CPHQThe Certified Professional in

Healthcare Quality

Quotes:"Quality is never an accident; it is always the result of high intention, sincere effort, intelligent

direction, and skillful execution. It represents the wise choice of many alternatives."

William A. Foster, Source Unknown

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"Quality in a product or service is not what the supplier puts in. It is what the customer gets out

and is willing to pay for."

Peter F. Drucker

Innovation and Entrepreneurship: Practice and Principles, p.228

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"Quality is free. It's not a gift, but it is free. What costs money are the unquality things - all the

actions that involve not doing jobs right the first time...."

Philip B. Crosby, Quality Is Free

Definitions of Quality in HealthCare

Quality

1. Quality means having a high degree of excellence

2. Quality means doing the right things right the first time (and every time).

3. Standards are created when experts are able to understand what the right

things are and how the right things are best achieved. So quality can be

said to be, at least in part, compliance with standards.

4. When recipients define quality, they judge whether or not the right things

are done in ways that meet their own needs and expectations.

 

• The Juran Institute: defines quality as both:

1. "Freedom from deficiencies": A deficiency is any avoidable intervention required to achieve an equivalent

patient outcome.

• Examples:

- Healthcare-associated (nosocomial) infection, postoperative site infection- ED triage delay- Unscheduled return to ED/urgent care, surgery (inpatient or outpatient)- Managed care treatment authorization delay- Excessive wait time (physician office, ancillary service, ED, nursing care)- Lost lab results, X-Rays, medications, patient belongings- Cold meals (acute care, long-term care, adult day care, residential care, home

care)- Premature discharge or release from treatment (acute care, skilled or sub acute

care, long term care, partial hospitalization, ambulatory surgery, home care)

• "Product features": Both services and goods that attract and satisfy

patients, meet customer expectations, and distinguish one practitioner

or organization from others.

• Examples:

- Case management/care coordination- Pleasant waiting area (with current magazines) - Knowing what to expect - Knowing all treatment options- Computerized health record- Food access in room, as appropriate (acute care, long term care, home

care) - Follow-up care (telephone queries, clear instructions, home care,

return visits)

• JURAN : Fitness For Use

IOM: Quality of Care

Quality Defined by:

1. The Institute of Medicine

2. U.S. Joint Commission

3. The Joint Commission International

Defined As:

Quality of care is the degree to which health services for individuals

and populations increase the likelihood of desired health outcomes and

are consistent with current professional knowledge.

AHRQ: Quality Healthcare

The U.S. government Agency for Healthcare Research and Quality

(AHRQ)

Defines quality healthcare as healthcare that is “...accessible, effective, safe,

accountable, and fair...."

This means:

• Providers deliver the right care to the right patient at the right time in the right

way.

• Patients can access timely care, have accurate and understandable information

about risks and benefits, are protected from unsafe health care services and

products and have reliable and understandable information on the care they

receive.

• Both patients and clinicians have their rights respected.

 

Three Aspects of Quality - The "Map"

• Measurable quality

Compliance with, or adherence to, standards.

We assume that quality can be adequately, if not completely,

measured-once clinical practitioners define the standards of care

under which they can comfortably practice and the healthcare

field acknowledges the applicability of what become essentially

community standards.

Clinically these standards may take the form of practice

guidelines or protocols, or they may establish acceptable

expectations for care processes and patient outcomes. Such

standards also set expectations for organization performance.

Performance measures or indicators are measurement tools.

Acceptable compliance with standards is now the basis for

granting healthcare organizations licensure and/or accreditation,

certification, awards, and, in some cases, reimbursement. At their

best, however, standards serve as guidelines for excellence.

• Appreciative quality

Is the comprehension and appraisal of excellence beyond minimal

standards and criteria, requiring the sometimes even non-articulate

judgments of skilled, experienced practitioners and sensitive, caring

persons.

Peer review bodies rely on the judgments of like professionals in

determining the quality or nonquality of specific patient-practitioner

interactions. Courts of law use "expert witnesses" to determine

whether professional behavior was "reasonable" or "negligent."