Quality of Health Services

1. Quality of Health Services prof. MUDr. martin rusnak, csc http://rusnak.truni.sk rusnakm0@GMAIL.COM

2. OUTLINE • What does quality health care mean? • Key international documents • Key international recommendations • Situation in the Czech Republic • Examples from various countries: EU & non-EU ones • What is healthcare quality and safety? • Why is healthcare quality important? • What are quality indicators in hospitals? • Discussion rusnakm0@gmail.com

3. Overview of Quality of Health Care: Knowledge Check https://www.globalhealthlearning.org/course/improving-health-care-quality/quiz/overview-quality-health-care-knowledge-check Query Google: „USAID healthcarequalityknowledgecheck“ rusnakm0@gmail.com

4. What does quality health care mean? Quality in healthcare means providing the care the patient needs when the patient needs it, in an affordable, safe, effective manner. rusnakm0@gmail.com

5. Quality = Conformance with criteria ... ...the excellence Two dimensions: • Objective (scientific) criteria; • Subjective (perceived) criteria; • The accountability of health professionals with respect to stakeholders, clients, consumers, patients • The right care for the right person at the right time, the first time (Clancy C. AHRQ) www.bmj.com/cgi/content/full/312/7031/626 http://kff.org/interactive/measuring-health-care-quality-tutorial/ rusnakm0@gmail.com

6. "Many patients, doctors, nurses, and health care leaders are concerned that the care delivered is not, essentially, the care we should receive." "Health care today harms too frequently and routinely fails to deliver its potential benefits." "Between the health care we have and the care we could have lies not just a gap, but a chasm" To Err Is Human: Building a Safer Health System, IOM, 2000 Crossing the Quality Chasm, IOM-report USA, 2001 rusnakm0@gmail.com

7. Relations between Quality and Safety • Patient safety is the cornerstone of high-quality health care. • Much of the work defining patient safety and practices that prevent harm have focused on negative outcomes of care, such as mortality and morbidity. • Nurses are critical to the surveillance and coordination that reduce such adverse outcomes. • Patients should be informed of all outcomes of care including “unanticipated outcomes.” Recent efforts to develop a system of disclosure have included a far more specific set of expectations including conveying to the patient: • facts about the event • presence of error or systems failure • expression of regret • a formal apology rusnakm0@gmail.com

8. Serious Events Death/Severe Harm Iceberg Model of Accidents and Errors Near Miss Unwanted consequence prevented because of recovery No Harm Events To Err Is Human: Building a Safer Health System, 2000, IOM, USA http://www.nap.edu/catalog.php?record_id=9728 rusnakm0@gmail.com

9. Addressing medical errors • Institutions are expected to integrate the disclosure process with other aspects of patient safety and risk management activities, provide support for the process including educating clinicians, and keeping track of the use of disclosure at their institutions. • Such formal efforts to disclose errors are becoming increasingly common in clinical care. It is still too early to determine the impact of these efforts on quality and their ability to reduce malpractice suits. However, there has already been an a growing acceptance of disclosure as a way of addressing medical errors. rusnakm0@gmail.com

10. What are quality indicators in hospitals? Quality Indicators (QIs) are standardized, evidence-based measures of health care quality that can be used with readily available hospital inpatient administrative data to measure and track clinical performance and outcomes. rusnakm0@gmail.com

11. Quality Domains • Effectiveness: Relates to providing care processes and achieving outcomes as supported by scientific evidence. • Efficiency: Relates to maximizing the quality of a comparable unit of health care delivered or unit of health benefit achieved for a given unit of health care resources used. • Equity: Relates to providing health care of equal quality to those who may differ in personal characteristics other than their clinical condition or preferences for care. • Patient centeredness: Relates to meeting patients' needs and preferences and providing education and support. • Safety: Relates to actual or potential bodily harm. • Timeliness: Relates to obtaining needed care while minimizing delays. rusnakm0@gmail.com

12. What are the patient safety indicators? A tool to help identify potentially preventable complications for patients in hospitals. The Patient Safety Indicators (PSIs) are a set of measures that screen for adverse events that patients experience as a result of exposure to the health care system. rusnakm0@gmail.com

13. Approaches to Improving Quality • Delivering improvements in the quality and safety of healthcare remains an international challenge. • In recent years, quality improvement (QI) methods such as Plan–Do–Study–Act (PDSA) cycles have been used in an attempt to drive such improvements. • The method is widely used in public health and healthcare improvement. • Taylor MJ, et al. Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ QualSaf 2013;0:1–9. doi:10.1136/bmjqs-2013-001862 rusnakm0@gmail.com

14. PDSA Cycle PDSA Cycle rusnakm0@gmail.com

15. PDSA cycle • Presents a pragmatic scientific method for testing changes in complex systems. • The four stages mirror the scientific experimental method of formulating a hypothesis, collecting data to test this hypothesis, analyzing and interpreting the results and making inferences to iterate the hypothesis. • The pragmatic principles of PDSA cycles promote the use of a small-scale, iterative approach to test interventions, as this enables rapid assessment and provides flexibility to adapt the change according to feedback to ensure fit-for-purpose solutions are developed. rusnakm0@gmail.com

16. Quality management in practice Interest in the whole system - • Structure • Process • Outcome (Donabedian, 1980) rusnakm0@gmail.com

17. Quality is openness to change • Reengineered care processes • Effective use of information technologies • Knowledge and skills management • Development of effective teams • Coordination of care across patient-conditions, services, sites of care over time rusnakm0@gmail.com

18. rusnakm0@gmail.com

19. Topics for discussion • Your experience of health care services re: • excellent quality; • low - poor quality or even unsafe ? • What did you do? • What you should have done? rusnakm0@gmail.com