Quality Movement In Health Care Research Articles

Patient Safety: A Deep Concern to Caregivers.

Patient safety is a global concern and is the most important domains of health-care quality. Medical error is a major patient safety concern, causing increase in health-care cost due to mortality, morbidity, or prolonged hospital stay. A definition for patient safety has emerged from the health care quality movement that is equally abstract, with various approaches to the more concrete essential components. Patient safety was defined by the IOM as "the prevention of harm to patients." Emphasis is placed on the system of care delivery that prevents errors; learns from the errors that do occur; and is built on a culture of safety that involves health care professionals, organizations, and patients. Patient safety culture is a complex phenomenon. Patient safety culture assessments, required by international accreditation organizations, allow healthcare organizations to obtain a clear view of the patient safety aspects requiring urgent attention, identify the strengths and weaknesses of their safety culture, help care giving units identify their existing patient safety problems, and benchmark their scores with other hospitals.

Quality of Work Life and Organizational Performance

Background The quality movement in health care has recognized better quality of work life (QWL) of employees as an important rubric for a health care organization’s performance. Health care employees are the front lines of the health care delivery system. However, studies on the QWL of private health care unit’s employees are limited. Methodology This research investigates the relationship between QWL, organizational performance (OP) and employee commitment (EC). A self-designed questionnaire was distributed to 300 health care employees. Out of which only 205 valid responses were received resulting in a response rate of 68 per cent from the survey. The data were analyzed using SPSS 20. Results The findings show that EC acts as a partial and a significant mediator in the relationship between QWL and OP. Mediation analysis was also conducted for each dimension of QWL, EC and OP to reinforce the results. Conclusions and Recommendations Findings can be used by health care units’ managers and policy makers to design and implement appropriate initiatives to improve QWL. Better QWL is the key to attract and retain qualified and motivated employees and can possibly lead to enhanced quality of services in health care organizations.

Quality and Safety in Health Care, Part I: Five Pioneers in Quality.

Five pioneers had a huge impact on the quality movement in health care in the United States. Ernest Codman contributed in many ways, including his focus on outcome analysis. Avidis Donabedian is known for his focus on the 3 domains of structure, process, and outcome in health care. Walter Shewhart is known especially for the control chart and early work on what W. Edwards Deming made into the PDSA cycle. Deming is also known for other contributions, including his 14 points of management, correcting system problems rather than blaming the workers, and his System of Profound Knowledge. Juran is known for the Pareto principle and his emphasis on customer satisfaction and addressing the human, not just statistical side, of quality improvement.

Why should and how can hospitals improve their organizational health literacy?

In late modern "multi-option" and "health" societies, health literacy (HL), understood as a specific competence, is considered necessary to successfully deal with the multitude of health relevant decisions and tasks to be taken every day. The concept has been used in the US, primarily in healthcare, to research the consequences of HL on the outcome of treatment specifically in patients with limited HL. In this context, it became evident that HL has to be understood as a relational or contextual concept. That is, the adequacy of HL does not only depend on personal HL, but equally on the demands organizations put on their users. This understanding of HL opened the road to measure not only individual HL, but also the HL sensitivity of organizations, i.e. organizational HL, and to use targeted measures to improve it. The ten attributes of a health-literate healthcare organization, as defined by the US Institute of Medicine, are a first systematic attempt to use this strategy in healthcare. In the meantime, the strategy has been used in other settings as well. Using experiences from health-promoting hospitals and the quality movement in healthcare, the authors develop this approach further into the comprehensive Vienna concept of the health-literate hospital, which considers all stakeholders and tasks of the hospital which are relevant for HL. A self-assessment tool was developed and tested as a basic instrument for developing a health-literate hospital. By doing so, hospitals are empowered to make a contribution to the promotion of HL as an important societal task.

Brief history of quality movement in US healthcare

The current healthcare quality improvement infrastructure is a product of a century long experience of cumulative efforts. It began with an acknowledgement of the role of quality in healthcare, and gradually evolved to encompass the prioritization of quality improvement and the development of systems to monitor, quantify, and incentivize quality improvement in healthcare. We review the origins and the evolution of the US healthcare quality movement, identify existing initiatives specific to musculoskeletal care, outline significant challenges and opportunities, and propose recommendations for the future. Elements noted to be associated with successful healthcare quality improvement efforts include the presence of physician leadership, infrastructural support, and prioritization of healthcare quality within the culture of the organization. Issues that will require continued work include the development of a valid and reliable evidence base, accurate and replicable performance measurement and data collection methods, and development of a standard set of specialty specific performance metrics, with accurate provider attribution, risk adjustment and reporting mechanisms.

Defining “quality of care” persuasively

As the quality movement in health care now enters its fourth decade, the language of quality is ubiquitous. Practitioners, organizations, and government agencies alike vociferously testify their commitments to quality and accept numerous forms of governance aimed at improving quality of care. Remarkably, the powerful phrase "quality of care" is rarely defined in the health care literature. Instead it operates as an accepted and assumed goal worth pursuing. The status of evidence-based medicine, for instance, hinges on its ability to improve quality of care, and efforts are made by both proponents and detractors to unpack the contents and outcomes of evidence-based practice while the contents of "quality of care" are presumed to be understood. Because the goals of medicine are far from obvious, this paper investigates the neglected term, "quality of care," in an effort to understand what it is that health care practices are so uncritically assumed to be striving for. Finding lack of consensus on the terminology in the quality literature, I propose that the term operates rhetorically by way of persuasive appeal (and lack of descriptive meaning). Unsatisfied that "quality of care" operates as a mere buzzword in morally contentious debates over resource allocation and duties of care, I implore health care communities to go beyond mere commitments to quality and, instead, to focus attention on the difficult task of specifying what counts as quality care within an economically constrained health care system.

Pay-for-Performance Principles That Promote Patient-Centered Care: An Ethics Manifesto

Pay-for-performance programs are growing, but little evidence exists on their effectiveness or on their potential unintended consequences and effects on the patient-physician relationship. Pay-for-performance has the potential to help improve the quality of care, if it can be aligned with the goals of medical professionalism. Initiatives that provide incentives for a few specific elements of a single disease or condition, however, may neglect the complexity of care for the whole patient, especially the elderly patient with multiple chronic conditions. Such programs could also result in the deselection of patients, "playing to the measures" rather than focusing on the patient as a whole, and misalignment of perceptions between physicians and patients. The primary focus of the quality movement in health care should not be on "pay for" or "performance" based on limited measures, but rather on the patient. The American College of Physicians hopes to move the pay-for-performance debate forward with a patient-centered focus--one that puts the needs and interests of the patient first--as these programs evolve.

Defining the volume-quality debate: is it the surgeon, the center, or the training?

The quality movement in health care is ubiquitous in our society. The volume-quality debate is a central component of this that affects surgeons. In colorectal surgery and other fields, studies have demonstrated improved outcomes for patients having care provided at higher volume centers. What is unclear about this relationship however, is whether this improvement is related to the center, the surgeon, or the surgeon's training and experience. Some studies have tried to better examine this relationship and have suggested that limitations in administrative data may exaggerate the impact of a high-volume center. The use of crude mortality as the primary outcome instead of more specific outcomes such as cancer recurrence, inadequate risk data, and the failure to account for clustering of cases are other important limitations. Although higher volume likely equates to higher quality in some form, this may be more related to surgeon-specific factors rather than high-volume centers alone. The role of subspecialization, especially colorectal-trained surgeons with a high individual case volume may be the most important predictor of higher quality in colorectal surgery. This relationship may be especially important for the treatment of rectal cancer. The relationship of volume to outcomes is difficult to understand, and to appropriately answer these questions will require the collection and analysis of comprehensive, risk-adjusted data after adequate outcome measures are defined. This will only occur with significant institutional support, and a commitment to follow outcomes longitudinally and implement necessary changes to improve outcomes.

Quality and standards in health care

SynopsisThe chapter describes the professional and regulatory landmarks which have influenced the development of the quality movement in health care in the UK and the USA. They reflect the similarities and differences in the approach to quality which have evolved within the National Health Service in Britain when compared with a free market system of health care such as that in North America.A conceptual framework is used to approach the definition and assessment of quality of health care, noting in particular Donabedian's seminal triad of structure, process and outcome as well as the outcomes movement and other theoretical approaches to defining quality.The characteristics of criteria, standards, guidelines and protocols are described and the terminological problems in this field are discussed. The use of standards for improving quality includes their application in clinical audit, for accreditation and re-accreditation, in contracting for health services and in regulation and inspection.There is a new and unfolding relationship between clinical standard setting and management. Concepts such as continuous quality improvement and total quality management are challenging traditional assumptions about the need for a separation between professional, consumer and managerial approaches to improving quality. The National Health Service, following implementation of an internal market for public health care provision in Britain, is well placed to absorb and synthesise the many differing philosophies in the health care quality movement to the benefit of both patients and the health professions alike.