Quality is very important with relation to healthcare. It has to be measured not only to evaluate healthcare, but also to improve it. There are many stakeholders with relation to quality of healthcare including the patients, healthcare providers, healthcare professionals, investors, consumers, purchasers, accreditation organizations, etc. One hospital may provide better services than another for a particular disease or condition, whereas another may provide better services with relation to a diagnostic test or treatment process. Hence, quality needs to be intricately measured.
Several quality alliance firms are gathering information and providing data to others about the quality standards that prevail in the hospitals (HHS, 2008). However, consumers, patients and healthcare providers have their own methods and ways of measuring quality and choosing options put forth to them. The stakeholders need to give greater importance to different ways in which various parties would measure quality. Measuring quality of care for the patient Today patients and consumerism play a very important role in determining and developing the quality standards in healthcare.
The patient would be acquiring information about quality standards of a particular hospital or physician from various sources including the internet, other patients, etc. Besides, the patient would also place his or her own experiences in evaluating the quality of care provided by the physician or the healthcare organization. A patient would understand quality as the ability of the service to achieve a satisfactory level rather than the service being superior to similar services provided by other healthcare organizations.
Frequently, the quality standards for patients are referred to as patient satisfaction. However, there are a huge number of differences between patient satisfaction and quality. Patient satisfaction would include many aspects such as ways in which healthcare is delivered, the nature and effectiveness of the treatment, information provided to the patient, ability to meet with the consent guidelines, ability of the patient to make an informed decision, ability of the patient to exercise greater amount of choices and autonomy, etc.
On the other hand, quality is something much greater than patient satisfaction and often involving a significant portion of patient satisfaction. Patient satisfaction is also an important criterion in determining the quality of care, but overall quality of care is a scientific assessment of the healthcare data and outcomes. It may be too technical for the patient to assess and understand what quality would actually mean. Patients would often ignore the importance of technical quality with respect to treatment.
Frequently, the patient would consider only the aspects that are visible to him including interaction between the providers and the patient, the general environment in the healthcare organization, etc. If the outcomes are positive, there would also be a greeter impact on patient satisfaction. Studies have demonstrated that if the patient satisfaction levels are high and if the quality standards of the organization as perceived by the patients are good, then there are every chance that the patient would return to the same healthcare organization for treatment in the future.
On the other hand, if the patient satisfaction levels are low and if the patient perceived quality of care are poor, then there is every chance that the patient would sue the healthcare organization (and the information would spread preventing other patients from visiting the same hospital or practitioner). Besides, good perceived quality of care by the patients would mean greater cooperation in treatment, greater tolerance of adverse effects and greater compliance with treatment (Allison, 2008).
Cunningham 1991 tried to breakdown the various components of quality that the patient may consider important. These included:- • Ability to provide good patient care such as compassion, nursing assistance, affection, understanding, etc • Responsiveness which is the ability to respond to calls from the patient or answering their queries • Good doctors which refers to the ability of the doctor to understand the problem of the patient and solve them appropriately • Good reputation refers to the impression of the healthcare organization provided through feedback from others or news reports
• Updated use of equipment means the ability of the organization to utilize the latest technology and equipment for treating the patient (which are more effective than use of older technology) • Cleanliness and tidiness • Provision of adequate amount of food and nutrition • Reducing the amount of noise and turmoil that may be negative to the recovery of the patient • Provision of prompt and accurate billing (Allison, 2008). The patient satisfaction levels and perceived quality standards can depend on two types of factors, namely clinical factors and non-clinical factors.
Some of the clinical factors include provision of updated equipment and drugs, ability of the organization to comply with accreditation standards, quality standards, use of modern treatment techniques and diagnostic tests, etc. Some of the non-clinical factors include staff being courteous and compassionate, ability to respond to their demands, ability to exercise autonomy, etc. Frequently it is found that the non-clinical factors play a major role and are more important than the clinical factor, when considered by the patient (Allison, 2008).
Studies have demonstrated that may untrained people who practice quackery and do not have significant amount of medical knowledge and practice various streams of alternative medicine, may be able to achieve a high level of patient satisfaction, primarily because they are able to listen to the problems faced by the patient, understand them and offer various options to comfort the patient (Ryaner, 1999). Measuring quality of care from the provider’s perspective It is very obvious that the providers have to be included in any program in which the quality of care would be assessed.
The healthcare providers would require measuring the quality of healthcare in order to determine its appropriateness and validity. The professionals who administer healthcare need to utilize their professional skills to analyze and interpret the process of delivering healthcare. The process of assessing the quality of healthcare requires a lot of judgment and options being exercised. One way of assessing quality is to develop certain guidelines and implement them.
The ability to determine how these guidelines are implemented and achieve the desired outcome needs to be checked through the use of performance measures. It is important to note that performance measures are not practice guidelines by themselves, but are measure to determine if the guidelines are implemented and the ability of the guidelines to achieve the desired outcome. Performance measures play a vital role in quality assessment, and it is more often used by the providers to determine the quality standards in the organization.
The practice guidelines would be made based upon certain evidence-based criteria. Each and every process concerned with the management of the patient including examination, history-taking, diagnosis, investigations, treatment, follow-up, etc, need to be considered as a part of the quality management process. Most of the practice guidelines that would be inscribed would be concerned with the diagnosis or treatment of the patient, and it is left to the physician to actually use these guidelines in the management of the patient, based on their discretion.
On the other hand, performance measures do not suggest the ability of the providers to stick to the guidelines, but are vital indicators suggesting the errors performed during management. Performance measures as quality indicators not only need to suggest the presence of errors but also suggest the appropriate action that needs to be taken in specific situations (AHA, 2000). Providers as such need to utilize strong performance measures or quality indicators that are well connected to the practice guidelines.
The practice guidelines and the performance measures are strongly build upon evidence-based literature. The development of performance measures should be a combined effort from various organizations including the healthcare providers. All performance measures and practice guidelines need to be utilized in various situations that may be applicable clinically. As such it may be very difficult to implement such measures in the most extraordinary situations. From the very start of the development of the practice guidelines, the providers can use clinical experience as well as the latest research findings.
The use of the practice guidelines would also require further developments and modification so that research findings can be implemented and that results obtained through previous implementations can be accommodated. The development of the practice guidelines would also require continuous development and subsequent implementations of performance measures to assess how well the practice guidelines are being implemented. The performance measures should be utilized to determine if the intervention is able to achieve what it is supposed to obtain and also determine the patient satisfaction, adherence and compliance levels.
The experts would be able to suggest the strong indicators that can be used to determine the implementation of evidence-based ideas into clinical practice (AHA, 2000). The process for determining the quality, would involve several steps including collection of data of the patient’s condition, determining if the patient is a good candidate for performance assessment, collecting information of the use of practice guidelines and performance assessment, evaluating the data obtained, and presenting the results. In all these steps, the role of the healthcare professionals is very important.
The process of quality assessment also includes meeting several challenges such as poor data sources, inconsistencies in documenting the data, absence of a medical record system, etc. Again the role of the healthcare professionals and the providers are vital in developing work-around solutions for these problems (AHA, 2000). Measuring quality of care from the purchaser’s perspective In today’s age of consumerism, decisions regarding choosing the healthcare provider, plan and the treatment mode are very important.
A purchaser may have to choose a health plan or a healthcare provider either for himself, family, relatives, employees or the entire organization. An important aspect for all purchasers with regards to healthcare would be the ability to access information. Based on the information, the purchaser can make a decision of the manner in which the helath of self or the employees can be improved or sustained. Frequently, performance measures would be utilized by the purchaser in determining the health information.
The other frequent ways in which quality would be determined including consumer ratings, accreditations, advertisements, clinical ratings, etc. A purchaser would be mostly looking for quality and value for money whilst choosing healthcare. Purchasers also feel that if the quality standards are high, then the outcome or the prognosis of the illness would be positive. Several public and private players are developing ways and means of helping them identify the plan or the hospital that provides top quality healthcare.
For the purchaser, quality plays a role in exercising options and selecting the best option. The AHRQ has developed a checklist to help the purchaser choose the most appropriate plan, doctor, or hospital through determining certain criteria:- • Rating by other users • Accreditation • Meeting the appropriate needs of the users • Custom-made plans • Within the limits of cost • The staff meets the training and experience requirements • Preventive healthcare is followed • Greater amount of listening to the patient • Treating the patients with compassion and empathy
• Autonomy and respect of the patient • Patient is informed of the benefits, risks and options before any intervention • The performance measure for treating a required condition is good • Constant efforts in improving the quality in a particular organization (AHRQ, 2008). The purchaser may also look on the internet for health information and health education in order to identify those hospitals, practitioner or plans that provide top-quality healthcare. However, it is important that before using such information, the nature and the content of the information is thoroughly reviewed.
In the past, health information existent on the internet has created a lot of disasters with users. The purchaser would have to ensure the credibility, currency, authority and purpose of the health information. If the data is used inappropriately, it can lead to a lot of disasters. The very purpose of seeking quality healthcare would be lost (AHRQ, 2008). Conclusion Overall, there are many aspects of quality that need to be considered. A hospital or a healthcare provider needs to give importance to all these aspects of healthcare.
The consumer may consider non-technical data which is important, whereas the health professionals would be giving importance to the ability to meet the performance measures. However, each stakeholder would be giving importance to different aspects of healthcare. The organization providing healthcare needs to consider all quality measures in order to achieve, maintain and further improve the quality standards. References AHA (2000). Measuring and Improving Quality of Care, AHA, 101: 1483. http://circ. ahajournals. org/cgi/content/full/101/12/1483 AHRQ (2008).
Your Guide to Choosing Quality Health Care, Retrieved on April 3, 2009, from Web site: http://www. ahrq. gov/consumer/qnt/ Allison, A. C. (2008). Managers and the new definition of quality, Retrieved on April 3, 2009, from Web site: http://www. entrepreneur. com/tradejournals/article/182976467. html HHS (2008). Quality Standards, Retrieved on April 3, 2009, from Web site: http://www. hhs. gov/valuedriven/fourcornerstones/quality/index. html Rayner, C. (1999). A patient’s eye view of quality, BMJ, 319: 525. http://www. bmj. com/cgi/content/full/319/7208/525