“Quality is never an accident, it is always the results of intelligent efforts” John Ruskin”..The institute of Medicine defined quality as “The degree to which health series for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. (IMO,2004)
Quality of care was usually measured by patient satisfaction, which is mainly related to the outcomes triggered by getting the medical care within the healthcare facilities. However, the quality of healthcare is much more than a matter of patient satisfaction, and technical care, it should be a total sum up of different components classified using a framework and special matrices or criteria.
According to Donabedian’s classification, quality can be assessed using three main components, structure, process and outcomes. Structure is related to the physical environment including the facility’s building, design, technology, equipment. Structure is also related to healthcare providers, credentials and qualifications etc. Structure refers to the organizational factors that define the health system under which is provided. Whereas process refers to the way of organizing the services within the facility (S.M. Campbell,2000). Process is also related to how efficient healthcare is provided by talking into consideration patient safety embeds infection control and reducing medical errors (Fiona Moss, 2004). Finally, the outcomes assessed by improving patient health status, and patient satisfaction as well. On the other hand, poor quality of care is represented in three forms; overuse of unnecessary or ineffective treatment, or underuse which reflects the fail to provide the care that works, and misuse means making mistakes that harm the patient’s medical errors”. Overuse when care is provided when inappropriate, and underuse when not provided when necessary (Robert H, et.al, 1996), However, both are correlated with less effectiveness of care resulted in unwanted outcomes. Whereas misuse is correlated with poor process resulted in an inefficient quality of care. On the other hand, Maxwell had addressed six dimensions of healthcare quality; Effectiveness efficiency, appropriateness, acceptability, access and equity, are addressed by Maxwell.
Classification of Donabedian generates another kind form of quality measures slotting healthcare into three parts: technical aspects “process, interpersonal aspect “process & patient perceptions, amenities or environment aspect in which that healthcare is provided.
The structure is represented by physical environment including design and healthcare required inputs, the report further inspect how this structure will affect both the process component representing “Efficiency” by highlighting on staff safety and performance, and patient safety in terms of infections, medical errors and injuries. Furthermore, how the structure will affect the outcomes component representing “effectiveness”, by highlighting on the impact of structure on clinical outcomes, and patient satisfaction.
Efficiency and effectiveness are the main aspect of quality. The former represents the process and the latter represents the outcomes. According to the institute of Medicine, effectiveness defined as” providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse). Efficiency is defined as “avoiding waste of equipment, supplies, ideas and energies (6). Effectiveness is related to achieving the intended outcomes and results, or all the targeted problems were solved without reference to cost. In healthcare setting, effectiveness is about making sure that “the right things are done”. Whereas the efficiency is related to performance, process, using best methods without wasting. It’s about “Doing things right” (IMO,2004)
Safian, C.S. (2014). Fundamentals of Health Care Administration 1st Edition, Pearson, 2014, ISBN-13: 978-0133065633
Brent C. James, , 1989. Quality Management for Healthcare Delivery. Research and Educational Trust . ISBN 0-87258-537-9.
Robert H. Brook, Elizabeth A. McGlynn,, Paul D. Cleary. Measuring Quality of Care. J Med 1996; 335:966-970S 1996DOI: 10.1056/NEJM199609263351311
E.R.C.M. Huiman , E. Moralesb, J. van Hoofa, H.S.M. Korta. . Healing environment: A review of the impact of physical environmental factors on users. Building and Environment, (.2012) pp. 70-80
Fiona Moss. Risk management and quality of care. Quality in Health Care 1995;4:102-107
Florence Nightingale’s Rose Diagram (1858 – January 1859).
Institute of Medicine (IOM).(2004). Keeping patients safe: Transforming the work environment of nurses. Washington, DC: National Academy Press. Institute of Medicine (IOM) (2001). Crossing the Quality Chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
Joint Commission on Accreditation of Healthcare Organizations (2002). Health care at the crossroad: Strategies for addressing the evolving nursing crisis. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations.
S.M. Campbell, M.O. Roland, S.A. Buetow. Defining quality of care. Social Science & Medicine 51 (2000) 1611-1625.
WHO. Preamble to the constitution of the World Health Organization as adopted by the International Health Conference. New York: 19–22 June, 1946; 1948; signed on 22 July 1946 by the representatives of 61 states (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.