Measurement and Quality Improvement
Published: 15 April 2024
Published: 15 April 2024
Quality. It’s something we all strive for. It’s the optimum level of care experienced by patients.
‘Measurement and quality improvement’ is the second component of Patient Safety and Quality Systems, as outlined by the National Safety and Quality Health Service Standards: Standard 1 Clinical Governance.
As part of the governance process of a health service, patient safety and quality systems are created to advance the safety and the quality of patients’ care (ACSQHC 2022a).
The intent of measurement and quality improvement is to implement effective quality improvement systems that operate across the entire organisation (ACSQHC 2021).
The public’s perception of quality in healthcare has assessable consequences. There is growing evidence to indicate that people will avoid using services they deem as lacking in quality (Hanefeld et al. 2017) and that this is ‘a barrier to universal health coverage’, regardless of physical access to care (Berendes et al. 2011).
According to the American Institute of Medicine, quality in a healthcare context is ‘he degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’ (Institute of Medicine, as cited in AHRQ 2020a).
Regular measuring of a system is essential to ensuring quality improvements. It allows a facility to determine the baseline level of current operational performance; establish goals for future performance; and monitor the impact of changes as they are made (AHRQ 2020b). When measured properly, metrics can guide every decision made to ultimately improve the end product, in this case, patient care.
Standard 2: The Organisation - Outcome 2.3: Accountability and quality systems of the strengthened Aged Care Quality Standards highlights the importance of maintaining a quality system that facilitates the continuous improvement of care and services (ACQSC 2024).
(ACQSC 2024)
To be able to determine whether goals have been met, it’s first necessary to define the desired end outcome. Without a clear goal established from the very start, it’s difficult to measure and recognise whether the changes that were made have resulted in improvements - or if they are just changes (Health Quality Ontario 2013).
A measurement plan should contain the following (at a minimum):
(Health Quality Ontario 2013)
The plan must be reviewed frequently. Rather than displaying data in a standard pre/post-implementation way, plot the data over time (for example, by month) for a clearer picture of how the changes are affecting outcomes. This process should be actively shared with staff to create momentum on an organisation-wide scale (Health Quality Ontario 2013).
An effective quality measurement tool must:
(AHRQ 2020a)
(AHRQ 2020a; Health Quality Ontario 2013)
Six important considerations for designing measurement systems are:
(Hanefeld et al. 2017)
The presence of measurement and quality improvement in the NSQHS Standards implies its importance and represents a gap present in Australian facilities and services. The NSQHS Standards identify two missions for facilities in terms of measurement and quality improvement:
(ACSQHC 2022b)
(ACSQHC 2022c)
To up-scale health interventions, it’s necessary for facilities to recognise the multifaceted nature of quality of care. Technical quality must be increased, but equally crucial is better acceptability and a shift toward greater patient-centred care (Hanefeld et al. 2017).
The outcomes of care quality improvement should be tailored specifically to the needs of the community the facility exists in.
Question 1 of 3
Which one of the following is criteria for an effective measurement tool?