UNDERSTANDING AND DEFINING QUALITY

Quality Academy – Cohort 6 April 8, 2013

Defining Quality

History:– Institute of Medicine – 7 dimensions– OECD (Organisation for Economic Co-operation and

Development )– BC: Health Quality Network

Who’s perspective?– Patient– System

Dimensions of Quality

Acceptability Appropriateness Accessibility Safety Effectiveness Efficiency Equity

Acceptability

Care provided considers patient and family preferences Respecting cultural values and encouraging family

involvement in decision making Health care providers being empathetic to patients and

families, Following the wishes and expectations of patients and

families Empowering patients and families to be active in their

own care.

• Avoiding unnecessary visits with good communication (e.g. discharge instructions, case management)

• Improved adherence to treatment Time taken to deal with complaints

Appropriateness

Care provided is evidence-based and specific to individual clinical needs.

Care provided optimizes an individual‘s health outcome.

Appropriate care weighs the benefits and risks of care – aiming to provide maximum benefit (supporting best outcomes).

Practice variations– Overuse– Underuse– Misuse

What are the costs to patient?

Accessibility

Ease with which health services are reached Extend to which individuals can easily obtain the care

when and where it is needed Aims to ensure there are no physical, financial or

psychological barriers to receiving information, care and treatment

• Multiple visits due to access problems• Misuse of Emergency due to access

limitations• Costs of maintaining a wait list• Missed appointments due to poor access

(e.g. mental health appts)

Safety

Avoiding harm resulting from care. Involves designing and implementing processes to

prevent and minimize adverse outcomes or injuries that could unintentionally result from the delivery of care.

• Hospital acquired infections• Adverse drug events in Community• Pressure ulcers in LTC• Never events (e.g. wrong surgery)• Drug costs and length of stay due to

preventable complications

Effectiveness

Care that is known to achieve intended outcomes. Based on clinical evidence and best practices. A commitment to effectiveness is demonstrated by

continuously studying the results of care to find ways to improve care for all patients

• Avoidable hospital admissions/readmission• Early discharge• Errors in cancer screening leading to recalls• Failure to to provide accurate and timely

diagnose

Efficiency

Optimal use of resources to yield maximum benefits and results.

Maximizing capacity and eliminating/avoiding waste in the health system.

• Reduction of waste time spent looking for materials,

records, information• OR cancellations• Social impact

Equity

Distribution of health care and its benefits fairly according to population need.

British Columbians have equal access to the health services they need, regardless of gender, ethnicity, socioeconomic status, or where they live.

Areas of Care

Staying Healthy– Preventing injury, illness and disabilities.

Getting Better– Care for acute illness of injury.

Living With Illness and Disability– Care and support for chronic illness and/or disability.

Coping with End of Life– Planning care and support for life limiting illness and

bereavement.

How Is It Used?

• Program / Strategic Planning• Evaluation• Measurement Frameworks

An Example: Surgical Quality Framework

A framework to describe a comprehensive picture of surgical quality

BC Health Quality Matrix Dimensions acceptable, appropriate, accessible, safe, effective, efficient

+Segments along Surgical Pathway

REFER DECISION SURGERY RECOVER FOLLOW

ACCEPTABLE Patient Experience

Patient Experience

Experience Survey

Patient Experience

Patient Experience

APPROPRIATE Alignment of determination that benefits outweigh risks of care

Patient, primary care provider and surgeon

ACCESSIBLE Time to diagnostics

Time to specialist, diagnosis

Time to Surgery Time to follow-up care and treatment

SAFE Crude Infection Rates (PICNET)Adjusted Infection and

Complication Rates (NSQIP)

EFFECTIVE Risk Adjusted Mortality Rates, Return to OR (NSQIP)Patient Reported Outcome – functional status and quality of life

EFFICIENT Appropriate Referrals

Risk Adjusted LOS(NSQIP)Costs saved (lower LOS, fewer complications, fewer readmissions and return to OR)

Efficiencies in hospital and OR flow (e.g. cancelled procedures)

REFER DECISION SURGERY RECOVER FOLLOW

ACCEPTABLE Techniques for shared decision making and teamwork among providers and patients; opportunities identified from Patient Experience

APPROPRIATE Pathways, guidelines, decision aids, shared decision techniques

ACCESSIBLE Decision aids - when to refer

Advanced Access for Specialists and DI

MoH/PSAC work on prioritization, targeted funding, management of waitlists; Centre for Surgical Innovation

Advanced Access

SAFE Surgical Checklist, VTE Prophylaxis, SSI Protocol (SHN!, CPSI, Collective)

EFFECTIVE Focus on PROMs/QOL

EFFICIENT Flow in OR, Discharge Planning, Safety Initiatives

WHERE DOES YOUR PROJECT FIT?