activity occurring in a healthcare setting: (1) “Are the right things done?” and (2) “Are things done $ right?” Dezi The first question assesses the effectiveness of clinical care; the second considers the efficiency of care services. ↳ i - 8% /  gili Aloe & effective - efficient-ju ijl is N Effectiveness The ability of a program to produce the expected results in the field Efficiency The ability of a program to produce the expected results with the least time and resources Efficacy The ability of a program to produce the expected results under ideal conditions · i Miss is js. , 55 ·j. J in so  Focused view of quality Effectiveness Efficiency Are the right things done? Are things done right? Services must be based on scientific Avoiding waste (waste of knowledge equipment, supplies, ideas, and energy). Refrain from providing services to those not likely to benefit (Avoiding underuse and overuse)” Crossing the Quality Chasm (IOM, 2001), proposed that health care should be: Steeep,,,,, S: Safe -> Y T: Timely Sjg > - E: Effective E: Efficient > media E: Equitable - ↑ P: Patient-centered > - A S &31 Why Is Clinical Quality Management Important? * H One of the key issues in health care quality is the appropriate use of ow 3. limited resources to improve the health of both individuals and the entire population. Efficiency and effectiveness hinge on ethical stewardship of resources, and problems in this domain can take three forms: underuse, overuse, and misuse. Did si stuff &11 0 07MI. : My Jy  · 4, is & / / Sil ,. /911- , gyl ji i j,1 , Antibiotic & Slodg 5,54168195 & (Medical errors) 2/11 4. 154  Underuse a problem since clinical research has produced a large number of effective treatments that are not widely used. Even when these practices reach clinicians, evidence-based recommended treatments may not be consistently used. For example, McGlynn and colleagues (2003) found that 54.9% of participants in a nationwide study received recommended care. Overuse Gonzales, Steiner, and Sande (1997) documented the overuse of antibiotics among their sample of adults. They found antibiotics were prescribed 51% of the time for common colds, 52% for upper respiratory infections, and 75% for bronchitis. The prescriptions were written even though these maladies are caused by viruses, not bacteria, rendering antibiotics useless in these cases. The indiscriminate use of antibiotics has fed the rise of multi-drug-resistant strains of bacteria (Arias & Murray, 2009). I  Misuse Definition of misuse focuses on errors related to the delivery of medical care, rather than the misapplication of medical care without untoward consequences. The publication of the first IOM report on patient safety (Kohn et al., 2000) examined the high rate of medical errors in hospitals, noting, as pointed out earlier, that thousands of patients (44,000 and 98,000) die every year from preventable adverse events and another million are injured. e * jgls - Bri & Cerrors) - ·different medical All together practices The 3 problems together will result in a wide variation in medical practice which is the result of “idiosyncratic and unscientific” practice patterns and “local supply of resources”. Example: Boston and New Haven are demographically similar and geographically close might be expected to be fairly similar in their utilization of surgical services. However, there are big differences in the use of surgical services (Wennberg, 2002). ~ ais rais - & S Patient-centered care An emerging interest for many patient populations is high-quality health care responsive to the patient’s non-physical and non-medical needs and desires. Patient-centered care is “centered around the individual, and is responsive to the individual’s physical abilities, and medical needs, as well as social and psychological abilities, preferences and lifestyles” (Rasmussen, Jorgensen, & Leyshon, 2014, p. 30). The benefits of this approach not only engage the patient in the decision-making process, but also lead to a better quality of life for patients, better health outcomes, and benefits to other stakeholders.  Total Quality Management It is a holistic approach to the art of managing quality output considering together the people, process and products rather than independent factors and driven towards the objective with effective & efficient performance output”. Quality comprises three elements : $ & J +, refers to stable, material characteristics (infra-structure, tools, technology) and the resources of the organizations Structure that provide care and the financing of care (levels offunding, staffing, payment schemes, incentives the interaction between caregivers and patients during which Process structural inputs from the health care system are transformed into health outcomes. health status,deaths, or disability-adjusted life years—a measure that Outcome encompasses the morbidity and mortality of patients or groups of patients. Also include patient satisfactIon or patient responsiveness to the health care system O 6 so > - -& 4% / File G Is ·  INPUTS PROCESSES OUTCOMES Client expectations Quality Design Staff performance monitored Organizational structure Planning for quality Compliance with Trained personnel Setting standards standards Budget Monitoring quality Increased efficiency Standards Supervision Culture of quality Political support Quality Improvement Increased access Organizational culture Accreditation and utilization Satisfied clients Improved health outcomes  $ The Complex Nature of Health Care Wi 3 & M It is critical that today’s healthcare manager understands the difference between manufacturing and healthcare (Lindberg, Nash, & Lindberg, 2008, p. 128). Manufacturing is engineered and the inputs are controllable to a high degree with potentially very tight Why ?tolerances. In health care, we cannot control the customer-supplied I material, the patient. 2 In contrast, healthcare providers work with a high degree of ↳ i ambiguity in many diagnoses&and[uncertainty as to how patients are going to respond to treatments. Providing health care means working in this complex, dynamic, and ambiguous environment (Lipsitz, 2013) 10& - ↳JGN's did 25/ & Edifferential diagnosis3  ike, gas & S Additionally, the process of evaluation, treatment, and caring for patients requires a high number of human transactions that interface with complex and imperfect information systems. Because of these conditions, small system failures can align, resulting in catastrophic 3 > - outcomes including disability and death. Managers need to be aware that efforts to improve the provision of health care through “mechanical approaches, often lead to unintended consequences”. errors.. do interaction between drugs s  As part of these improvement efforts, it is vital that managers understand actions need to be carefully thought out to avoid unintended consequences. Every improvement should be treated as an experiment. Increasingly, the healthcare literature has excellent resources to help understanding and applying the science of complexity. As healthcare managers gain experience, they will recognize the patterns. Healthcare leaders and quality professionals must consider the science of complex systems to be effective in the management and continuous improvement of their organizations (Pelletier & Beaudin, 2018).