Case 3: Quality management in healthcare
Quality of care has been defined in many different ways. Several authors have defined quality of care
by describing the concept according to a set of dimensions, such as safety, effectiveness, etc. These
dimensions are, however, neither comprehensive nor mutually exclusive. In addition, there are
different levels at which quality of care can be addressed.
In the last two decades growing attention has been paid to quality management in healthcare. Policy
reports and articles in leading journals frequently highlight important problems in healthcare
delivery, related to underuse, overuse and misuse of care. Reports such as ‘To Err is Human’ and
‘Crossing the Quality Chasm’ of the Institute of Medicine (US), have stimulated health care
professionals and policymakers worldwide to put quality management issues high on their agendas.
In the literature on quality of care, various terms are used to describe quality management, such as
quality assurance and continuous quality improvement. These approaches have in common that they
are all aimed at assuring the quality of healthcare by monitoring healthcare performance and
improving it when necessary. Assessment is important.
Practical application (to be discussed during the post-discussion of case 3)
A patient, a doctor and a manager of a hospital participate in a survey on quality of care. They are
asked to rank the dimensions of quality of care from ‘most important’ to ‘least important’, and to
provide a rationale for their ranked dimensions.
Now imagine that you are the patient, the doctor and the manager. Rank the dimensions of quality of
care for each of them and provide a rationale for each of the rankings.
Patient
- Safe
- Effective
- Timely
- Patient-centered
- Equitable
- Efficient
Doctor
- Effective
- Safe
- Patient-centered
- Efficient
- Timely
- Equitable
Manager
- Efficient
- Safe
- Equitable
- Effective
- Timely
- Patient-centered
What is the definition of ‘quality of care’?
Quality of care
Defining quality of care (Legido-Quigley, 2008)
Two influential definitions
, - Donabedian (1980): Quality of care is the kind of care which is expected to maximize 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
- Institute of medicine (1990): 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
Differences between definitions of Donabedian and IOM
- The IOM has
o Narrowed down their definition from improving total patient welfare to improving
health outcomes
o Shifted the focus from patients to individuals and populations
o Added consideration of the perspective of the care receiver
o Added consistency of care with current standards
Which dimensions of quality of care are there?
Definitions distinguishing various dimensions of quality of care
- The 6 dimensions used by the IOM have been especially influential
o Effective: the extent to which the intervention in question produces the intended
effects
o Efficient: the extent to which objectives are achieved by minimizing the use of
resources
o Timely: receiving treatments within a reasonable time frame
o Safe: the reduction of risk
o Patient-centered: consideration of individual patients’ and society’s preferences and
values
o Equitable: implies considerations of fairness so that, in some circumstances,
individuals will receive more care than others to reflect differences in their ability to
benefit or in their particular needs
Lack of consensus
- Literature on quality of care is extensive
- Quality of care is defined in many different ways
- Two types of definitions
- Some definitions are more influential than others
Why do you need a definition for quality management?
- Common understanding
- Guides the operationalization and measurement
- Influences the choice of interventions and policies
What are quality indicators?
Assessing quality of care
Quality indicators: indicators to measure/evaluate quality of care
- A measurable element of practice performance for which there is evidence or consensus that
it can be used to assess quality of care, and hence can change the quality of care provided
(Campbell, 2002)
How do you measure quality of care and how can it be assessed?
Quality assessment
Quality of care has been defined in many different ways. Several authors have defined quality of care
by describing the concept according to a set of dimensions, such as safety, effectiveness, etc. These
dimensions are, however, neither comprehensive nor mutually exclusive. In addition, there are
different levels at which quality of care can be addressed.
In the last two decades growing attention has been paid to quality management in healthcare. Policy
reports and articles in leading journals frequently highlight important problems in healthcare
delivery, related to underuse, overuse and misuse of care. Reports such as ‘To Err is Human’ and
‘Crossing the Quality Chasm’ of the Institute of Medicine (US), have stimulated health care
professionals and policymakers worldwide to put quality management issues high on their agendas.
In the literature on quality of care, various terms are used to describe quality management, such as
quality assurance and continuous quality improvement. These approaches have in common that they
are all aimed at assuring the quality of healthcare by monitoring healthcare performance and
improving it when necessary. Assessment is important.
Practical application (to be discussed during the post-discussion of case 3)
A patient, a doctor and a manager of a hospital participate in a survey on quality of care. They are
asked to rank the dimensions of quality of care from ‘most important’ to ‘least important’, and to
provide a rationale for their ranked dimensions.
Now imagine that you are the patient, the doctor and the manager. Rank the dimensions of quality of
care for each of them and provide a rationale for each of the rankings.
Patient
- Safe
- Effective
- Timely
- Patient-centered
- Equitable
- Efficient
Doctor
- Effective
- Safe
- Patient-centered
- Efficient
- Timely
- Equitable
Manager
- Efficient
- Safe
- Equitable
- Effective
- Timely
- Patient-centered
What is the definition of ‘quality of care’?
Quality of care
Defining quality of care (Legido-Quigley, 2008)
Two influential definitions
, - Donabedian (1980): Quality of care is the kind of care which is expected to maximize 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
- Institute of medicine (1990): 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
Differences between definitions of Donabedian and IOM
- The IOM has
o Narrowed down their definition from improving total patient welfare to improving
health outcomes
o Shifted the focus from patients to individuals and populations
o Added consideration of the perspective of the care receiver
o Added consistency of care with current standards
Which dimensions of quality of care are there?
Definitions distinguishing various dimensions of quality of care
- The 6 dimensions used by the IOM have been especially influential
o Effective: the extent to which the intervention in question produces the intended
effects
o Efficient: the extent to which objectives are achieved by minimizing the use of
resources
o Timely: receiving treatments within a reasonable time frame
o Safe: the reduction of risk
o Patient-centered: consideration of individual patients’ and society’s preferences and
values
o Equitable: implies considerations of fairness so that, in some circumstances,
individuals will receive more care than others to reflect differences in their ability to
benefit or in their particular needs
Lack of consensus
- Literature on quality of care is extensive
- Quality of care is defined in many different ways
- Two types of definitions
- Some definitions are more influential than others
Why do you need a definition for quality management?
- Common understanding
- Guides the operationalization and measurement
- Influences the choice of interventions and policies
What are quality indicators?
Assessing quality of care
Quality indicators: indicators to measure/evaluate quality of care
- A measurable element of practice performance for which there is evidence or consensus that
it can be used to assess quality of care, and hence can change the quality of care provided
(Campbell, 2002)
How do you measure quality of care and how can it be assessed?
Quality assessment
