Quality of care is just one of those issues that have become front and center in health care today. Regardless of recent attention, quality of care as a goal of the health care professional has been around for centuries. A thorough understanding of quality in health care will provide an overview and introduction to this concept as a whole; define what quality is and how it relates to health care; explore some of the challenges to implementing quality in a health care organization; and examine some of the historical aspects of quality. What is Quality?
Webster’s Dictionary (2010) defines quality as “a degree of excellence,” “superiority in kind,” and “an inherent feature. ” Although the list of definitions and synonyms on the subject in general is exhaustive, these definitions give us a general sense of what the concept really means. When we hear the word ‘quality’, we immediately think of something having value or great importance. When we go shopping for an item, we want the best item we can find, and are usually willing to pay more money for that item in the assumptive expectation that cost assures the item is of higher quality.
In general, our choices are based on the quality of an item or service regardless of cost, within reason. The same holds true as it relates to health care. We all want and deserve the best care when we become consumers of the health care industry’s services. So, how do we define quality in health care? According to Buchbinder and Shanks (2007, pp 82-84), quality in health care is a term that can be defined in several ways.
The National Academies Institute of Medicine (IOM) (1990) defines health care quality as “the degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge. ” This is perhaps the most accurate description of quality as it relates to health care. It addresses the important perspective of health outcomes for populations and individuals and speaks to the development of and adherence to professional standards.
Defining quality as a whole implies selecting the best when shopping for a particular item. Health care is no different. Patients and their families want and deserve nothing but the very best of care from a health care facility. Historical Aspects of Quality in Health Care Although the focus on quality has recently become a major topic of discussion in health care, this issue has been around for many years. As far back as 1700 B. C. , some form of quality as a consideration in health care has been in existence. Buchbinder and Shanks (2007, p. 6) speak of the Codex of Hammurabi (a Babylonian king), which provided for the execution of doctors and nurses for providing inadequate health care. The well-known challenge to health care providers within the Hippocratic Oath, which was originated in Greece by the physician Hippocrates around 400 B. C. , to “do no harm” speaks directly to the concept of quality. In modern times, we have operational processes, such as quality assurance, total quality management, and systems improvement, in place as standard business practices.
All of these initiatives carry the single goal of ensuring positive outcomes for the patient. Challenges to Health Care Quality As is the case with any seemingly simple concept, health care quality has it challenges. The challenges for the health care organization can be external or internal. The downward trend of our nation’s economy is a good example of an external force that has impact on the delivery and availability of quality health care due to financial limitations placed on the industry and its consumers. Organizations have to spend many hours and financial resources on quality improvement initiatives (e. . , the purchase and maintenance of new equipment). Examples of economic pressures on the consumers include the growing population of uninsured and unemployed individuals and their families, both of which can greatly alter the income of the health care organization. It has become a national trend for individuals with no insurance to use a hospital’s emergency room; much of this care goes uncompensated. Organizations subsequently absorb the costs or raise prices for services to insured individuals through higher insurance premiums and health care delivery costs.
Such factors greatly limit the health care organization’s ability to execute other important initiatives, such as quality improvement. Internal challenges are also present as it relates to health care quality. An example of this could be a shortage of qualified health care professionals. For example, the national shortage of nurses and primary care physicians, which is due to a number of factors, can greatly affect the quality of care provided by an organization. Another example is the lack of interest or buy-in of the major stakeholders within the health care organization itself.
When there is a lack of interest or even a lack of understanding of the importance of quality in the organization, including its various components, each with its own perspective, the organization may suffer greatly in this regard. For this reason, health care administrators should greatly stress health care quality, its importance, and the implications. Many public and private payers of health care services are now beginning to associate patient outcomes to reimbursement. Conclusion
This is just a very general overview of health care quality to establish that quality has very much to do with achieving the best outcomes in a given situation. Health care organizations have just recently begun to focus on the various aspects of quality concepts and perspectives, including how they interact to affect an organization beyond the goal of positive outcomes; however, quality as a concept in some form or other has been around for thousands of years. Health care organizations face many challenges relating to quality, but more and more it is very important to the survival and sustainability of the health care organization.