quality in healthcare

Question 1

what are the 6 dimensions of quality in healthcare?

Answer 1

-effectiveness - delivering health care that is evidence based
-efficiency
-safety
-patient centered care - takes into account the preferences + aspirations of the individual
-equity / equal for all races gender etc
-accessibility - timely, geographically reasonable etc

Question 2

how can we ensure quality in health care at a national, organisational and local level?

Answer 2

national level
-clinical audit
-HSE - key performance indicators eg average time of hospital stay
organisation level
-quality reviews
-accreditation eg CORU
local level
-standards/audits
-clinical guidelines
-clinical outcomes

Question 3

what are the functions of the health information and quality authority?

Answer 3

-setting standards in health and social services eg hygiene standards
-monitoring healthcare quality
-social services inspectorate
-health technology assessment
-providing health info and resources

Question 4

what is a key performance indicator (KPI)?

Answer 4

which means a quantifiable measure of performance over time for a specific objective

Question 5

what is an example of a KPI?

Answer 5

the number of patients that are waiting for more than 6 hours in the emergency department for admission to a hospital bed

Question 6

what are examples of health performance metrics?

Answer 6

-access- waiting times
-integration - are services patient centered?
-resources - best use of its human and financial resources, use of budgets

Question 7

what are examples of health performance metrics and targets?

Answer 7

Question 8

what is accreditation?

Answer 8

means a process involving a measurement of performance of a institution against a set of pre-determined standards
-usually conducted by an authorised body of external agency
-eg educational institutions -schools of physio by ISCP/ CORU

Question 9

what are standards?

Answer 9

something that is established for use as a rule or basis of comparison in measuring quantity, quality , value etc
-healthcare standards provide rules or minimum requirements for clinical practice

Question 10

what are the 3 different criteria to meet standards?

Answer 10

-structural criteria
-process criteria
-outcome criteria

Question 11

what are examples of structural criteria?

Answer 11

-skills
-buildings
-equipment
-staffing rations

Question 12

what are examples of process criteria?

Answer 12

-referral pathways
-prescribing patterns

Question 13

what are examples pf outcome criteria?

Answer 13

-patient satisfaction
-clinical outcomes

Question 14

what are the CORU standards of proficiency?

Answer 14

-professional autonomy and accountability
-communication, collaborative practice and teamworking
-safety and quality
-professional development
-professional knowledge and skills

Question 15

define a clinical audit

Answer 15

a clinically led quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and to act to improve care when standards are not met

Question 16

what does autonomy and accountability mean?

Answer 16

-professioanl autonomy = the ability of professionals to make independent, informed decisions based on their knowledge, skills, and expertise
-Professional accountability is the obligation of individuals to answer for their actions, decisions, and outcomes in their professional roles

Question 17

what’s the difference between research and audit?

Answer 17

-research generates the knowledge used for the audit, may involve placebo and random allocation and identifies the best form of Rx/ practice
-audit raises questions to be answered by research, no random allocation or placebo, it is an ongoing process and tests whether things are being done the right way

Question 18

what is the job of the national office of clinical audit?

Answer 18

• to constantly review clinical practice - measure structures, processes & outcomes to make improvements

Question 19

what are integrated care pathways?

Answer 19

-ICPs define the expected course of events in the care of a patient with a particular condition within a set time scale
-ie a pre-defined plan of patient care relating to a specific diagnosis or operation

Question 20

what are examples of conditions used in ICPs?

Answer 20

-acute myocardia infarction
-stroke
-DVT
-THR
-TKR
-management of femur fracture
-surgical procedures

Question 21

what are benefits of care pathways?

Answer 21

-encourages review of current practice
-improves resource utilisation
-builds best practice into everyday care
-improves patient information and encourages involvement
-promotes MDT collaboration

Question 22

what are the barriers / risks of integrated care pathways?

Answer 22

-ICP may not suit all patient types - must use clinical judgement
-may be seen as prescriptive
-ensuring to update the ICP as new evidence emerges

Question 23

what are clinical guidelines?

Answer 23

systemically developed standards which assist clinicians and patients in making decisions about appropriate treatment for specific conditions

Question 24

what are the uses of clinical guidelines?

Answer 24

-reducing inappropriate variation in practice
-as a tool for implementation and evaluating evidence based practice
-a tool for learning

Question 25

what is NICE?

Answer 25

the national institute clinical excellence - its a organisation in the UK responsible for providing national guidance on promoting good health and preventing and treating ill health

Question 26

what are examples of topics for NICE guidelines?

Answer 26

-guidelines on:
RA
LBP
stroke
stroke rehab
OA
COPD
respiratory tract infections

Question 27

what is the difference between a quality standard and a clinical guideline?

Answer 27

-a standard is established for use as a rule or basis of comparison for measuring quantity, quality or value - so eg a healthcare standard provides rules or min requirements for clinical practice
-clinical guidelines are systematically developed statements which assist clinicians and patients in making decisions about appropriate Rx for their condition

Question 28

what are the uses of an ICP?

Answer 28

-outline roles of MDT
-promote evidence based practice
-improves organisation and efficacy of care

Question 29

what are the advantages and disadvantages of ICPs?

Answer 29

advantages
- MDT collab
-reduces variation in Rx
-improves patient info
disadvantages
-may not suit all patients
-may not have the time
-may be seen as prescriptive