How do healthcare administrators measure and assess the quality of care provided by healthcare organizations?

How do healthcare administrators measure and assess the quality of care provided by healthcare organizations?

Healthcare begins with the patient. In assessing the quality of care that an organization provides, we need to establish the wellbeing of our patients. Whether the care they receive is optimized to deliver timely, safe, and accurate diagnosis and treatment. Are their needs regarding values and preferences being adhered to? Are the communication lines between clinic staff and the patient open and transparent?

Following a number of studies that highlighted irregularities in the way healthcare was being administered, the focus in healthcare has moved toward patient wellbeing, encouragement of teamwork among medical staff in possession of various skills, healthcare policies, and evidence-based practices that determine the method of treatment suitable for the diagnosis and treatment of patients.

In assessing the quality of healthcare organizations, there are numerous factors that give an indication of whether the organization meets the required standards.

The basic requirements for quality care can be identified as follows:

  • Effective health care: Accurate diagnosis of the problem, and treatment that works.
  • Safety: Health care that does not harm the patient in any way.
  • People-centered: Treatment should be tailored to the patient’s specific needs and administered with their values in mind.
  • Timely: The administration of health care when it is needed, as delays can cause further complications.
  • Equity: Everyone should receive the care they need regardless of race, culture, or their financial situation.
  • Integrated care: Where the diagnosis is complex, a team of caregivers with the necessary skills should work together to achieve the required results.

To achieve this, service must be timely and efficient, thus avoiding possible complications and maximizing the best resources available while avoiding waste. Prevention measures in disease and infection control are also key to a successful healthcare organization.

According to the World Health Organization (WHO), more deaths are due to poor quality care than to lack of access to health services, with as many as one in ten people in high-income countries being harmed while receiving poor hospital care.

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How to measure and assess quality healthcare

Fortunately, there are ways to measure the level of good practice in a healthcare organization, bearing in mind that, when it comes to quality healthcare, none of the points below should be compromised.

Perhaps the most important indicator is the level of education of the administrative and top management staff, and their dedication to their patients and staff. When this requirement is met, there are likely to be sound policies and procedures in place, a contingent of satisfied staff, and positive patient outcomes. We discuss some points for well-administered, top-class healthcare.

As studies have shown a high prevalence of inappropriate healthcare practices, there has been a move toward evidence-based practice, not only in local clinics and hospitals but also on a global level. Evidence-based practices (EBP) can incorporate many of the points mentioned below, depending on the depth to which these practices have been implemented in the organization. More on EBP further down.

Ethics

Just as important is the organization’s code of ethics. A specific code of ethics provided by the American Nurses Association Center for Ethics and Human Rights gives healthcare professionals an in-depth guide to correct healthcare practices.

It is important for organizations to adopt a code of ethics or draw up their own that is relevant to the particular type of practice. This code can be communicated as part of an induction process when new employees join the organization, with regular follow-up sessions. All staff must be aware of the code and that any breach of ethics will have consequences.

There must be open channels of communication in case of a violation of ethics. The person who has acted unethically should be encouraged to discuss the action with a senior member of staff or the human resources department. Failing that, if a member of staff would like to report an unethical action, there needs to be a confidential manner in which to do so.

Unethical behavior could be detrimental to the organization and result in litigation. A culture of responsibility and accountability needs to be established within the organization.

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Quality control and safety

This subject overlaps with that of policy, as quality control is a policy. Ideally, though, in larger environments, a quality control supervisor should be employed with the directive of putting processes in place that regularly monitor critical issues, such as the correct functioning of equipment, cleanliness, and appropriate staff training.

A fundamental component of healthcare is safety. Safety breaches include errors in medication, care-associated infections, unsafe surgical procedures, errors in diagnoses, unsafe transfusion practices, overexposure to radiation, as well as conditions that are not identified timeously, such as venous thromboembolism (blood clots) and sepsis.

To err is human, and the expectation that mistakes will not happen is unrealistic. The successful healthcare organization, however, will have various checkpoints in place as a matter of procedure. For example, a simple procedure for two people to check, sign off, and administer medicine can be implemented. Disease prevention by adhering to cleanliness policies is of utmost importance in any healthcare practice. Evidence-based procedures should eliminate errors and unsafe practices to a large extent, and the improved efficiency that results should enable the timely treatment of patients, thereby avoiding further complications.

Registering with a quality assurance body that monitors individual organizations’ compliance with quality standards is an additional recommended safety measure.

Staff wellbeing and the implementation of HR systems

It’s a well-known fact that America is facing a shortage of care providers across the board, from physicians to nurses, specialists, and clinical administrators. That aside, many healthcare practitioners are being pressured to perform an increasing amount of administration, resulting in less time with their patients. These factors lead to unhealthy levels of stress and, ultimately, a high turnover in staff. This in turn affects the continuity of patient care, with possible negative patient outcomes.

Successful healthcare organizations have systems in place that alleviate the administrative pressure on doctors and nurses, leaving them to focus on their specialized areas of practice. An evaluation of the computerized administration systems in place can give management an indication of the kind of measures in place, if any, that will lessen the admin workload. Analysis of HR data should give an idea of the rate of staff turnover, and if there is an indication that staff are unhappy or working under extreme pressure, measures can be put in place to encourage staff wellbeing.

The most important part of the healthcare organization are the doctors, nurses, and therapists who put in long hours of dedicated care. The performance of healthcare professionals depends on their training, skills and motivation, and regular refresher courses are not a waste of time.

Systems and data analytics

Various systems exist in the healthcare field to facilitate the efficient running of the organization, such as HR, procurement, statistical data, and patient information, including family or emergency contact details, as well as current and historical health information. The timely availability of this information empowers management in the efficient running of the organization.

Data regarding patients is of utmost importance, and with the ethos of patient-centered care, sharing of clinical data regarding the patient, including age, chronic ailments if they exist, and previous medical history regarding treatment and prescribed medicines is paramount. This would enable current and potential caregivers to administer timely treatment and possibly save lives in emergency situations. Patients, too, can benefit from access to their medical details, helping them make informed decisions about their personal health.

Technology tools like MRI scans and CT scans can pick up diseases that would not otherwise be identified, thus identifying risks and promoting better preventive care. This information, too, should be made available in the patient’s clinical records.

Data analytics are used to interrogate the various systems in place to determine types of treatment and success rates, hospital statistics such as the duration of visits, rates and hours worked by independent practitioners and specialists, the level of success of treatments, and the results of MRI and CT scans, and many more hi-tech monitoring systems. This data should be included in the patient’s records for efficient treatment in the future.

The analysis of trends and patterns can be used to predict outbreaks of an epidemic or gain insights into which treatments are working and which are not.

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Accountability

For staff to be held accountable, they need to know what standards they are being measured against. This could be tracking of infections or the timeliness of patient care.

Setting goals with regular tracking as well as the measuring of progress will encourage accountability. Identifying what works best in certain cases will improve the level of care in the areas being tracked.

The establishment of a policies and procedures handbook is ideal for conveying the standards of the organization and can be updated when necessary.

Evidence-based outcomes

EBP is an approach to healthcare that integrates the best available research with clinical knowledge while considering patient values and preferences. Healthcare professionals make well-informed decisions based on a scientific approach, with positive patient outcomes. The evidence-based process in a healthcare environment should encompass the entire range of patient care procedures relative to that facility.

In an organized healthcare environment, these practices should be documented, giving sufficient detail to avoid confusion or misinterpretation. Once a procedure has been established and used, it should be evaluated, and when measurable success is achieved, it should be documented for further use.

The advantages of this practice in healthcare facilities are many:

  • The patient reaps the benefits of scientific research that is translated into strategies and policies for the best possible practice and administered with their wellbeing in mind.
  • It improves efficiency, enabling the caregiver to follow specific guidelines and reducing risk in the process.
  • It introduces new technology into the practice, keeping staff updated at the same time.
  • It increases the patient’s chances of recovery as the decisions are based on proven procedures.
  • In cases of a multi-disciplined solution, a documented process could save the individual practitioners time by indicating exactly who is needed and at what point of the treatment.

The availability of multi-skilled practitioners enables an efficient diagnosis and treatment, thus improving efficiency and avoiding waste.

There are different methods of the evidence-based process and different levels in the research process. For the sake of uniformity in the organization, it is recommended that investigations into the different methods be undertaken and one specific method be adopted and documented.

In the example below, the exercise was done for an individual patient. After completion of the process, its success is measured, and if the outcome is positive, the process can be documented and included in the standard procedures of the organization for further use in that particular type of treatment.

The following five steps outline a typical evidence-based cycle:

Step 1 – The question: A detailed, clearly worded question needs to be posed, prompting a thorough investigation into the process at hand. The more thought that goes into the question, the more detailed and accurate the outcome is likely to be.

Step 2 – Gathering evidence: Time needs to be spent on gathering the best possible evidence. This includes high-quality articles and papers written by respected specialists in their field, case reports, and evidence.

Step 3 – Analysis of the evidence: A critical appraisal of the gathered evidence is necessary, as is an analysis of the situation the material is intended for. Is the material applicable to the question, and will it enable a nurse to carry out instructions in that particular environment? When there is doubt, a practical application of clinical experience may help.

Step 4 –- Application of the evidence to the organization: This step is about the integration of the evidence with the current clinical experience. At this point, the clinician should take the patient’s profile, values, and preferences into account.

Step 5 – Assess the result: Was the procedure a success, and if used again, is it applicable to other patients with the same symptoms or illness? Did it answer the original question in Step 1?

Various levels of evidence-gathering can be defined, including randomized controls, clinical cohort studies, case-controlled studies, and epidemiological studies. Expert opinion and evidence acquired from group consensus may be used in cases where there is insufficient evidence. More complex cases can be viewed using a combination of methods.

Conclusion

As can be seen, the quality of care in the healthcare environment is multi-faceted and of utmost importance in any medical environment. Practicing in a safe and healthy environment is essential for the wellbeing of both staff and patients, and is key to the success of the organization.

 

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