Consumer and Provider Views on Key Dimensions of Quality Hospital Care: A Review of the Literature
Rhode Island Department of Health Health Care Quality Steering Committee
QUALITY PERFORMANCE MEASUREMENT AND REPORTING PROGRAM REVIEW OF LITERATURE
TABLE OF CONTENTS Executive Summary Introduction Lessons in Quality Assessment from Other Industries The TQM/CQI Movement Why Is Quality Important? Quality Compared to Satisfaction Measurement of Quality The Dilemma of Measuring Quality Attributes of Quality Differing Dimensions of Quality Technical Functional A Comparison of Quality Dimensions by Various Researchers Table Overlaps and Gaps Summary of Researchers Recommendations Conclusion • This report was supported by the Health Quality Measurement and Reporting Program through the Rhode Island Department of Health. 1 2 5 7 8 10 10 13 14 16 16 17 19 21 24 25 29
Quality Performance Measurement and Reporting Program Review of Literature Executive summary: As efforts to cut costs and restructure health care continue, the need for quality measurement intensifies. Quality measurement and management is one of the most important topics in health care today. There are many structured efforts, which seek to measure quantifiable or technical components, such as infection and hospitalization rates. Other efforts seek to improve processes and outcomes, using TQM and CQI techniques. Still others seek to measure less tangible components of quality, such as consumer satisfaction. However, the health care system still lacks a unified process for assessing and measuring the various elements of quality. This survey will begin by looking at the lessons in quality assessment from other industries. It will attempt to answer the question of why quality is important, and then compare quality to satisfaction. We will review formal quality measurement efforts, such as those of the Joint Commission on the Accreditation of Health Care Organizations, and other formal entities. We will also explore how various writers compare and contrast technical measurement of quality with functional components of the concept. The latter (functional components) tend to be the way in which consumers evaluate quality. Lastly, we will draw upon the recommendations of the researchers we have reviewed to identify the most effective way to conduct our inquiry into a more comprehensive definition of quality, and its meaning to physicians, and administrators, but also to patients or consumers.
Few concepts are more important or elusive than “quality” in the current environment of health care services. Quality information is important to consumers and providers alike. However, the essential elements of “quality” may be understood in quite different ways and ranked with different priorities among various consumer and professional groups. For example, health professionals may relate to objective and technical measures of quality, such as statistical measures of clinical performance. Lay consumers of health services may base quality on less technically complex and more subjective notions, such as overall measures of satisfaction. This review of literature on the topic of quality, while not exhaustive, is a survey of current thinking on the issue of quality in health care, with emphasis on hospital care. We seek to broaden our thinking beyond the traditional measures of mortality, length of stay, adverse events and accreditation parameters. Statistical measurement, (i.e. HEDIS, ORYX and other databases) serves some, but not all informational needs. Gaps still exist between physician/administrator quality measurement, and the patients’ perception of a satisfying and meaningful (i.e. quality) experience as a consumer in the health care system. The review was conducted with these key questions in mind: a) what can we learn about quality measurement from other industries/researchers; b) what are the key...