Redefining quality of care

Everyone aspires to quality health care. Defining "quality" seems straightforward, yet finding metrics to measure health care is difficult, a point recognized by Donabedian [1] almost half a century ago. While we often associate quality with price, Americans have the world's most expensive health care system, yet have disappointing patient outcomes [2]. As a means to improve outcomes and control costs, payers in the United States, United Kingdom, and elsewhere are increasingly using metrics to rate providers and health care organizations as well as to structure payment.

Advances in Medical Diagnosis, Treatment, and Care, 2000

Quality of care from the patient's perspective and patient satisfaction are two major multidimensional concepts that are used several times interchangeably. Patient satisfaction is a topic that is important both to medical (health) providers, the patients (consumers) and other third-party stakeholders in the medical care industry; it is, therefore, a dominant concept in quality assurance and quality improvement programmes. Patient satisfaction is an important measure of healthcare quality because it offers information on the provider's success at meeting the expectations of most relevance to the client. The importance of quality in the health care sector has been recognized recently, but it has been accelerated over the past years through the development of quality assurance, quality improvement programmes and patients' agendas. Patients are the ones situated at the front lines of care; therefore their opinion may provide useful insights into the quality of healthcare in different European systems, nevertheless the methodological limitations that should be taken into consideration.

Journal of Nursing Management, 2001

A study of the criteria used by healthcare professionals, managers and patients to represent and evaluate quality care Aim To explore the perceptions of and criteria used by healthcare professionals, managers, patients and relatives to represent and evaluate their concept of quality care. Methods A qualitative approach using grounded theory was adopted in this exploratory descriptive study. Data collected by semi-structured interviews from a purposive sample of nurses, doctors, managers (n=36), patients (n=34) and relatives (n=7) from one acute medical ward, were subjected to content, question and thematic analysis, using an inductive categorizing scheme. Findings Three categories of criteria relating to Care Resources, Processes and Outcomes were identi®ed by healthcare professionals, managers, patients and relatives. Resource criteria included Human Resources: staff numbers, ratio to patients, skill mix; as well as Environmental/Physical and Financial Resources. Process criteria included Care Functions, Practices and Standards as well as Interpersonal Processes. Outcome criteria were either patient-focused: feeling comfort, happy, informed and satis®ed; or health-related: maintenance or progress with health problems and goals. Conclusions The criteria used by healthcare stakeholders in this study were not unusual; virtually all were supported by the literature, a proportion of which was evidence-based. The criteria identi®ed in this study are however consensual, agreed upon by healthcare professionals, managers, patients and relatives as representing their view of quality care. These consensual criteria could be used as unifying constructs for the development and testing of more comprehensive, reliable and valid methods of evaluating quality care which represent its multiple dimensions and perspectives.

The Milbank Memorial Fund Quarterly. Health and Society, 1979

2007

In the healthcare industry, quality of care is more than a concept. It has become essential to patient well-being and financial survival. This chapter will discuss the complex concept and multiple definitions of quality of care and evaluate how it has become an increasingly important factor in the delivery of healthcare. We will start by providing a historical perspective to help readers understand the evolution of quality in the healthcare industry. This perspective will include landmark reports and events that have helped shape the role quality of care currently plays in the industry. We will then explore the key principles and definitions that are essential to healthcare quality. After reviewing the key principles, we will explore a case study that illustrates the impact that quality improvement is having on a particular company within the industry. Last, we will speculate on the role quality will play as the healthcare industry continues to evolve. The authors of this chapter ar...

2016

Objective 1: To determine what domains capture the contemporary meaning of healthcare quality to inform the development of a theoretical model of quality of healthcare.

Health Care Management Review, 2003

Over the past decade, consumer-oriented health care has emerged as the preeminent model for service delivery. This model requires an effective blend of clinical, managerial, and consumer input. 1 The emerging model should reflect a melding of professional provider and consumer perspectives. At the union of these perspectives is a demand for quality health care services. However, while health care providers are in a position to judge the biomedical and technical aspects of care, it has been argued that consumers do not have the capacity to do so. 2 The consumer, for the most part, has not been involved in defining health services quality. This is true primarily because the core of the quality definition in health care has been thought of as a balance of health benefits and health harms and therefore judgments regarding the essential elements of care are best left to the providers. 1 Attempts to rectify this evaluative imbalance in judging health care quality no doubt have contributed to the growth of a vast and burgeoning patient satisfaction measurement industry that purports to give patients a voice in expressing their views about the care they received. An examination of the patient satisfaction literature produced over the past decade reflects work that, unlike the consumer satisfaction studies found in the general marketing literature, generally consists of substantively shallow, empirical reports that address circumscribed, idiosyncratic, or context-specific questions. Much of the work comprising this literature is based on simple descriptive and correlational analyses that appear devoid of any theoretically or substantively compelling framework. Examples of notable exceptions to this criticism are the works of Ware and

2020

Tracking the origins, defi ning and quantifying quality of care: can we reach a consensus J Hum Growth Dev. 2016; 26(2): 133-138 DOI: http://dx.doi.org/10.7322/jhgd.119237 Abstract This editorial presents a summary of the narrative used in teaching fundamentals of quality management in healthcare to medical students and health professionals with limited or negative prior experience in the fi eld of quality monitoring and improvement -i.e. those who fi nd the topic dry and disconnected from their everyday clinical experience, lacking in human dimension, and confusing due to the multitude of defi nitions of quality of care and the considerable inconsistency of the terminology used in quality assessment. In order to remedy the problem, the topic is presented through an historical perspective of the concept of quality as seen throughout the ages -beginning in antiquity, through 19 th and early 20 th century quality control initiatives which evolved into the quality management policies a...

2007

In the healthcare industry, quality of care is more than a concept. It has become essential to patient well-being and financial survival. This chapter will discuss the complex concept and multiple definitions of quality of care and evaluate how it has become an increasingly important factor in the delivery of healthcare. We will start by providing a historical perspective to help readers understand the evolution of quality in the healthcare industry. This perspective will include landmark reports and events that have helped shape the role quality of care currently plays in the industry. We will then explore the key principles and definitions that are essential to healthcare quality. After reviewing the key principles, we will explore a case study that illustrates the impact that quality improvement is having on a particular company within the industry. Last, we will speculate on the role quality will play as the healthcare industry continues to evolve. The authors of this chapter ar...