Question

When conducting healthcare services quality improvement initiatives, why it is important to integrate Structure, Process, and Outcome quality assurance measures? Which of these measures will help you evaluate the impact of the quality initiative?

Answer 1

ANS. The necessity for quality and safety improvement initiatives permeates health care.Quality health care is defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

the majority of medical errors result from faulty systems and processes, not individuals. Processes that are inefficient and variable, changing case mix of patients, health insurance, differences in provider education and experience, and numerous other factors contribute to the complexity of health care. With this in mind, the IOM also asserted that today’s health care industry functions at a lower level than it can and should, and it put forth the following six aims of health care: effective, safe, patient-centered, timely, efficient, and equitable. The aims of effectiveness and safety are targeted through process-of-care measures, assessing whether providers of health care perform processes that have been demonstrated to achieve the desired aims and avoid those processes that are predisposed toward harm. The goals of measuring health care quality are to determine the effects of health care on desired outcomes and to assess the degree to which health care adheres to processes based on scientific evidence or agreed to by professional consensus and is consistent with patient preferences.Efforts to improve quality need to be measured to demonstrate “whether improvement efforts

(1) lead to change in the primary end point in the desired direction,

(2) contribute to unintended results in different parts of the system, and

(3) require additional efforts to bring a process back into acceptable ranges. The rationale for measuring quality improvement is the belief that good performance reflects good-quality practice, and that comparing performance among providers and organizations will encourage better performance.

In the past few years, there has been a surge in measuring and reporting the performance of health care systems and processes.While public reporting of quality performance can be used to identify areas needing improvement and ascribe national, State, or other level of benchmarks,some providers have been sensitive to comparative performance data being published.Another audience for public reporting, consumers, has had problems interpreting the data in reports and has consequently not used the reports to the extent hoped to make informed decisions for higher-quality care.

Because errors are caused by system or process failures, it is important to adopt various process-improvement techniques to identify inefficiencies, ineffective care, and preventable errors to then influence changes associated with systems. Each of these techniques involves assessing performance and using findings to inform change.

Plan-Do-Study-Act (PDSA)

Quality improvement projects and studies aimed at making positive changes in health care processes to effecting favorable outcomes can use the Plan-Do-Study-Act (PDSA) model. This is a method that has been widely used by the Institute for Healthcare Improvement for rapid cycle improvement.

Root Cause Analysis

Root cause analysis (RCA), used extensively in engineeringvand similar to critical incident technique, is a formalized investigation and problem-solving approach focused on identifying and understanding the underlying causes of an event as well as potential events that were intercepted. The Joint Commission requires RCA to be performed in response to all sentinel events and expects, based on the results of the RCA, the organization to develop and implement an action plan consisting of improvements designed to reduce future risk of events and to monitor the effectiveness of those improvements.