1. Quality, safety and diversity in
healthcare
Dr Charles Shaw

2. Dimensions of quality
1980s, Maxwell OECD 2015
Equity Patient-centredness
Access Patient safety
Effectiveness Clinical effectiveness
Efficiency
Appropriateness
Acceptability

3. Quality trends in healthcare
• Quality assurance
• Evidence-based medicine
• Rights of patients
– Families, clients, customers
– Charters of rights
– Accreditation standards
• Patient safety
– Risk assessment
• Performance management
• Universal health coverage

4. Evidence-based medicine
• Economic evaluation, cost-benefit
• Balancing individual versus population benefit
• Priority for issues with high cost, high risk, high volume
– or wide variation
• Clinical guidelines for sharing with patients
• Bias of biomedical research to Caucasian population
– Ethnic variation

5. Cultural influence on standards
• Social
– Screening for neural tube defects
– Consent to treatment
• Legal
– Informed consent, competence and language
• Governmental
– Transparency, empowerment, command and control

6. Conclusion
• “Responsiveness” of healthcare to individuals and
populations is a common priority in systems
• Clinical quality and patient safety aim to be based
on evidence of risk and benefit
• Evidence-based health policy?