Case 3: Quality management in healthcare
Learning goals
1. How to define quality of care? What are the different dimensions/ components of
quality?
2. What are the different levels of quality of care?
3. What is quality management? What are the different approaches?
a. What is quality assurance?
b. What is total quality management?
c. What is continuous quality management?
4. What are the challenges for question 3?
5. How can quality of care be assessed/ monitored?
1. How to define quality of care? What are the different dimensions/ components of
quality?
Lack of consensus on this topic:
- Literature on quality of care is extensive
- Quality of care is defined in many different ways
- Some definitions are more influential than others
Influential definitions of quality of care
World Health Organisations (WHO): “The extent to which health care services provided to
individuals and patient populations improve desired health outcomes. In order to achieve
this, healthcare must be safe, effective, timely, efficient, equitable and people-centred”.
Quality of care is the level of attainment of health systems’ intrinsic goals for health
improvement and responsiveness to legitimate expectations of the population.
Institute of Medicine (IOM): “Quality 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”.
- WHO and IOM use the same 6 dimensions of quality of care (but use the term
patient-centred (IOM) instead of people-centred).
, Donabedian (1980): “Quality of care is the kind of care which is expected to maximize and
inclusive measure of patient welfare, after one has taken account of the balance of expected
gains and losses that attend the process of care in all its parts”.
Difference between Donabedian and IOM:
- The IOM has narrowed down their definition from improving total patient welfare to
improving health outcomes;
- The IOM shifted the focus from patients to individuals and populations;
- IOM added consideration of the perspective of the care receiver;
- IOM added consistency of care with current standards.
Currently, we can see a shift where the definition also focusses more on cost-effectiveness
since the society became more aware; health outcomes achieved per dollar spent!
Donabedian – Components of Quality
- Efficacy
The ability of science and technology of healthcare to bring about improvement in
health when used under the most favourable circumstances.
- Effectiveness
The degree to which attainable improvement in healthcare, in fact, attained.
- Efficiency
The ability to lower the cost of care without diminishing attainable improvements in
health
- Optimality
The balancing of improvement in health against the costs of such improvements.
- Acceptability
Conformity to the wishes, desired, and expectations of patients and their families.
- Legitimacy
Conformity to social preferences as expressed in ethical principles, values, norms,
mores, laws and regulations.
Learning goals
1. How to define quality of care? What are the different dimensions/ components of
quality?
2. What are the different levels of quality of care?
3. What is quality management? What are the different approaches?
a. What is quality assurance?
b. What is total quality management?
c. What is continuous quality management?
4. What are the challenges for question 3?
5. How can quality of care be assessed/ monitored?
1. How to define quality of care? What are the different dimensions/ components of
quality?
Lack of consensus on this topic:
- Literature on quality of care is extensive
- Quality of care is defined in many different ways
- Some definitions are more influential than others
Influential definitions of quality of care
World Health Organisations (WHO): “The extent to which health care services provided to
individuals and patient populations improve desired health outcomes. In order to achieve
this, healthcare must be safe, effective, timely, efficient, equitable and people-centred”.
Quality of care is the level of attainment of health systems’ intrinsic goals for health
improvement and responsiveness to legitimate expectations of the population.
Institute of Medicine (IOM): “Quality 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”.
- WHO and IOM use the same 6 dimensions of quality of care (but use the term
patient-centred (IOM) instead of people-centred).
, Donabedian (1980): “Quality of care is the kind of care which is expected to maximize and
inclusive measure of patient welfare, after one has taken account of the balance of expected
gains and losses that attend the process of care in all its parts”.
Difference between Donabedian and IOM:
- The IOM has narrowed down their definition from improving total patient welfare to
improving health outcomes;
- The IOM shifted the focus from patients to individuals and populations;
- IOM added consideration of the perspective of the care receiver;
- IOM added consistency of care with current standards.
Currently, we can see a shift where the definition also focusses more on cost-effectiveness
since the society became more aware; health outcomes achieved per dollar spent!
Donabedian – Components of Quality
- Efficacy
The ability of science and technology of healthcare to bring about improvement in
health when used under the most favourable circumstances.
- Effectiveness
The degree to which attainable improvement in healthcare, in fact, attained.
- Efficiency
The ability to lower the cost of care without diminishing attainable improvements in
health
- Optimality
The balancing of improvement in health against the costs of such improvements.
- Acceptability
Conformity to the wishes, desired, and expectations of patients and their families.
- Legitimacy
Conformity to social preferences as expressed in ethical principles, values, norms,
mores, laws and regulations.
