The healthcare journey is rarely a smooth road. Fraught with twists and turns, fear of the unknown and lack of trust are common emotions for new sojourners. It doesn’t help that most Americans are likely to get a wrong or delayed diagnosis at least once in their life.
Quality healthcare won’t eliminate the angst when working through your health condition, but it can make the healthcare journey much easier to navigate and more pleasurable overall. For this reason, it’s vital to understand the “how” and ‘what” of quality care so you can feel more in control of your healthcare outcomes and eliminate some of the unknown.
In this guide, we will discuss:
- What is quality of care
- How health consumers identify quality of care
- How health organizations identify quality of care
- How to measure quality of care
- How to improve quality of care
- How to find high-quality care for yourself
“What is Quality of Care and How Do I Know What to Look for?”
The term “quality of care” gets thrown around a lot, and some of the related research and information can be confusing to digest. But, it’s not that complex when you think about it in terms of the patient experience.
If you’ve ever felt immediate peace from your health anxieties after a nurse told you a heartwarming story about her three-year-old grandchild, you experienced quality care.
If you ever left a doctor’s appointment with all of your questions answered, and you felt you were genuinely cared for, you experienced quality care.
If you ever worked with a doctor or hospital that helped make healthcare more affordable for you, you experienced quality care.
Dealing with health issues, though necessary at times, is never a welcomed experience. But, high quality of care can lessen the burden this journey brings to ensure you receive safe, effective, and timely help.
Let’s dig deeper into the quality of care and define it in more detail.
Crossing the quality chasm: A new health system for the 21st century (2001) reports the following recommendation from the Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998) as initially published by the Institute of Medicine (IOM).
“All health care organizations, professional groups, and private and public purchasers should adopt as their explicit purpose to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States.”
The Commission also recognized the quality of care as inclusive of the following six factors: safe, effective, patient-centered, timely, efficient, and equitable.
- Safe – Reduce harm and prevent injuries during care
- Effective – Leverage science to provide the best care and prevention of chronic disease while avoiding overuse of service to those who do not need it
- Patient-centered – All health decisions should focus on the patient’s individual needs and preferences and respect the patient’s values
- Timely – Speedy care by reducing delays and wait times
- Efficient – Make better use of resources by avoiding waste
- Equitable – Provide care with the same standard of quality for every human being regardless of their individual traits and characteristics
While the specific criteria above outline the main categories for quality care, you also may have your own measuring stick for evaluating quality, based on your personal experiences. For example, you may regard cleanliness as the highest determinant of safety while another patient may prioritize doctor-patient communication.
In a set of 16 randomized focus groups on quality of care in hospitals, data collectors surveyed a group of people from four cities in which most were either recently hospitalized or had a loved one hospitalized. Patients rated the characteristics of healthcare based on their experiences.
Among the factors presented, participants prioritized:
- Patient-doctor communication
- Patient-nurse and patient-hospital communication
- Rapid responsiveness to needs
- Cleanliness of hospital facilities (prevent the risk of infection)
When asked about quality communication, participants mentioned respect, kindness, and the ability for providers to offer relief and support to worried patients. Participants also desired ample time with staff, citing they wanted providers to weigh their input when making health decisions. Listening was also important. Doctors should slow down communication to explain complex topics so patients can comprehend them comfortably.
While participants seemed most concerned with the above topics, additional important issues included medication errors and problems, aftercare, pain management, physician expertise and hospital specialization, nurse-to-patient ratio, and others.
How Do You Measure the Quality of Healthcare?
Measuring quality of care allows you to select the best providers and also keep providers accountable to identify issues and improve over time. But, to measure accurately, you need actual criteria to determine what, if any, changes are resulting in improvement.
When measuring the quality of care, we turn to health organizations that have been championing the quality healthcare movement by monitoring provider data and implementing standards from which to measure.
- The Joint Commission
- Center for Medicare & Medicaid Services
- The American Health Quality Association
- The National Committee for Quality Assurance
- National Quality Forum
- Institute for Safe Medication Practices
Some of these organizations outline criteria healthcare providers must follow to acquire and maintain accreditation. They publish their findings and make them accessible to consumers.
This data is important when you are researching providers. Each provider must remain compliant, or it will lose accreditation, which means it has not maintained the organization’s standards of quality healthcare.
What are measurable outcomes?
Healthcare quality can be challenging to measure with so many complexities to weigh and analyze. Defining measurable outcomes can simplify this process and provide standardized data providers can use to analyze their level of quality and improve over time.
According to the World Health Organization, an outcome measure is a “change in the health of an individual, group of people or population that is attributable to an intervention or series of interventions.”
Measurable factors are those that organizations gather from quantitative data (i.e.number of accidents, complaints, etc.) and qualitative data (patient satisfaction, patient experience, etc.) collected from surveys and focus groups.
The Centers for Medicare & Medicaid Services, an arm of the Department of Health and Human Services rates hospital quality according to multiple measures, 37 on average. These measures are grouped into the following broader categories:
Mortality is a standard quality measure that reports patients who die during hospital admission or shortly after. It is difficult to directly correlate mortality data with quality of care, however, because other variables are also a factor (patient’s age and comorbidities, etc.).
Safety of Care
The Institute of Medicine (IOM), as reported by Patient Safety and Quality: An Evidence-Based Handbook for Nurses, defines patient safety as “the prevention of harm to patients.”
To promote safer practices, providers must prevent and learn from errors. These errors often include medical mistakes such as hospital-acquired infections, skin breakdown, and other medical errors that subject patients to more harm.
Readmission is inefficient and often unnecessary, which places an additional burden on patients and healthcare facilities. Research reported by Health Affairs suggests that inadequate coordination and management of care cost $25 to $45 billion in 2011 due to preventable complications and unnecessary hospital readmissions.
Organizations such as the Agency for Clinical Innovation conduct regular patient surveys to identify patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), which ask patients questions about their experiences with the health services they consulted.
Effectiveness of Care
Health providers should be consulting the most recent best practice guidelines to maintain compliance and reduce readmission rates.
Timeliness of Care
According to Healthy People, a division of the Office of Disease Prevention and Health Promotion (ODPHP), “Timeliness is the health care system’s ability to provide health care quickly after a need is recognized.” Timeliness includes a reduction in overcrowding, utilizing better appointment availability, and reduced time waiting for health providers and emergency services.
Efficient Use of Medical Imaging
Unnecessary use of medical imaging is wasteful and potentially harmful. The efficient use of medical imaging urges healthcare providers to use evidence-based best practices to reduce unnecessary radiation exposure to patients and prevent resource wasting.
How Can Healthcare Organizations and Providers Improve Their Quality of Care?
We discussed how value-based care starts with measuring quality, for quality of care is impossible without measuring and assessing outcome measures. Tracking and reporting these measures over time allows healthcare organizations and providers to improve and communicate these initiatives to patients.
But, this alone is not enough. Let’s look at three ways healthcare providers can improve quality of care.
Holistic Value-Based Healthcare
Healthcare is shifting to a more value-based system that looks at patient care more holistically to better serve patients long after the initial doctor/hospital visit. Lowering healthcare costs is also vital to make high-quality care affordable to more patients.
The value-based health care model focuses on more personalized, affordable care. This includes after-care involvement and services, and better data integration across healthcare systems to ensure a more comprehensive patient experience.
To institute value-based care, doctors can access a patient’s electronic health records to offer more personalized treatments and provide continued care recommendations based on a patient’s lifestyle and behaviors.
While the internet has become a wealth of information (and easy to access), it may not be the best place to assess quality of care. Most internet reviews (when legitimate) cover fundamental traits such as staff friendliness and doctor bedside manner, but they won’t detail a physician’s expertise and experience.
If you don’t use online reviews, how can you quickly and easily determine quality of care to find providers who meet your criteria? Currently, there is no standardized reporting system in the U.S.
A lack of standardization is problematic because it can result in a misinterpretation of data. One organization may present the same data in a different way, which can confuse you when you are searching for the best care.
Context is also essential. For example, a hospital reporting 10 deaths out of 100 patients admitted is not the same as another hospital reporting 10 deaths out of 1,000 patients admitted. According to Stanford Health Care, a better measurement would be to use the Case Mix Index (CMI), which takes into account the overall number of severely ill patients a hospital treats to report quality of care data.
Improving the quality of care requires more comprehensive, standardized reporting to empower healthcare providers to improve and give patients better tools to find the right healthcare for their unique needs. More standardized reporting and data-gathering would reduce confusion and make it easier for patients to assess quality of care when searching for healthcare services.
Greater Physician Communication and Engagement
As seen in the survey we discussed earlier, communication is a critical doctor-patient issue. But, physician communication and engagement with hospitals and affiliated providers also directly affects the quality of care.
For example, let’s say a healthcare administrator notices more doctors referring to a particular facility or provider more than the one they align with. The organization should engage with the doctors and research why this is happening. If patients have been reporting issues with the neglected provider, effective communication can reveal the problems which allow all parties to rectify them, providing better experiences for patients.
The Power is in Your Hands
As a health consumer, your experiences directly affect the success of health providers. Improving the quality of care is integral to a healthcare organization’s longevity and success as it has become a measuring stick for how well a healthcare provider or organization positively or negatively impacts patient experiences. Unfavorability can drive patients to seek competitors, which can stagnate growth and damage an organization’s reputation. But, this is an essential driver for change as the quality of care can also become a high standard to achieve as it measures and prompts progress, improvements and provides growth opportunities for organizations focused on delivering quality services.
How to Find a High Quality of Care for Yourself or a Loved One
If you are searching for quality health providers, specific practices and modern tools can make the process quicker and less painful.
Ask the Right Questions
You have a right to request data from healthcare providers for the facilities where you are getting a procedure done, or receiving treatment for your condition. Below are some questions to ask:
- Does the facility have quality data for my condition or procedure?
- Do you recommend this hospital for my condition or procedure?
- What have other patients with my condition reported about this hospital?
- How many patients with my condition has the hospital treated?
- How many procedures has the hospital performed of this nature?
- Does The Joint Commission accredit the facility?
- Will my insurance cover my care from this facility?
Questions adapted and revised from Stanford Health Care
The Joint Commission offers a Quality Check for healthcare organizations that have achieved The Gold Seal of Approval, its internal rating system for quality. The tool will display the healthcare organizations that comply, along with their accredited programs and certifications.
Nonprofit organizations such as The Leapfrog Group keep healthcare organizations accountable by reporting outcome measures and patient survey results to help reduce preventable errors and improve quality of care. Leapfrog rates hospitals by avoidable mistakes, gathering data such as:
- Preventable infections
- Problems with surgeries (accidental complications and death)
- Practices to prevent errors
- Safety issues
- Administration of medication
- Communication with staff
- Communication about medications
- Staff qualifications
Note that some people have criticized organizations such as Leapfrog due to a lack of independent studies on the program’s impact. Use Leapfrog as one component of your healthcare research, instead of as a sole resource in your decision-making process.
As mentioned previously, we do not recommend consulting online reviews when looking for quality providers. While reviews may be helpful to assess a provider’s communication style and office environment, they do not evaluate doctor training and expertise, which is vital to receiving a high quality of care. Also, word-of-mouth recommendations, while sometimes helpful, often base provider reputation on personal criteria, which may or may not reflect your values or satisfy your unique healthcare needs.
Suppose you want to find an experienced doctor without investing hours of online research. In that case, MediFind’s cutting-edge machine learning software pulls and sorts millions of pieces of research data and compiles it in one easy-to-access place. A proprietary algorithm and team of medical experts extract the more than one million research reports and clinical trials that get published yearly and simplify the terminology so you can easily comprehend it. Find the best doctors for every condition and get doctor ratings, recent clinical studies, condition information, and more.
You Deserve the Highest Quality Healthcare
While measuring and improving quality of care is far from a perfect endeavor, standard-setting organizations and private groups compel healthcare providers to meet quality standards of care. By continually reviewing patient experiences and working toward standardizing data to remove confusion, quality of care will continue to traject forward and provide patients with more certainty and less risk when choosing healthcare providers.
Quality of care is all about your health and well-being. With more information, you can better control the outcome of your health interactions and feel more equipped to make the best health choices for yourself and your loved ones. We are here to help you every step of the way.