Healthcare quality has several dimensions like reporting, documentation, quantity of or access to care, patient satisfaction, reputation, clinical processes, utilisation, review and medical necessity determinations. By observing the quality of care laws and metrics, and how they relate to these eight quality dimensions, healthcare professionals can plan to achieve and retain a high-quality care.
8 Quality Dimensions in Healthcare Management
Quality of Reporting
This is the first quality Dimensions in healthcare management. The National Health Profile (NHP) is a collection of currently available data regarding broad range of indicators related to health status and health services in India. The NHP concentrates on key information regarding the nation’s overall health status, health expenditures, infrastructure and human resources in health. It also discloses major trends over the years especially in the recent past. The NHP also provides up to date information for the country, provides a comparison of health situation existing in different states.
The health statistics of India was later called as ―Health Information of India‖, which is currently published annually by Central Bureau of Health Intelligence (CBHI). The NHP is aimed towards providing meaningful information to policymakers, health administrators, researchers, students and others to contribute towards the improvement of health services and equitable distribution of health resources in the country.
Transparency in healthcare system is a critical component to improve accountability and outcomes. Transparency helps a healthcare provider to drive improvement in the system of care. Transparent reporting of services helps to improve care.
The Health Management Information System (HMIS) not only helps the administrators to have better monitoring and controlling the functions of hospitals using decision support indicators but also assist the doctors and medical staff to improve health services with ready reference patient data, workflow enabled less-paper process and parameterised alarms and triggers during patient treatment cycle. The HMIS monitors determined health indicators and the embedded reporting facilitates decision making by the hospital management and administrators for policy and strategic decisions.
Confidentiality of reports and records is one of the major concerns of most hospitals. HMIS provides multiple levels of security in the software, so that data pertaining to various functions of the hospital remains confidential. A role based access control mechanism is deployed for restricting or permitting the form level data access.
Quality of documentation
Healthcare data is the source of healthcare information, so it stands to reason that a health care organisation cannot have high quality healthcare information without first establishing that it has high-quality healthcare data. Data quality must be established at the most granular level. Much healthcare information is collected through patient care documentation by clinical providers and administrative staff.
In India, different types of centers have well established primary healthcare delivery and health information systems. The current health information system was paper based.
Quality of Quantity
Quantity and quality of care are different but related concepts used to evaluate the present and future state of a person or group of people. Considered together, quantity and quality must represent a complete picture of the person or group. Quantity of care is measured in terms of length of survival.
Health-related quality of care is confined; it is defined as the value assigned to the duration of life as altered by the social opportunities, perceptions, functional states and impairments that are influenced by disease, injuries, treatments or policy.
The value attributed to the particular status of patient defines health-related quality of life. The time spent in that state or the chance of moving from one state to another defines quantity of life. Therefore, a complete representation of health-related quality of care involves specification of relevant states or combination of dimensions, the values or preferences assigned to these states, and the duration or probability of duration in different states.
Quality of Patient Satisfaction
Patient satisfaction plays a crucial role in the growing accountability among healthcare providers. Patient satisfaction leads not only to a satisfied patient and its family members but also high confidence of the staff and the community. Patient satisfaction is a top priority for healthcare organisations.
Patient satisfaction surveys are valuable tools for healthcare providers that are used to identify areas that need improvement. By extracting accurate and measurable data, patient satisfaction surveys can help an organisation to assess the quality of care and service from patients’ perspectives.
Patient-centred approach to quality management is essential in today’s competitive healthcare environment. Patient satisfaction surveys demonstrate to patients and the community that the organisation cares about high quality and is proactively searching for ways to provide better service. These surveys empower patients while introducing the organisation with honest, insightful feedback can be interpreted and acted upon.
Patient satisfaction surveys can highlight opinions like:
Waiting room and procedure room environments and cleanliness.
Thoroughness of medical exam.
Patient-physician communication and interaction.
Staff courtesy and compassion.
Ease of getting appointments and referrals.
Billing procedures and personnel.
Facility access and parking.
Desired new services.
Quality of Reputation-Quality Dimension
Customer satisfaction is the key factor with respect to service quality and this appears to be relevant for the evaluation of healthcare services. The process of constructing an organisational reputation relies on:
Customer experience of service quality.
Clear communication of organisation values and culture.
Words-of-mouth about past positive experiences by other customers.
Moreover, the main factor to affect customer satisfaction is the perceived quality of the doctor-patient relationship. Thus, the role of the doctor-patient relationship is an important factor for construction and maintenance of the organisational reputation. Three dimensions for the evaluation of perceived quality are performance, communication, and facilities and equipment.
Reputation is the overall estimation in which an organisation is held by its constituents (Fombrum, 1996). Based on a combination of all expectations, perceptions and opinions of an organisation developed over time in relation to organisation’s qualities, characteristics and behaviour, the same definition of reputation can be applied to professional services such as healthcare.
According to this definition, reputation is affected by the personal experience of a patient when in contact with the organisation. More precisely there is the perceived quality of the product or service, so one can argue that perceived quality is one of the determinants of reputation.
Quality of Clinical Process
The quality of clinical process by which clinical decisions are made is evaluated by random sampling to see whether certain protocol is followed or not as accepted in the medical community. Emphases is laid on assessing robustness of clinical decision-making process, assessing variance in activities and sequence of activities in clinical decision-making process, and ensure system for continuum of care. Rating at no point questions the decision made by the clinicians on the applied therapeutic treatment, if the process adopted to arrive at the diagnosis is robust.
The clinical criterion of focus is on system for clinical credentialing, clinical audits, clinical risk management and clinical outcome measurement. The focus is on analysing the trend of healthcare organisation’s utilisation and success indices.
Quality of Utilisation Review
An utilisation rate is the number of times a hospital performs a specific procedure on a specific targeted population. Hospital utilisation indices are an objective measure of the efficiency of the hospital management system. The consistent use of utilisation indices will help the administrators in making their decisions more realistic, scientific and free from subjective preconception.
Trends can be used to forecast future utilisation patterns. Service providers must be interested in knowing the effect of various services of the hospital on the utilisation rate. These tools help in identifying the relationship between a particular service and the profile of the health seeker.
Some examples of utilisation rates include medical equipment utilisation, operation theatre utilisation and human resources utilisation.
Quality of Medical Necessity Determinations
This is the last Quality Dimensions in healthcare management. The determination of medical necessity is the process by which a specific service is estimated to be necessary in the clinical care of a patient. Services estimated necessary are eligible for compensation by the payer. Such determinations often have a subjective factor, and differences in interpretation of this concept can be conceived along time. At one end is a strict interpretation of medical necessity that excludes most psycho-social elements from consideration and does not recognise several prevention, remediation, rehabilitation and recovery service needs. At the other end, psychosocial elements are seen as necessity considerations in determining whether a service is necessary.
The concept of evidence-based necessity determinations is developed in response to rising evidence of prevalent and potentially unjustifiable variation in medical practices. In this concept, no weight is given to the standards of health professionals, the opinion of an individual’s treating physician and informal clinical experience. Rather, the decision-maker depends upon evidence gathered from controlled randomised clinical trials, with coverage based on quantitative evidence of efficacy resulting from the trials.