1.1 Defining quality and quality improvement in healthcare
Definitions of ‘quality improvement’ tend to be broad to reflect the diverse range of stakeholders involved in healthcare (such as patients, carers, family members, healthcare staff, managers and educators). Batalden and Davidoff (2007) propose that quality improvement is:
…the combined and unceasing efforts of everyone – healthcare professionals, patients and their families, researchers, payers, planners and educators – to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning…)
This definition of quality improvement identifies three areas that may result in positive change after an improvement intervention:
- patient outcomes (health)
- system performance (care)
- professional development (learning).
Thinking about what these three areas mean (in relation to the healthcare system with which you are most familiar), what do you consider to be important examples of each of these three areas? You may want to use an internet search to see what aspects of your healthcare system are being subject to quality improvement interventions.
Your answers will inevitably reflect your healthcare system and context. Here are some examples from the UK NHS context.
Examples of patient outcomes (health): Essentially, this addresses how you would know whether the healthcare service is improving the health of the population. So you might want to record and monitor:
- prevalence rates (the proportion of people in the population who have an illness or condition) for obesity, diabetes, hypertension, depression, asthma, dementia and many more conditions
- survival rates of people with cancer and long-term or chronic conditions
- average life expectancy for different groups in the population (females, males and ethnic minorities) may also provide useful information about the health outcomes of the population.
Examples of system performance (care): This addresses how you would know whether the healthcare service or system is doing its job effectively and efficiently. So you might consider:
- waits and delays in the system, such as how long a patient has to wait until they can get an appointment with their GP, practice nurse or any other healthcare professional
- the number of patients who get readmitted to hospital soon after discharge is also monitored to indicate whether people are being discharged safely from hospital
- patient complaints about their healthcare service could indicate whether the system is performing well.
Examples of professional development (learning): This aspect addresses whether staff working in healthcare settings are continuing to learn, sharing knowledge, developing skills and training so that the care they offer is of high quality. So you might want to survey staff about:
- whether they have access to resources (such as books, journals and conferences) to keep up-to-date with their field and any developments in patient care
- whether they are satisfied with their training and their continuing professional development opportunities related to improving quality and safety.