Quality HC Flashcards
Healthcare is the maintenance of improvement of health via the diagnosis, treatment and prevention of disease, illness, injury and other physical and mental impairments in human beings.
Healthcare is the maintenance of improvement of health via the diagnosis, treatment and prevention of disease, illness, injury and other physical and mental impairments in human beings.
Definition of quality healthcare: - WHO and US institute of medicine.
6 dimensions
1) Safe:
minimize risk and avoiding injuries to service users from the care that is intended to help them.
2) Effective:
Providing healthcare that is adherent to an evidence base and results in improved health outcome for individuals and communities, based on need (indication).
3) Patient-centered:
Providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions; consider cultures of their communities as well.
4) Accessible:
Ensure timeliness, reducing waits and sometimes harmful delays; ensure care is provided in the right setting where skills and resources are appropriate to the medical need.
5) Efficient:
Maximize resources use, avoid waste, including waste of equipment, supplies, ideas and energy.
6) Equitable:
Providing care that does not vary in quality because of personal characteristic such as gender, ethnicity, geographic location, and socioeconomic status.
Gist of quality of healthcare:
Gist of quality of healthcare:
- Meet the needs of patient/community
- Most effective – based on best evidence and provide best outcomes
- Minimize risk
- Maximize the use of resources.
It is not easy to provide quality healthcare due to the presence of barriers.
1) Rapid changes:
Medical science and technology have advanced at an unprecedented rate during the past half-century.
2) Growing complexity of health care:
More to know, more to do, more to manage, more to monitor, and more people involved.
3) Change in public health need:
aging population, people living with chronic diseases in the community.
4) Healthcare delivery is disorganized, complex and uncoordinated especially at transition of care, institutions working in silos: loss of information
How to ensure quality?
WHO has specific quality and safety approaches – 4 broad categories at a country level.
- Strengthen the role of patients/consumers and citizens:
The consumer approach can be enhanced through consumer protection or patients’ rights regulations, or through programmes to involve patients and communities in improving safety and quality in different ways. Some see co-payments by patients as a means of involvement. Community involvement program is also an example. - Regulation and assessment of health professionals and services:
A regulatory background and dedicated agencies (governmental or non-government) can institute accreditation and licensing services to providers. This may or may not involve making public lists of those licensed or accredited. To make sure system is safe and quality is taken care of. Practitioners need to undergo training. - Apply standards or guidelines locally: Implementation will require systems to supervise and encourage compliance (all external assessment processes use standards). This applies more to how local management defines safety and quality standards and ensures they are followed using quality management systems. This method can use agreed standards or guidelines developed by national or international bodies. To get everyone on the same page, by writing guidelines based on best practices / evidence. Need to ensure they are followed.
- Quality problem - solving teams:
The teams work on specific problems using simple methods (“quality tools”) which they have been trained to use. Examples are a team in a health centre working on appropriate prescription of antibiotics or improving medical records, or district officers working on the problem of lack of transport and resources for supervision. Sometimes methods are used by teams to describe and improve processes or patient pathways. To keep improving in person and healthcare system. Quality improvement efforts must be in place.
IOM has 10 approaches for redesign of health system level.
1) Care is based on continuous healing relationship (ACCESSABILITY)
2) Care is customized according to patient needs and values: (Pt centered)
3) The patient is the source of control (pt centered)
4) Knowledge is shared and information flows freely.
5) Decision making is evidence-based (EFFECTIVENESS)
6) Safety is a system property (safe)
7) Transparency is necessary (EQUITABLE)
8) Needs are anticipated.
9) Waste is continuously decreased. (effeciency)
10) Cooperation among clinicians is a priority (effectiveness)
Singapore healthcare philosophy
1) Ensure quality and affordable basic med service for all
2) Anchored on individual responsibility - copayment, pay more for more service
3) Achieve better health for all - promote healthy living , preventive health programme
beyond HC 2020
1) move beyong hospital to commuity
- so sgrean can rcv care inthe community nearer to home
2) move beyond quality to value
- to give q sgrean best value, while keeping our system sustainable.
3) Move beyond hc to health
- to help and support sgrean to lead healther lives.
sg hc financing
- Financing system anchored on the twin philosophies of individual responsibility and affordable healthcare for all
- Mixed financing system, use of market-based mechanism to promote competition and transparency.
Quality HC in sg
Singapore Legislative framework for quality
- Private hospitals and Medical Clinics Act.
- Professional registration and conduct
Singapore Non- Legislative framework for quality
- Introduce evidence-based clinical practice guidelines and practice standards
- First national survey done ( Monitoring patient satisfaction )
- Market-based mechanisms to promote competition and transparency
- Voluntary accreditation for Quality and safety Standards
Quality improvement mantra
- Will
- you must have the will to improve - Ideas
- you must have ideas about alternatives
to the status quo - exceute
then, you must make it real
Gap analysis in quality improvement
The first step in the journey toward improvement is to decide what needs to be improved or what you’d like to improve. - Gap analysis – find out what is wrong o Identify the existing process. o Identify the existing outcome(s) o Identify the desired outcome(s) o Identify and document the gap(s)
Plan do check act
Model for QI
- set an aim
- what is expected to happen. - Establish measure
- feedback to know if a specific change actually leads to an improvement - identify changes
- test changes using PDSA cycle
- implement changes
