Quality assurance can be defined as all activities that contribute to defining, designing, assessing, monitoring and improving healthcare outcomes - Quality assurance introduction. Quality assurance in the area of healthcare is a continuous process which emphasizes ongoing commitment at various levels to improve quality procedures / processes and develop a robust, cost-effective patient-oriented health care system. Healthcare organizations use various strategies to perform quality assurance like increasing resources, patient empowerment, establishing standards and guidelines, benchmarking, performing quality assessment, reengineering and risk management procedures. The key indicators of a robust healthcare organization include superior quality of care, access to services, safety, continuity of services provided, optimum delivery of the services and patient-oriented care. The key to developing an efficient quality assurance program are clear understanding of systems/ processes, measuring quality and focusing on client requirements. Hence implementing a good quality assurance program undoubtedly has tremendous benefits and significantly improves quality of care.
The three core principles of healthcare quality assurance include measuring, defining and improving quality. (i) Measuring quality – This involves performing a quality assessment, constant monitoring and external evaluation of quality. Quality assessment not only accurately measures the difference between expected and actual performance but also identifies opportunities for change and improvement. This process is commonly performed using a combination of various methods including data reviews, interviews and auditing patient information. Often, quality assessment provides valuable insight and feedback regarding various quality improvement procedures designed to improve quality of healthcare services. (ii) Defining quality – This refers to defining standards of quality for inputs, processes and outcomes based on solid scientific evidence. The healthcare standards defined should be realistic, valid, measurable and reliable. (iii) Improving quality – Quality assurance improvement is a continuous process which can be performed by process improvements, redesign, restructuring and benchmarking. The fundamental difference between the quality assurance and quality assessment are quality assurance refers to the practice of systematically planning the course of actions in order to ensure that there is no scope for errors. Quality assessment on the other hand refers to the practice of measuring the actual performance against the pre-determined quality standards and procedures to detect any errors. Quality assurance generally occurs before quality assessment and is a preventive measure while the latter is a curative one.
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There are three important reasons that justify why the hospitals’ quality assurance program is not a wasteful expenditure but is a resourceful program which has significant benefits in terms of improved quality of healthcare services and lower spending. Concerns regarding patient safety and occurrences of medical errors/preventable conditions have become increasingly concerning in recent times. According to the Patient safety and quality improvement act of 2005, patient safety organizations are entitled to conduct various quality assurance activities to improve safety / equality of healthcare delivery, collect / analyze information and disseminating material as best practices and recommendations in order to minimize medical errors and redundancies. Various quality assurance programs implemented by the hospital ensure accuracy of patient information, effectiveness of care, safety using medications, safety reporting systems, usage of decision support tools at point of care, limiting shifts for hospital staff members and other procedures to reduce medical errors. Secondly, statistics clearly reveal that medical errors and preventable adverse conditions account for not only loss of lives but potentially serious life-threatening complications hence, the need for quality assurance program cannot be undermined. Reports show that wasteful spending primarily due to various inefficiencies account for $1.2 trillion of the $2.2 trillion spent nationally on healthcare. The inefficiencies in the system can be broadly classified into three categories namely (i) behavioral – individual behavioral patterns lead to medical conditions. (ii) Operational – addition of costs due to administrative / business processes. (iii) Clinical – involves overuse, misuse or under-use of interventions, medical errors and clinical issues. The quality assurance program implemented by the hospital plays a vital role in identifying and addressing various clinical inefficiencies like practice of defensive medicine, preventable hospital readmissions, medical errors, unnecessary ER visits, treatment variations, medical errors and hospital acquired infections. It also addresses operational inefficiencies in claims processing, IT resources, and staffing turnover and prescription errors. Thirdly, evidence based practice is a decision making process which integrates best available research, clinician’s expertise and client characteristics. Evidence based medicine which is part of the hospitals quality assurance program promotes collection, interpretation and integration of patient-reported, clinician-observed and research-driven evidence to improve clinical judgments and cost-effective care. Hence all three reasons stated above clearly reveal that the hospitals quality assurance program is very critical to maintaining high quality of services in a cost effective manner. Quality assurance programs has a major impact on the various policies pertaining to the hospital facilities including laboratories since it ensures that the various operations/tests conducted adhere to quality guidelines and any deficiencies identified is corrected. It ensures that the physician, personnel, equipment, technical specification and routine inspections meet quality requirements.
Several key organizations have been actively involved in setting quality standards in order to improve healthcare outcomes. These are enlisted – (i) Agency for healthcare research and quality (AHRQ) support research activities to improve care and reduce costs. (ii) Joint Commission on Accreditation of Healthcare Organizations (JCAHO) provides healthcare accreditation to support performance improvement in healthcare organizations. (iii) National Association for Health quality (NAHQ) provides resources for continuous quality improvement in healthcare. (iv) Institute of Medicine (IOM) addresses issues regarding prevention of medical errors. (v) National Committee for Quality Assurance (NCQA) identifies and explains the processes of accreditation and performance measurement, including the HEDIS report card.
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