1 How do we understand and define quality improvement in healthcare?
- 1.1 Quality in healthcare
- 1.2 How is quality in healthcare assessed and evaluated in the Australian context
- 1.3 Quality and safety commission in healthcare
- 1.4 Contemporary challenges related to quality in healthcare
1.1 Quality in healthcare
Quality in healthcare has been described as the degree to which healthcare services meet the needs and expectations of patients, and it is a critical aspect of healthcare delivery. In the nursing and midwifery professions, quality is an essential aspect of patient care. This section covers the key concepts related to achieving quality in healthcare.
Patient safety
Patient safety is a fundamental and critical component of high quality healthcare. For both nursing and midwifery professions, ensuring that woman and patients are safe and that any risk of harm is minimised during their care is essential. For example, when caring for women and newborns, midwives must ensure that both the mother and baby are safe during the antenatal, intrapartum and postnatal periods. Nursing professionals must ensure that patients are safe during medication administration, wound care, and other procedures. Patient safety aims to be ensured through Professional Standards for Nursing and Midwifery and organisational policy and procedures to minimise harm.
Improved patient outcomes
Quality healthcare is an important component to promote the best physiological and psychological patient outcomes. In nursing and midwifery, quality care can reduce the risk of complications, improve recovery times, and promote patient satisfaction. By ensuring that patients receive high-quality care after discharge from their care, nursing and midwifery professionals can reduce readmissions and complications, which ultimately improves patient outcomes.
Patient satisfaction
Patient satisfaction is another aspect in the determination of healthcare quality. In nursing and midwifery, ensuring that patients are satisfied with their care is critical in promoting quality. Satisfied patients are more likely to comply with their care plan and are less likely to experience anxiety or depression related to their healthcare experience. By promoting patient satisfaction, nursing and midwifery professionals can improve patient outcomes and reduce healthcare costs.
Efficiency
Quality healthcare promotes efficiency in healthcare delivery. In nursing and midwifery, efficient care delivery ensures that patients receive the care they need in a timely manner, and consideration of how resources are utilised. For example, nursing professionals can ensure that medications are administered promptly and efficiently, reducing the risk of medication errors. Midwives can ensure that mothers receive timely care during labor and delivery, reducing the risk of complications. In terms of resourcing if there are two medications as an option to treat the same condition and one is significantly more expensive but does not offer any better outcomes, then consideration is needed in regard to the implications that may have on the organisation’s financial position.
Professional development
Quality healthcare promotes professional development in nursing and midwifery. By providing high-quality care, nurses and midwives can enhance their knowledge and skills, ultimately improving patient outcomes. This is emphasised through the notion of lifelong learning and, nursing and midwifes requirements to ensure that as clinicians they engage in ongoing professional development to support their registration and ability to provide contemporary evidence-based care. For example, nurses who provide quality care can gain a better understanding of patient needs and develop better communication skills. Midwives who provide quality care can gain more experience in maternal and neonatal care, improving their ability to handle complex cases.
Regulatory compliance
Quality healthcare ensures that both nurses and midwives comply with regulatory standards. Regulatory compliance is essential in promoting patient safety and ensuring that healthcare providers meet the required standards. In nursing and midwifery, compliance with regulatory standards ensures that patients receive safe and effective care. For example, nursing professionals must comply with medication administration standards to ensure that patients receive the correct dose of medication.
Quality care promotes patient safety, improves patient outcomes, enhances patient satisfaction, promotes efficiency, enhances professional development, and ensures regulatory compliance. As such, nursing and midwifery professionals must ensure that they provide high-quality care to patients to promote positive health outcomes.
1.2 How is quality in healthcare assessed and evaluated in the Australian context
In the Australian healthcare system, ensuring quality care for patients is of utmost importance. Various methods are employed to assess and evaluate healthcare quality, including accreditation, clinical audits, and patient feedback.
Accreditation is a key mechanism for evaluating and assessing healthcare quality in Australia. Accreditation agencies, such as the Australian Council on Healthcare Standards (ACHS), assess healthcare facilities against a set of standards to ensure they are providing safe, effective, and high-quality care. Accreditation assessments are conducted every 3-4 years, and facilities must meet all standards to maintain their accreditation status.
Clinical audits are another method for assessing healthcare quality in Australia. These audits are conducted to evaluate the clinical care provided to patients and identify areas for improvement. Clinical audits involve reviewing patient records and assessing the appropriateness of diagnosis, treatment, and follow-up care. The results of these audits are used to identify areas for improvement and develop strategies to enhance patient care.
Patient feedback is also an essential component of evaluating healthcare quality in Australia. Patients are encouraged to provide feedback on their experiences with healthcare providers and facilities, and this feedback is used to identify areas for improvement. The Australian Government has implemented the Patient Experience Survey, which assesses patient satisfaction with healthcare providers and facilities across the country.
In addition to these methods, the Australian healthcare system has established clinical quality registries (CQRs) to monitor and evaluate healthcare quality. These registries collect data on patient outcomes, treatment methods, and resource utilisation to improve clinical care and identify areas for improvement.
The Australian healthcare system employs a range of methods to assess and evaluate healthcare quality. These methods are designed to ensure that healthcare providers and facilities are providing safe, effective, and high-quality care to patients. By using accreditation, clinical audits, patient feedback, and clinical quality registries, the Australian healthcare system can continuously improve and enhance patient care.
1.3 Quality and safety commission in healthcare
A critical juncture in the idea of quality in safety in healthcare occurred in 1999 with the release of the Institute of Medicines report, “To Err is Human” (Kohn et al., 2000). This American based report identified significant estimates of patient harm occurring within hospital setting, significant cost implication because of injuries and deaths suffered and medication errors identified as a frequent occurrence.
This was followed up of the Crossing the Quality Chasm: A new health system for the 21st century (2001) which focused on how to enhance the delivery of healthcare to reduce the incidences of adverse events. This document included addressing the design and delivery of healthcare, and workforce preparedness in terms of educational attributes and capabilities needed to provide quality healthcare. The report identified six primary aims for the delivery of quality in healthcare and these included:
In the Australian context the National Safety and Quality Commission work to provide an independent synthesis of the literature to guide evidence-based practice that is underpinned by safety and minimisation of patient harm. These aim to reduce the incidence of harm to patients and consumers who engage with healthcare services. The implementation of these standards has contributed to significant and innovative changes in healthcare services such as: Modified early warning score of which QADDS (Queensland Adult Deterioration Detection Systems) is an example, and the implementation of rapid response teams (medical emergency teams) to support clinical areas in the management of acutely unwell patients.
Activity : Research in action
The formalisation and implementation of Rapid Response Teams (RRTs) provide clinical expertise to guide the clinical management of deteriorating patients in the hospital setting to reduce morbidity and mortality. A multicenter cohort study conducted by Orosz et al (2020) reported that RRTs have been implemented in 95% of hospitals with an ICU (Intensive Care Unit) and are associated with a reduction in in-hospital cardiac arrests and reducing overall hospital mortality. However, RRTs may not reduce unplanned ICU admissions with between 10% to 25% of patients reviewed by RRTs leading to an ICU admission (Jones, 2014). The implementation of modified early warning scores aimed to support clinicians’ ability to detect physiological changes suggestive of clinical deterioration. These detection methods provide an aggregate score based on measurable physiological changes, with accompanying escalation of intervention to guide ongoing care. Although widely adopted research indicates that 33-62% of clinical deterioration events are not appropriately escalated (Sprogis et al., 2021).
1.4 Contemporary challenges related to quality in healthcare
One of the contemporary challenges related to quality in healthcare is the increasing demand for healthcare services. The global population is growing, and people are living longer, which has resulted in an increase in demand for healthcare services. This increased demand for healthcare services puts a strain on healthcare systems and healthcare providers, leading to the risk of decreased quality of care. Overcrowding, long wait times, and staff burnout are common problems that result from the increased demand for healthcare services. These issues can negatively impact patient outcomes and lead to increased medical errors, lower patient satisfaction, and increased costs.
Healthcare costs are increasing at an alarming rate, and this can adversely impact the quality of care. Rising healthcare costs can result in inadequate resources for healthcare providers, leading to lower quality care. It can also lead to decreased access to care, especially for those who cannot afford healthcare services. As a result, healthcare providers also need to factor in costs which may contribute to poor decision making and risky practices to converse costs, which may compromise quality of care.
Increasing complexity of healthcare
Advances in technology and medical science have led to an increase in the complexity of healthcare. This complexity can result in medical errors, misdiagnosis, and inappropriate treatments, leading to decreased quality of care. The complexity of healthcare can also lead to increased costs, as healthcare providers may require specialised training and equipment to provide high-quality care.
An aging population
The global population is living longer with a higher proportion of older adults that presents unique challenges for healthcare providers. Older adults require specialised care, and healthcare providers may not be adequately equipped to meet their needs. Older adults are also at increased risk of developing chronic diseases, which can further complicate their care. The aging population can also lead to increased healthcare costs, as older adults generally require more healthcare services than younger people.
The increasing prevalence of chronic diseases
Chronic diseases such as diabetes, heart disease, and cancer are becoming more prevalent globally. These diseases require expertise in care, and healthcare providers may not be adequately equipped to provide high-quality care for these conditions, particularly when considering geographical location. Large metropolitian hospitals tend to have the contained clinical expertise for many complex conditions, which may be difficult to access for those who reside outside of major cities. As a result there is a disparity in access to healthcare, particularly when needing specialist care. Chronic diseases can also result in increased healthcare costs, as patients require ongoing treatment and management.
The increasing prevalence of mental health issues
Mental health issues such as depression, anxiety, and substance abuse are becoming more prevalent globally. Many of the mental health services aim to provide out of hospital services, with often less inpatient capacity. Access to services and ongoing support can be challenging for individuals and families to access in times of need, and thereby creating a perception that quality of care may be lacking. The financial costs of seeking out some support services may also act as a deterrent and thereby negatively impacting on individuals overall well – being and ability to improve quality of life.
The increasing need for patient-centered care
Patients are becoming more informed and empowered, and they are demanding more personalised care. Patient-centered care requires healthcare providers to focus on the patient’s needs and preferences, which can be challenging in a busy healthcare environment. As a result of workflow processes, prioritisation of needs and demands on service resources the intention of patient centered care can be compromised. Patient centred care is defined as:
“Patient-centred care is healthcare that is respectful of, and responsive to, the preferences, needs and values of patients and consumers. The widely accepted dimensions of patient centred care are respect, emotional support, physical comfort, information and communication, continuity and transition, care coordination, involvement of family and carers, and access to care” (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2010, p. 7).
Reflection
The increasing need for interdisciplinary care
Healthcare is becoming more complex, and patients often require care from multiple healthcare providers. Interdisciplinary care requires healthcare providers to work together to provide high-quality care, but this can be challenging when varying services may not be effectively staffed, role delineation can impact on effective interventions and on-going support, accessibility issues whereby regional and rural areas may not have the range of services available in metropolitan areas.
Check-in
References
Australian Commission on Safety and Quality in Health Care (ACSQHC) (2010). Patient-centred care: Improving quality and safety by focusing care on patient and consumers. www.safetyandquality.gov.au
Baker, A. (2001). Crossing the quality chasm: a new health system for the 21st century. National Academies Press. https://doi.org/10.17226/10027
Bingham, G., Fossum, M., Hughes, L., Digby, R. & Bucknall, T. (2020). The pre-Medical Emergency Team response: Nurses’ decision-making escalating deterioration to treating teams using urgent review criteria. Journal of Advance Nursing. https://doi.org/10.1111/jan.14433
Jones, D. (2014). The epidemiology of adult rapid response team patients in Australia. Anaesthesiology & Intensive Care. 42, 213–219.
Kohn, L.T., Corrigan, J.M. & Donaldson, M.S. (2000) To Err is Human: Building a safer health system. National Academy of Science. Washington. https://www.safetyandquality.gov.au/standards
The National Safety and Quality Health Service Standards: https://www.safetyandquality.gov.au/standards/nsqhs-standards
Orosz, J., Bailey, M., Udy, A., Pilcher, D., Bellomo, R., & Jones, D. (2020). Unplanned ICU admission from hospital wards after rapid response team review in Australia and New Zealand. Critical care medicine, 48(7), e550-e556. https://doi.org/10.1097/CCM.0000000000004353
Sprogis, S. K., Currey, J., Jones, D., & Considine, J. (2021). Use of the pre-medical emergency team tier of rapid response systems: A scoping review. Intensive and Critical Care Nursing, 65, 103041. https://doi.org/10.1016/j.iccn.2021.103041
