2. Quotes:
"Quality is never an accident; it is always the result of high intention, sincere effort, intelligent
direction, and skillful execution. It represents the wise choice of many alternatives."
William A. Foster, Source Unknown
________________________________________
"Quality in a product or service is not what the supplier puts in. It is what the customer gets out
and is willing to pay for."
Peter F. Drucker
Innovation and Entrepreneurship: Practice and Principles, p.228
________________________________________
"Quality is free. It's not a gift, but it is free. What costs money are the unquality things - all the
actions that involve not doing jobs right the first time...."
Philip B. Crosby, Quality Is Free
3. Definitions of Quality in HealthCare
Quality
1. Quality means having a high degree of excellence
2. Quality means doing the right things right the first time (and every time).
3. Standards are created when experts are able to understand what the right
things are and how the right things are best achieved. So quality can be
said to be, at least in part, compliance with standards.
4. When recipients define quality, they judge whether or not the right things
are done in ways that meet their own needs and expectations.
4. • The Juran Institute: defines quality as both:
1.
"Freedom from deficiencies": A deficiency is any avoidable intervention required to achieve an equivalent
patient outcome.
• Examples:
-
Healthcare-associated (nosocomial) infection, postoperative site infection
-
ED triage delay
-
Unscheduled return to ED/urgent care, surgery (inpatient or outpatient)
-
Managed care treatment authorization delay
-
Excessive wait time (physician office, ancillary service, ED, nursing care)
-
Lost lab results, X-Rays, medications, patient belongings
-
Cold meals (acute care, long-term care, adult day care, residential care, home
care)
-
Premature discharge or release from treatment (acute care, skilled or sub acute
care, long term care, partial hospitalization, ambulatory surgery, home care)
5. •
"Product features": Both services and goods that attract and satisfy
patients, meet customer expectations, and distinguish one practitioner
or organization from others.
• Examples:
-
Case management/care coordination
Pleasant waiting area (with current magazines)
Knowing what to expect
Knowing all treatment options
-
Computerized health record
Food access in room, as appropriate (acute care, long term care,
home care)
Follow-up care (telephone queries, clear instructions, home care,
return visits)
-
•
JURAN : Fitness For Use
6. IOM: Quality of Care
Quality Defined by:
1.
The Institute of Medicine
2.
U.S. Joint Commission
3.
The Joint Commission International
Defined As:
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.
7. AHRQ: Quality Healthcare
The U.S. government Agency for Healthcare Research and Quality
(AHRQ)
Defines quality healthcare as healthcare that is “...accessible, effective, safe,
accountable, and fair...."
This means:
• Providers deliver the right care to the right patient at the right time in the right
way.
• Patients can access timely care, have accurate and understandable information
about risks and benefits, are protected from unsafe health care services and
products and have reliable and understandable information on the care they
receive.
• Both patients and clinicians have their rights respected.
8. Three Aspects of Quality - The "Map"
•
Measurable quality
Compliance with, or adherence to, standards.
We assume that quality can be adequately, if not completely,
measured-once clinical practitioners define the standards of care
under which they can comfortably practice and the healthcare
field acknowledges the applicability of what become essentially
community standards.
Clinically these standards may take the form of practice
guidelines or protocols, or they may establish acceptable
expectations for care processes and patient outcomes. Such
standards also set expectations for organization performance.
Performance measures or indicators are measurement tools.
Acceptable compliance with standards is now the basis for
granting healthcare organizations licensure and/or accreditation,
certification, awards, and, in some cases, reimbursement. At
their best, however, standards serve as guidelines for
excellence.
9. • Appreciative quality
Is the comprehension and appraisal of excellence beyond minimal
standards and criteria, requiring the sometimes even non-articulate
judgments of skilled, experienced practitioners and sensitive, caring
persons.
Peer review bodies rely on the judgments of like professionals in
determining the quality or nonquality of specific patient-practitioner
interactions. Courts of law use "expert witnesses" to determine
whether professional behavior was "reasonable" or "negligent."
