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The US Institute of Medicine defines quality 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". This definition highlights the issues involved in measuring quality of care, including the need for a specific focus on what is to be assessed, understanding the links between process and outcome, and measuring the ability of the system to keep pace with advances in treatment.
Many issues surrounding quality indicators are attributable to the differing needs of key stakeholders. Patients are concerned with the degree to which care meets their needs, as well as the communication, concern and courtesy shown to them during their health care experience (Peter A. Cameron, 2007). Purchasers measure quality based on efficient use of funds and resources. Providers and clinicians often focus on technical expertise and their ability to act freely in the best interests of their patients.
From a management perspective, quality may be best measured through outcomes at an organizational or systems level, while clinicians typically focus on processes of care for individual patients (Cameron D. Willis, 2007). Therefore, any attempt at measuring quality must first establish the purpose and from whose perspective measurement is occurring. The involvement of key stakeholders in directing the future trends of indicator measurement is essential to maintain the balance between political, economic and public interests.
“Quality indicators may be used to identify variations from best practice, permit comparisons between providers, and identify trends in quality of care over specified time periods” (Susan M. Evans, 2007). Such uses can drive local change through performance improvement projects or facilitate systems-level quality developments. For example, a quality indicator which flags cases of in-hospital falls may be able to reduce the impact of fall-related injuries at a specific hospital, while benchmarking best performance on a similar indicator may provide system-wide benefits for providers and patients.
A Quality Indicator (QI) is a measure of clinical management and/or outcome. Avedis Donabedian (1919-2000) first proposed the classification of QIs as structure, process or outcome based. Structural indicators relate to the attributes of the environment in which care is delivered and include material resources, personnel and the organizational structure. Process indicators are concerned with what is done by those involved in patient care, while outcomes are the results of the interaction between the patient and the health system, as well as other non-treatment factors.
Health-care workers play very active roles in determining quality care for their patient. The role is broad and duties are widely distributed in this regard starting from nurses, care assistants, support workers, doctors and even the administration. Every one is responsible with there own limitations and quality check procedures. The aims are wide to ensure good quality care being delivered to the patients, avoiding mal-practices and negligence by the health care workers. The most important factor is health care workers act like a time to deliver and ensure quality care.
The regulatory body or authority must be independent and helpful in the implementation of quality care procedures being delivered by the health care workers. I would say health care workers must contribute to the betterment of quality care in the health system which should be accessible to indoor, outdoor, emergency department patients as well as in clinics, care homes and other health centers. The quality care system is like a pyramid each and every health care regarding the duties fits in that pyramid.
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