Core Issues in Defining Healthcare Quality

Research Proposal Topic-Core Issues in Defining Healthcare Quality

PhD Thesis Writing Help in Service Quality-A Case Study on Healthcare Industry

 

Research Papers and Articles on Healthcare Quality Topics

Quality means different things to different people. All of us would intuitively know what quality is but may not be able to clearly define it. In healthcare it is obvious that a patient would include ‘getting well’ or ‘cured’ as one important criterion for judging the quality of the service. However, it is often debated whether the patient will be able to judge the technical aspects of medical care appropriately because of the specialized nature of medical knowledge. In general, the professional viewpoint of what is quality and how it can be achieved has dominated the debate in healthcare services. This paper examines the core issues in defining healthcare quality and finally arrives at “quality as a construct” to help managers define quality and manage it effectively in organizations.

Technical Aspects of Healthcare Quality

The traditional view is that quality depends primarily on provider knowledge and meeting professional standards. In fact, technical and clinical healthcare quality becomes almost synonymous with standards, guidelines and codes of organizations representing various medical and allied professionals and hospitals themselves. For instance, medical errors and patient safety continues to be a major concern for all involved in providing high quality clinical care (Sutcliffe, 2004). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) of US and the National Committee for Quality Assurance has stimulated interest in developing quality measures. The challenges are:

•       To always provide effective care to those who could benefit from it.

•       To always refrain from providing inappropriate services.

•       To eliminate all preventable complications.

As participant observers of the National Roundtable on Healthcare Quality, Chassin and Galvin (1998) have described the problems of healthcare as thus: Healthcare quality problems may be classified into three categories, under-use (missing measles vaccine), overuse (potential harm exceeds its potential benefits) and misuse (preventable complication occurs after an appropriate medical procedure).

Healthcare quality has two important dimensions, one in terms of professional quality requirements and the other in terms of patients’ and/or society’s expectations. Definition of quality of care as given by the Institute of Medicine in 1990 is: “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (cited in Jennison, 1995, p. 15). This definition stresses the importance of health outcomes and professional requirements.  It is a great challenge for experts to develop valid and reliable outcome measures for a wide range of diagnostic and therapeutic services encompassing an even broader array of health/medical problems.

It is often argued that defining quality of care from the physician perspective alone has limitations and at the same time it is said that customers (e.g., patients) are not competent to judge technical and scientific aspects of quality (Gaucher and Coffey, 1993). Most measures of quality are indicative of quality or process failure, e.g., mortality, morbidity, hospital-acquired infection rates, and unplanned readmissions. These measures are neither customer-focused nor focused on excellence. It is obvious that there would be few patients who go to a hospital expecting any of these complications to occur. Further, the concept of quality gets more complex looking at the traditional view that “quality means doing more”—using greater technology, doing more tests, giving more intensive care etc.

Most of the physicians have problems accepting fundamental challenges such as “patients are well-equipped to assess core dimensions of the quality of care they receive”. But chronic illnesses are becoming more prevalent and the patient’s involvement in determining the outcome of quality is crucial, e.g., diabetes or heart disease cannot be treated in an organized manner effectively and efficiently without the patient’s participation. Therefore, understanding patient preferences should become the foundations of organizations and hence an important quality dimension in addition to technical quality (Koeck, 1997).

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