Hospital Quality: Patient, Physician and Employee Judgements

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Abstract
A conceptual model of health care, a theory of quality improvement in health care and the role of patient, physician and employee judgements as part of organisation-wide improvement are introduced. The conceptual model of health care shows how the practitioner, the locus of care-giving and the social context interact to meet the needs of patients and highlights potential sources of unwanted variation in outcomes. This theory of quality improvement stresses the continuous improvement of processes throughout the entire organisation to meet the needs and expectations of customers. Basic building blocks for continuous improvement - knowledge of customers, knowledge of work as processes, and statistical and scientific thinking - are discussed along with the need to transform the entire organisation. A method for gaining customer knowledge and for monitoring hospital quality, based on measuring quality from patients', physicians', and employees' judgements of quality, is introduced. The method, called the Hospital Quality Trend (HQT) family of quality measures, is described and its uses to promote organisation-wide quality improvement are illustrated. Health care work is complex and unique. Careful analysis of the way that work is done and knowledge of the customers in defining and improving quality is essential for achieving better quality and value from the health care system.

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