SUMMARY BMZ2024
All tasks & lectures summarized
,Task 1 – Caring for quality
Two influential definitions of QoC:
- “Quality of care is the kind of care which is expected to maximise an 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.”
o Donabedian, 1980
- “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.”
o Institute of Medicine, 1990
Source: Ayanian, 2016.
Care = a systems based model composed of health structures and two processes of care (clinical and
inter-personal) which result in consequent outcomes. Systems and processes increase or decrease
the likelihood of individuals receiving the care they need, but they do not guarantee quality care.
2 definitions quality of care
1. Quality of care for individuals = whether individuals can access the health structures and
processes of care which they need and whether the care received is effective.
Access (domain of quality)
Do users get the care they need?
- Geographic/physical access
o Relate to geographic barriers to getting to health care facilities such as rurality, or
use of premises access by disabled or elderly people.
- Organizational access = availability
o Relate to barriers to accessing care, e.g. the length and availability of appointments
or whether the health professionals can speak their language.
- Affordability like monetary costs
o E.g. the material cost of attending an appointment (transport, childcare, prescription
charges) or the opportunity costs incurred (loss of earning)
Health status and user evaluation are key outcomes of access for individuals, in addition to equity.
Effectiveness (domain of quality)
Is the care effective when users get it? Aim: maximize health benefits according to need
- Effectiveness of clinical care
, o Evidence-based, legitimate and knowledge-based care. Knowledge-based care
incorporates the extent to which a treatment or service is consistent with patient’s
reasonable expectations and contemporary professional standards of care, reflecting
both societal and professional norms.
- Effectiveness of inter-personal care
o Effective care requires appreciation of the patient’s personal experience of illness,
and must align the agendas of the professional and the patient. Care should be
planned for and with individual patients.
- Co-ordination or integration of care
o Effectiveness with which health professionals deal with those other organizations /
professionals within the same organizations, which impact (in)directly upon the
health or health related quality of life of the patient, e.g. social care, education or
housing.
2. Quality of care for population = the ability to access effective care on an efficient and equitable
basis for the optimisation of health benefit/well-being for the whole population.
Access
- Local or national factors
o E.g. the availability of primary and secondary health care services
- Equity = the extent to which all individuals in a population access the care they need
o Horizontal equity = equally accessible to effective care for all users
o Vertical equity = greater access to effective care for those with more need
Effectiveness
- Equity
- Efficiency = the most efficient use of care to maximize outcome
o Allocative efficiency = focusing on procedures which produce maximum benefit
o Technical efficiency = employing procedures in the most technically competent
manner
- Cost-effectiveness
- Outcomes: user evaluation, health status, cost & equity.
Source: Campbell, 2000.
Underlying reasons for inadequate quality of care
- Growing complexity of science and technology
- Increase in chronic conditions
- A poorly organized delivery system need of:
o Evidence-based, planned care
o Reorganization of practices to meet the needs of patients
o Systematic attention to patients’ need for information and behavioural change
o Ready access to necessary clinical expertise
o Supportive information systems
- Constraints on exploiting the revolution in information technology
Source: IOM, 2001.
Donabedian model
Key assumption: “if the right things are done (structure, process), and are done right, good results
for the patient (good outcomes
of care) are more likely to occur.
Donabedian (1996) framework
, Donabedian’s model has been used previously as a basis for defining quality.
3 domains
1. Structure = the organisational factors that define the health system under which care is
provided.
The opportunity for individuals to receive care, but do not guarantee it. 2 domains of structure:
- Physical characteristics
o Resources e.g. personnel, equipment, dimensions
o Organisation of resources, e.g. opening hours, booking system for appointments
o Management
- Staff characteristics
o Skill mix
o Team working
2. Process = the actual
delivery and receipt
of care
Process of care involve
interaction between
users and the health care
structure. 2 key
processes of care:
- Technical care (interactions)/clinical care = the more bio-medically oriented aspects of
health professional’s behaviour. The application of clinical medicine to a personal health
problem and is based upon a theory of function which can be evaluated for efficacy and
generally standardised. Care should be appropriate and necessary.
- Interpersonal care (interactions) = the interaction of health care professionals and users of
their carers. This includes the management of the social and psychological interaction
between client and practitioner.
Both clinical and inter-personal care processes involve the definition and communication of problems
or needs, diagnoses, management and co-ordination by the patient and professional concerned.
3. Outcome = consequences of care. Structure as well as processes may influence outcome,
indirectly or directly. E.g. a patient may die from cervical cancer either because a screening
service is not available (structure) of because her cytology report is misread (process)
- Health status
o Functional status
o Symptom relief
- User evaluation incorporating non-health as well as health related outcomes
o Satisfaction
o Enablement
The effectiveness of structure and processes can be defined in terms of their capacity to result in two
principal domains of outcome: health status & user evaluation. They might influence each other, but
they definitely influence outcome.
Source: Campbell, 2000.
Quality of care is a function of 3 domains
1. Structure refers to the condition under which care is provided
o E.g. material resources, human resources and organizational characteristics
2. Process relate to the activities that constitute health care
All tasks & lectures summarized
,Task 1 – Caring for quality
Two influential definitions of QoC:
- “Quality of care is the kind of care which is expected to maximise an 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.”
o Donabedian, 1980
- “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.”
o Institute of Medicine, 1990
Source: Ayanian, 2016.
Care = a systems based model composed of health structures and two processes of care (clinical and
inter-personal) which result in consequent outcomes. Systems and processes increase or decrease
the likelihood of individuals receiving the care they need, but they do not guarantee quality care.
2 definitions quality of care
1. Quality of care for individuals = whether individuals can access the health structures and
processes of care which they need and whether the care received is effective.
Access (domain of quality)
Do users get the care they need?
- Geographic/physical access
o Relate to geographic barriers to getting to health care facilities such as rurality, or
use of premises access by disabled or elderly people.
- Organizational access = availability
o Relate to barriers to accessing care, e.g. the length and availability of appointments
or whether the health professionals can speak their language.
- Affordability like monetary costs
o E.g. the material cost of attending an appointment (transport, childcare, prescription
charges) or the opportunity costs incurred (loss of earning)
Health status and user evaluation are key outcomes of access for individuals, in addition to equity.
Effectiveness (domain of quality)
Is the care effective when users get it? Aim: maximize health benefits according to need
- Effectiveness of clinical care
, o Evidence-based, legitimate and knowledge-based care. Knowledge-based care
incorporates the extent to which a treatment or service is consistent with patient’s
reasonable expectations and contemporary professional standards of care, reflecting
both societal and professional norms.
- Effectiveness of inter-personal care
o Effective care requires appreciation of the patient’s personal experience of illness,
and must align the agendas of the professional and the patient. Care should be
planned for and with individual patients.
- Co-ordination or integration of care
o Effectiveness with which health professionals deal with those other organizations /
professionals within the same organizations, which impact (in)directly upon the
health or health related quality of life of the patient, e.g. social care, education or
housing.
2. Quality of care for population = the ability to access effective care on an efficient and equitable
basis for the optimisation of health benefit/well-being for the whole population.
Access
- Local or national factors
o E.g. the availability of primary and secondary health care services
- Equity = the extent to which all individuals in a population access the care they need
o Horizontal equity = equally accessible to effective care for all users
o Vertical equity = greater access to effective care for those with more need
Effectiveness
- Equity
- Efficiency = the most efficient use of care to maximize outcome
o Allocative efficiency = focusing on procedures which produce maximum benefit
o Technical efficiency = employing procedures in the most technically competent
manner
- Cost-effectiveness
- Outcomes: user evaluation, health status, cost & equity.
Source: Campbell, 2000.
Underlying reasons for inadequate quality of care
- Growing complexity of science and technology
- Increase in chronic conditions
- A poorly organized delivery system need of:
o Evidence-based, planned care
o Reorganization of practices to meet the needs of patients
o Systematic attention to patients’ need for information and behavioural change
o Ready access to necessary clinical expertise
o Supportive information systems
- Constraints on exploiting the revolution in information technology
Source: IOM, 2001.
Donabedian model
Key assumption: “if the right things are done (structure, process), and are done right, good results
for the patient (good outcomes
of care) are more likely to occur.
Donabedian (1996) framework
, Donabedian’s model has been used previously as a basis for defining quality.
3 domains
1. Structure = the organisational factors that define the health system under which care is
provided.
The opportunity for individuals to receive care, but do not guarantee it. 2 domains of structure:
- Physical characteristics
o Resources e.g. personnel, equipment, dimensions
o Organisation of resources, e.g. opening hours, booking system for appointments
o Management
- Staff characteristics
o Skill mix
o Team working
2. Process = the actual
delivery and receipt
of care
Process of care involve
interaction between
users and the health care
structure. 2 key
processes of care:
- Technical care (interactions)/clinical care = the more bio-medically oriented aspects of
health professional’s behaviour. The application of clinical medicine to a personal health
problem and is based upon a theory of function which can be evaluated for efficacy and
generally standardised. Care should be appropriate and necessary.
- Interpersonal care (interactions) = the interaction of health care professionals and users of
their carers. This includes the management of the social and psychological interaction
between client and practitioner.
Both clinical and inter-personal care processes involve the definition and communication of problems
or needs, diagnoses, management and co-ordination by the patient and professional concerned.
3. Outcome = consequences of care. Structure as well as processes may influence outcome,
indirectly or directly. E.g. a patient may die from cervical cancer either because a screening
service is not available (structure) of because her cytology report is misread (process)
- Health status
o Functional status
o Symptom relief
- User evaluation incorporating non-health as well as health related outcomes
o Satisfaction
o Enablement
The effectiveness of structure and processes can be defined in terms of their capacity to result in two
principal domains of outcome: health status & user evaluation. They might influence each other, but
they definitely influence outcome.
Source: Campbell, 2000.
Quality of care is a function of 3 domains
1. Structure refers to the condition under which care is provided
o E.g. material resources, human resources and organizational characteristics
2. Process relate to the activities that constitute health care
