Understanding quality of care and analyzing different strategies to assure and improve it

Abstract

Assessing and improving quality of care presupposes an understanding of what it does and does not entail. Different definitions often specify relatively long lists of various attributes that they recognize as part of quality. Effectiveness, patient safety, and responsiveness/patient-centeredness seem to have become universally accepted as core dimensions of quality of care. The inclusion of a list of additional elements is confusing and often blurs the line between quality of care and overall health system performance. This presentation provides an in-depth look at this interplay, recognizing that the definition of quality changes depending on the level at which it is assessed. At the level of health services, there seems to be an emerging consensus that quality of care is the degree to which health services for individuals and populations are effective, safe, and people-centered. On the other hand, a health care system as a whole is of high quality when it achieves the overall goals of improved health, responsiveness, financial protection, and efficiency; here, there seems to be an international trend towards using the term health system performance. The workshop looks at different strategies to assure or improve the quality of health care. To understand, analyze, compare and ultimately prioritize or align different quality strategies, this presentation will introduce a comprehensive framework, which includes the following lenses: i) the three core dimensions of quality: safety, effectiveness, and patient-centeredness; ii) the four functions of health care: primary prevention, acute care, chronic care, and palliative care; iii) the three main activities of quality strategies: setting standards, monitoring, and assuring improvements; iv) Donabedian’s triad: structures, processes, and outcomes; v) the five main targets of quality strategies: health professionals, technologies, provider organizations, patients, and payers.

Perspectives: Envisioning healthcare quality and safety in 2030

“…The degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (Institute of Medicine, 2001). The degree to which the treatment dispensed increases the patient’s chances of achieving the desired results and diminishes the chances of undesirable results, having regard to the current state of knowledge (Busse et al., 2019). …”

“…The degree to which the treatment dispensed increases the patient’s chances of achieving the desired results and diminishes the chances of undesirable results, having regard to the current state of knowledge (Busse et al., 2019).…”

Hospital performance comparison of inpatient fall rates; the impact of risk adjusting for patient-related factors: a multicentre cross-sectional survey

“…A prerequisite for a meaningful comparison is that there is a potential for improvement. This is indicated if the hospitals report different fall rates, i.e., there is a certain degree of variability across the hospitals [ 11 ]. We therefore searched the literature for observational studies reporting hospital-level inpatient fall rates based on large sample sizes.…”

“…Third, variability may also be explained by differences in patient-related fall risk factors in the hospitals [ 10 ]. These patient-related fall risk factors are specific conditions that increase a person’s chance of falling but are mainly beyond the control of hospitals [ 10 , 11 , 18 ].…”

Healthcare professionals’ experiences with highly qualified nurses working in acute care teams in primary healthcare settings

“…Worldwide, the proportion of people aged 65+ with chronic conditions is increasing; this is proving challenging for the health- and elderly-care sectors [ 1–3 ]. The needs and expectations placed on these services are growing, making it important to develop new solutions to improve the quality of health- and elderly-care services and to develop more personalised and coherent services across sectors, ensuring more value for money [ 1 , 4 , 5 ].…”