Quality Management in Healthcare

Instructor: Julie Eiler
In today's transparent world, healthcare organizations are expected to focus on the quality of the service they provide for patients. This lesson reviews some of the measures of healthcare quality and ways it is managed, monitored, and assessed.

Measuring Healthcare Quality

Report Cards

Remember report cards? Those highly anticipated pieces of paper that let you (and your parents) know how your teacher graded your school work. Depending on what kind of student you were, report card time might have meant a crisp five dollar bill from grandma or losing your television privileges for a week. Either way, they revealed the quality of your performance to the interested parties. Did you know that you can get a report card on the performance of your hospital or even your doctor? The increasing transparency of healthcare quality performance has made healthcare organizations look more closely than ever at the care and services they provide and the outcomes their patients experience. There is a lot more than grandma's five dollars on the line.

How Is Quality Measured?

There are many ways to define and quantify quality healthcare depending on the types of services that an organization provides. For example, a surgical center would look at very different aspects of care compared to a long-term nursing home or rehab center. The main factor in any measure of quality, however, is the experience and the outcomes for the patient.

In 2001, the Institute of Medicine published six characteristics of quality that would shape the next decades of care and performance for healthcare organizations. These six characteristics are:

  • Care must be safe.
  • Care must be effective and reliable.
  • Care must be timely.
  • Care must be patient-centered.
  • Care must be efficient.
  • Care must be equitable.

These quality standards translate into everything from hospital infection rates to emergency room wait times. Organizations and facilities measure the outcomes of whatever service they provide whether that is surgery, emergency care, chronic illness management, rehabilitation, or even end of life care, and can compare these outcomes to similar care centers.

Some important measures focus on harmful patient outcomes deemed as reasonably preventable that occur during an episode of care. These are known as hospital acquired conditions. Some examples of these conditions are hospital acquired infections (pneumonia, catheter associated urinary tract infections, infections of central intravenous lines), falls, pressure injuries (also known as bed sores), and certain hospital readmissions. The frequency of these incidents is translated into rates usually based on the number of patients treated, so that organizations can compare their own internal areas against those of other similar organizations and facilities.

In addition to patient outcomes, data regarding organizations' resource utilization, professional guideline adherence, and care coordination processes may be monitored and reported.

Why Does Quality Matter?

Quality care is ethically important to healthcare providers and organizations because it is the cornerstone of their mission. Quality is also important to maintaining a positive reputation because that is what keeps organizations in business. If it is known that a clinic, hospital, or nursing home does not provide exceptional care, people will not bring themselves or their loved ones there.

Modern patients seeking care are consumers. They often have the ability to choose where they receive care, especially for elective procedures. As health organizations' quality measures become more and more transparent, the consumer patient can truly make informed decisions about who offers the best care. Hence, the 'report card.' A simple web search will reveal various public and private organizations that offer rankings, consumer reports, and performance reports on area hospitals or physicians. Healthcare organizations that do not share data miss the opportunity for consideration by the consumer.

Not only do healthcare organizations report performance for consumers, but some reporting is mandatory for organizations that accept payment from Medicare. Medicare is the federal health insurance provided to persons over 65 or with certain disabilities. In the early 2000's, the Centers for Medicare and Medicaid began passing regulations that denied payment to hospitals or nursing homes for the treatment of preventable illness or injury that occur during care in that organization, such as hospital acquired conditions (pneumonia, infections, pressure injuries). Medicare also offers financial incentives for organizations that properly report performance data as well as penalties for those that do not. This has increased the stakes for healthcare organizations and made them focus on the quality of care they provide.

Who Monitors Quality in Healthcare Settings?

Generally an organization monitors and measures quality internally and then reports this information to a third party. This may mean a private company or a mandatory government institution such as the Centers for Medicare and Medicaid. Depending on the size of the healthcare organization, internal monitoring and reporting may be done by healthcare executives and administrators or an entire team of professionals trained in quality management.

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