Health Care Quality

health care quality

examining health care services at the individual and community level so the needs can be custom to the patient and health care options. health care professions need to be lifelong learners to keep up to date on constant new practices.

factors involved in health care quality

-patient preference

-culture

-patient quality

-cost of care

scope of health care quality relation

ranges from direct patient care to state policies, national, and international

scope of health care quality satisfaction

ranges from consistently poor care and poor patient outcome to perfection, always delivering error-free, high quality care, resulting in optimal outcomes

scope of health care quality variables

-direct patient interaction

-socioeconomic status

-behavior and cultural preferences

scope of health care quality: micro systems

smallest unit of health care - unit

scope of health care quality: meso system

relationship between healthcare personnel and place - department

scope of health care quality: macro system

policy making and overall structure of healthcare - hospital / clinic

attributes of quality

-safe

-timely

-effective

-efficient

-equitable

-patient-centered care

safety

avoidance of injuries; practice within standards of care

timely

reduction of wait time

effectiveness

offers services most important; addresses needs of populations served

efficiency

transitions are coordinated; monitors costs; minimizes length of stay; work done well and with fewer resources

equitability

same quality for all patients

patient centered care

consideration of patient needs

Donabedian Model

3 part model of structure, process, and outcome that identifies ways to define, categorize, and measure quality

Donabedian model pt. 2

defined outcomes are the validators of the quality and effectiveness of medical care

structure

characteristics of the setting in which the care is delivered

process

the health care provided and includes both the technical aspects of care and the interpersonal aspects of care

outcome

the effect of care on the health status of individuals or populations

core competencies (pt. 1)

-evaluate outcomes of care

-consider the socioeconomic effect of the delivery of health care

-integrate best evidence principles in care delivery

-apply quality improvement principles in care delivery

-contribute to a culture of patient safety

core competencies (pt. 2)

-perform effectively in different team roles, using principles and values of team dynamics

-optimize system effectiveness through application of innovation and evidence-based practice

-use information and communication technology to gather data, create information, and generate knowledge

Triple Aim

1. better care

2. healthy people/ healthy communities

3. affordable care

better care

improve the overall quality by making health care more patient-centered, reliable, accessible, and safe

healthy people/ healthy communities

improve the health of the US population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher quality care

affordable care

reduce the cost of quality health care for individuals, families, employers, and government

requirements for nurses

-understand and participate in activities that promote and ensure quality patient care

-identify unsafe practices and make changes to ensure safe outcomes

-understand the outcomes of care

-be lifelong learners

regulatory agencies

-Centers for Medicare and Medicaid Services (CMS)

-The Joint Commission (TJC)

-Occupational Safety and Health Administration (OSHA)

-Centers for Disease Control and Prevention (CDC)

-U.S. Food and Drug Administration (FDA)

-U.S. Department of Justice

-U.S. Drug Enforcement Administration (DEA)

Advisory Bodies

-National Academy of Medicine (formerly IOM)

-American Nurse Association (ANA)

-Institute for healthcare Improvement (IHI)

-National Quality Forum (NQF)

-Nursing- specific advisory bodies

Science of Improvement: 4 key principles

-understand the systems and processes

-focus on the customers (patients)

-build the teams

-use data to drive decision making

Quality Improvement (QI)

data-driven, formal approach to the analysis of performance and the systematic effects to improve outcomes and processes

Methods of quality improvement (QI)

-continuous quality improvement (CQI)

-six sigma (DMAIC)

-lean

-model for improvement

3 questions of model of improvement

1. what are we trying to accomplish?

2. How will we know a change is an improvement?

3. what change can we make that will result in improvement?

Plan-Do-Study-Act

cycles examine whether or not a proposed test of change actually results in the desired outcome

interrelated concepts

-wellness and resilience

-safety

-person-centered care

-technology and informatics