Defining Goodnquality Health Services Chap 18

Question 1

Quality trade offs

Answer 1

It is not possible to maximize all four attributes of health services. For example, if you wanted to achieve equity of access to care (e.g. everyone has a health centre within 1 kilometre of their home), the health system would be very expensive (as there would have to be health centres even in remote areas with just a few scattered homesteads). So equity would only be achieved by sacrificing efficiency. Similar trade-offs occur between all four attribute.

In many ways, the decision a society has to make is not ‘what are the features we want in our system’ but ‘what are the shortcomings that we can accept and put up with (e.g. some lack of equity to ensure greater efficiency).’

Question 2

Quality improvement

Answer 2

Quality improvement is a systematic approach to achieving agreed standards of care. It is a continuous process or cycle involving selecting a topic, establishing criteria of good quality, setting standards, assessing quality and implementing change.

1. Topic selection (narrow)
2. Establish a criteria of good quality (statements or objectives of what constitutes good quality care: objective, measurable and acceptable.
3. Setting standards
4. Quality of the service needs to be assessed

Whilst carrying out these steps a group of individuals should be chosen: they are meant to disclose any possible interest issues to the matter and evaluate how they see the situation.

And the best way, initially, to find out why poor quality exists is to talk to those providing the service. It is essential to consult not only the leading members of staff but also those in supporting roles, such as receptionists and porters. Often the ‘discovery’ of a quality problem will not be a surprise to those involved and, if you’re lucky, the staff will also be able to advise on how it can be corrected.

Question 3

What criteria would you use to decide whether an existing guideline is suitable for your purposes?

Answer 3

The sorts of issues you might have considered are as follows: 1 Is it up-to-date? Research evidence accumulates rapidly in some fields. 2 Is it relevant to my country? Guidelines have to be relevant to the context in which they are going to be adopted, such as the level of health care expenditure or religious beliefs. 3 Is it of good quality? Has it been developed using accepted methods, such as incorporating the available research evidence? 4 Will it be credible or acceptable to local policy-makers and practitioners? Are the developers well respected? Did the developers have any conflict of interest?

Question 4

Preparing for quality improvement

Answer 4

Do a systematic review

Question 5

What is good quality?

Answer 5

To summarize, the four attributes are:
• effectiveness – does the intervention achieve the intended benefit?
• equity – is the intervention available to all who could benefit from it?
• humanity – is care acceptable to patients?
• Efficiency – is care provided in a way that ensures the greatest benefit at least cost?
Sustainable -