Measurement and Quality Improvement
Published: 23 October 2019
Published: 23 October 2019
Quality. It’s something we all strive for. It’s the optimum level of care experienced by patients.
‘Measurement and Quality Improvement’ is the second component of Patient Safety and Quality Systems, as outlined by the Australian Government’s National Safety and Quality Health Service Standards (NSQHSS).
As part of the governance process of a health service patient safety and quality systems are created to advance the safety and the quality of patients’ care (Australian Commission on Safety and Quality in Health Care 2017).
The intent of measurement and quality improvement is to implement effective quality improvement systems that operate across the entire organisation.
The public’s perception of quality in healthcare has assessable consequences. There is growing evidence to indicate that people will avoid using services they deem as lacking in quality (Hanefeld et al. 2017) and that this is ‘a barrier to universal health coverage’, regardless of physical access to care (Berendes 2011).
According to the American Institute of Medicine, quality in a healthcare context is ‘the degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’ (Institute of Medicine referenced by AHRQ 2018).
Regular measuring of a system is essential to ensuring quality improvements allows a facility to determine the baseline level of current operational performance; establish goals for future performance; and monitor the impact of changes as they are made (Health Quality Ontario 2017). Metrics, when measured properly, can guide every decision made to ultimately improve the end product, in this case, patient care.
To be able to determine if goals have been met, it is first necessary to define the desired end outcome. Without a clear goal, established from the very start, it is very difficult to measure and recognise if the changes that were made have resulted in improvements – or if they are just changes (Health Quality Ontario 2017).
A measurement plan should contain the following (at a minimum):
(Health Quality Ontario 2013)
The plan must be reviewed frequently. Rather than displaying data in a standard pre/post-implementation way, plot the data over time (for example, by month) for a clearer picture of how the changes are affecting outcomes. This process should be actively shared with staff to create momentum on an organisation-wide scale (Health Quality Ontario 2017).
Quality measurement is a type of evaluation, it requires a tool to carry it out. An effective quality measurement tool must:
(AHRQ 2018)
(AHRQ 2018; Health Quality Ontario 2013)
Six important considerations for designing measurement systems:
(Hanefeld 2017)
The presence of measurement and quality improvement in the Australian Commission Safety and Quality in Health Care (ASQHC)’s National Safety and Quality Health Service Standards implies its importance and represents a gap present in Australian facilities or services. The NSQHS Standards identify two missions for facilities in terms of measurement and quality improvement
1. The health service organisation should use organisation-wide quality improvement systems that:
(Australian Commission on Safety and Quality in Health Care 2017)
And:
2. An organisation must ensure that timely reports on safety and quality systems and performance are provided to the following four parties:
(Australian Commission on Safety and Quality in Health Care 2017)
To up-scale health interventions, it is necessary for facilities to recognise the multifaceted nature of quality of care. Technical quality must be increased but equally crucial is better acceptability and a shift toward greater patient-centred care (Hanefeld 2017).
The outcomes of care quality improvement should be tailored specifically to the needs of the community the facility exists in.
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Question 1 of 3
True or false? The public’s perception of a facility’s quality is a barrier for accessing care.
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