Controlling the quality of medical care: key aspects of a systematic approach and international experience

Abstract

Safety, quality of life, and ensuring the best results for the health of patients are the main goals of healthcare institutions and the system as a whole. The modern approach to ensuring stable and reproducible quality of medical services was shaped in the last century, and has now reached a high degree of generalization. Control in this field is a multi-level process that covers all parts of the medical institution’s activities, from logistics to personnel management.
 Indicators of the quality of medical services from the patient’s side range from potentially complex (postoperative morbidity and mortality) to simple (the frequency of hospital-acquired infections or surgical errors). When all of the clinic’s main business processes are clearly set up and improved as needed, this is called “process management.” This makes it possible to design quality by taking into account the indicators of meeting the requirements of technical documents. 
 The ISO 9000 family of standards, which is successfully used and adopted worldwide in healthcare organizations, contains requirements, specifications, instructions, and tools for the provision of products and services. They simplify comparison, information exchange, big data aggregation, and privacy protection. Regarding the patients, the standards are designed to provide high-quality, safe, and reliable products and services. There are certain precautions about an overly technological approach during quality assurance and control, but now the greatest threat is considered to be the destructive impact of war and the disruption of habitual relationships and processes.
 The state of medical care, the damage to the material fund, the depletion of human resources, and the lack of financial and other resources are all concerning. Fragmentation of healthcare and unequal access in different regions and social groups are potentially threatening. Examples of countries with long-term military conflicts on their territory indicate the “erosion” of activity standards, which are usually set by external actors in such conditions in response to the limited institutional, technical, and managerial capabilities of countries in a state of conflict. Complex measures to restore the functionality of the medical care system are organized at the level of communities, individual institutions, and their associations. In this case, the first steps are the most important, since they often determine the development for years and decades ahead. Therefore, the restoration, or sometimes the “reset,” of the domestic system is an exceptional opportunity to re-prioritize, correct shortcomings, and establish stronger ties with the global professional community.