Professional Development Assignment 7
November 4, 2014
Professional Development Assignment 7
Definitions of the quality of medical care are no longer left to clinicians who decide for themselves what technical performance constitutes “good care.” What are the other dimensions of quality care and why are they important? What has changed since the days when “doctor knows best?”
Patients deserve the best possible care we can provide to them. A patient or family may not always agree or like what their provider is telling them, but they deserve to have honest, excellent skilled, excellent bedside manner every day and every time. So how do measure “good care” in a system that is not always black and white? The importance of measuring and monitoring healthcare quality is no longer in doubt. Yet quantifying healthcare quality is a complex and challenging process for which public and payer demands clearly exceed current capabilities.
According to the document, Quality of Care: A process for making choices in health systems, there are six areas or dimensions of quality, These dimensions require that health care be; effective, efficient, accessible, acceptable and patient-centered, equitable, and safe. These six areas are pretty common sense thinking. As a provider if I were rating myself as a provider that delivered “good care” all six of these would be on my list (WHO, 2006).
Instead of focusing on “doctor knows best” our focus on improving the quality of medical care in the through initiatives like public reporting and pay for performance is based on the belief that measuring quality of care is an essential first step in improving quality of care. Without measurement, it is implored; it will be impossible to know if the care clinician’s deliver is good or bad. As a result, quality measurement has flourished and has been the foundation for quality improvement initiatives. Quality measures are publicly reported and perhaps influence consumer choice of physicians and hospitals and, therefore, create incentives to deliver high-quality care (Werner and McNutt, 2009).
Public reporting is a strategy to address quality and cost in the health care system by providing consumers, payers, and health care providers, such as doctors and hospitals, with information about the performance of these providers and insurance plans. It can include such tools as "report cards" on hospital performance. Public reports can allow for the comparison of costs, quality (such as rates of hospital-acquired infections), and how satisfied patients are with service.
I do believe that customers have the right to be informed of hospital, service or provider reputation, but I worry about perspective. As a manager I take multiple patient complaint calls. Though it is our duty to see everything from the patient’s perspective, it is hard to take some complaints seriously. I know it sounds wrong, but patients expect a lot from a profession that is humanly run. We offer the very most professional care to the very best of our ability, but we still fall short of some patient’s expectations. Public reporting is the best system we have to measure quality of care, but like everything it is not perfect.
Quality in medical care may be defined as achieving the greatest benefit at the lowest risk. How have the priorities of our health care system and the allocation of resources addressed this goal? Health care systems, like any business are confronted with budget constraints every day. Priority setting in resource allocation has to be addressed. Quality in medical care can be defined as achieving the greatest benefit at the lowest risk, but how about the lowest cost? In this essay we will look at how the priorities of our health care system and allocation of resources have addressed this goal.
Addressing prioritization of spend there needs to be a balance...
References: Ashton, C., Kuykendall, David H., Johnson, Michael M. (1999). An Empirical Assessment of the Validity of Explicit and Implicit Process-of-Care Criteria for Quality Assessment. 27(8). 798-808.
Farrar S., Ryan M., Ross D., Ludbrook A. 2000. Using discrete choice modelling in priority setting: an application to clinical service developments. Social Science and Medicine (50) 63-75.
Lyons T. and Payne B. (1974). The quality of physicians ' health-care performance: A comparison against optimal criteria for treatment of the elderly and younger adults in community hospitals. Journal of the American Medical Association. 227:925-8
Hofer T., Bernstein S., Hayward R. (1997). Validating quality indicators for hospital care. Joint Commission Journal of Quality Improvement 23: 455–467.
Mitton C. and Donaldson C (2003) Tools of the trade: a comparative analysis of approaches to priority setting in health care. Health Services Management Research (16) 96-105.
Werner RM, McNutt R. A New Strategy to Improve Quality: Rewarding Actions Rather Than Measures. Journal of the American Medical Association. 2009;301(13):1375-1377. doi:10.1001/jama.2009.423.
World Health Organization. (2006). Quality of Care: A process for making strategic choices in health systems. http://www.who.int/management/quality/assurance/QualityCare_B.Def.pdf.
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