Quality Management in Healthcare
In order to measure productivity of any industry, it is important to take into cognizance the nature of the inputs and outputs. However, in measuring productivity, it is important to have and output indicator which can be quantified and which does not depend on the input measures. However, if an output measure depends on an input measure, then change in productivity cannot be ascertained (Mark, 1982). When taking this into cognizance, one would realize that measuring productivity in healthcare would not be as straight forward as quantifying the inputs and outputs.
Quality measurements are done for several reasons. Some of which are that it allows trends and characteristics to be quantified thereby making quality assessment easier to perform. In addition, it allows for assessment towards the achievement of global health standards. Furthermore, it allows for the identification of aspects of care that needs to be improved. It also allows informed choices to be made by patients.
The institute of medicine defined quality as the extent to which health services both individuals and populations increase the possibility of desirable health outcomes, which are on consonance with current professional knowledge. This definition can be translated in several ways (McGlynn, 2012). One of which is the fact that quality performance is a concept that occurs in a continuum with measures that can range from unsatisfactory to excellent. In addition, it can also be translated to mean that quality can be evaluated from both the perspective of populations and individuals alike. In addition, one can also interpret this to mean that research evidence must be utilized in identifying the services that lead to an improvement in health outcome. In addition, professional consensus can help in developing criteria for measuring quality, in the absence of scientific data. (McGlynn, 2012).
In measuring the quality of healthcare by healthcare providers, parameters such as the reduction in the number of medication errors (Needleman et al, 2002), the decrease in the rate of readmission of patients for the same condition (Hewitt et al, 2003), the rate of occurrence of complications of illnesses such as pneumonia (Needleman et al, 2002) reduction in the amount of patients who suffer falls when on admission, and reduction in the level of Nosocomial infection are some of the parameters that can indirectly measure quality of care from the perspective of the healthcare service providers. It will be discovered that there is a direct correlation between a reduction in the above parameters and good patient outcome. These parameters would also serve as yardsticks through which the efficiency of the healthcare service providers would be measured.
The joint commission is a non-profit organization, which is independent. It provides accreditation and certification for health care organizations and programs in the United States. According to their website, the accreditation and certification are recognized throughout the country as a seal of quality and an affirmation of the fact that an organization is committed to meeting certain performance standards.
Moreover, according to their website, the mission of the corporation is the improvement of health care for the public while collaborating with stakeholders. This it plans to do by collaborating with other stakeholders in achieving this aim. The corporation also seeks to inspire these health organizations to provide excellent service in the area of effective care with the highest value and quality.
The Joint Commission provides accreditation services for several types of health organizations, including hospitals (General Hospitals, Psychiatric hospitals, Children hospitals and Rehabilitation Hospitals), Critical Access Hospitals. Home Care Organizations, Nursing Homes including other long term care facilities among others.
Moreover, Joint Commission also awards Disease-Specific Care Certification to organizations that provide disease specific care services. It also provides advanced level Certification for chronic Obstructive pulmonary Disease, Chronic Kidney Disease, Heart failure, in-patient Diabetes and Primary Stroke Centers. Health Care Staffing Services Certification is also available.
The Joint Commission Standards and Survey Process involve the assessment of parameters such as patient rights medication safety infection control and patient treatment. The focus of the standard is on the setting of a benchmark for an organization's performance for all activities that border on the safety and quality care of patients.
In developing the benchmarks, the Joint Commission makes wide consultations with health care experts, measurement experts, consumers, purchasers and providers.
Another commission for accreditation of health care providers is the Accreditation Commission for Health Care (ACHC). ACHC is a national organization that is developed by health care industry providers. The corporation is a nongovernmental, non-profit organization, which seeks to ensure high quality standards in the area of in-home aide services.
According to the website, ACHC has been recognized as the leader in the accreditation of health care service providers, particularly in the area of Home Health, Hospice Pharmacy, Private Duty, Sleep laboratory or Sleep center and Behavioral Health homes.
The accreditation process involves obtaining the Standards, which are specific to the program, or service that the individual organization provides and upon the payment of a fee, the accreditation process is carried out. The process involves the organization preparing its preliminary evidence report and submitting the required documents. Afterwards, an estimate of the fee is made and after payment, a survey of the facility is scheduled. Thereafter, accreditation decisions are made and the accreditation status of the health care service provider is made known.
The Agency for Healthcare Research and Quality (AHRQ) is a subsidiary of the United States Department of Health and Human Services. Its major aim is the advancement of Excellence in Health Care. AHRQ does this by providing comprehensive regional and national data on a lot of statistics and trends that relate to community hospitals in the United States. These data are made public so that anyone can access the data for personal research. The Project is called HCUPnet, which is part of the Healthcare Cost and Utilization project (HCUP). Data is generated from several databases, including the nationwide inpatient Sample (NIS), the State Inpatient Databases (SID), the State Emergency Department Databases (SEDD) and the Kids' Inpatient Databases. the statistics provides and insight into the current state of the quality of healthcare in the various hospitals, the potential areas of improvement and ultimately, the policy changes that need to be put in place to ensure quality care.
The importance of quality measurement in health care is also underscored by the congressional passage of the Affordable Care Act. The affordable Care act seeks to increase access by all Americans to affordable health care that is at the same time, high quality. An initiative of the congress is the National Quality Strategy, which seeks to promote quality health, which is centered on taking care of the needs of individual patients, their families and the community at large. The quality strategy has as its broad aims, the improvement of the overall quality of care; improvement of the general health of the population by the use of evidence based interventions to address health issues with the view to provision of better quality care; reduction in the cost of quality health care of individuals, families, employers and the government at large. To advance these aims a set of priorities for improving health outcomes. these include making care safer by reducing harm caused in the delivery of care; ensuring that each individual is actively engaged as a partner in their care; promotion of effective communication among all stakeholders, including caregivers, patients and administrators; promotion of the most cost effective prevention and treatment practices against the most prevalent causes of mortality; liaising with communities for the promotion of best practices to ensure healthy living; providing affordable quality care for individuals, families employers and the government.
Another organization involved in the measurement of quality health outcome is the National Quality Forum (NQF). The organization is involved in the standardization of performance measurement. These measures include those that assess structure, processes, outcomes and patient perception of the quality of their care among other things (NQF, 2012).
In conclusion, a number of organizations, most of them private, nonprofit organizations are involved in the evaluation of health services to ensure that all stakeholders play their part to ensure a better health care system in which all stakeholders reap maximum benefits.
References
J A Mark (1982) Measuring Productivity in Service Industries. Monthly Labor Review. Bureau of Labor Statistic. Retrieved on 16th Oct, 2012 from
N J, Buerhaus et al (2002) Nurse staffing levels and the quality of care in hospitals, New England Journal of Medicine, 346, pp.1715-1722.
C Hewitt et al (2003) Health service workforce and health outcomes – a scoping study, London: Service Delivery Organization.
E A McGlynn (2012). Six Challenges in Measuring The Quality Of Health Care. Health Affairs, 16, no.3 (1997):7-21. doi: 10.1377/hlthaff.16.3.7 retrieved on 16th oct, 2012 from, http://content.healthaffairs.org/content/16/3/7>
WHO (2003). Quality and Accreditation in Health Care Services: A Global Review. World Health Organization. Evidence and Information for Policy, Department of Health Service Provision. Geneva
Report to Congress (2011). National Strategy for Quality Improvement in Health Care. Department of Health and Human Services.
Health Reform Note (2010). Accreditation of Healthcare Providers. Econex: Trade Competition & Applied Economics. accessed 16 October 2012 from http://www.econex.co.za
The Joint Commission (2012). Facts about the Joint Commission. The Joint Commission. Accessed on 16th October, 2012 from http://www.jointcommission.org/facts_about_the_joint_commission/
NQF (2012). Improving Healthcare Quality. National Quality Forum (NQF). accessed on 16th October, 2012 from http://www.qualityforum.org/Show_Content.aspx?id=119
