As the American College of Emergency Physicians (ACEP) suggest, the resistance is likely due to the many questions surrounding expectations and effective implementation.
While there is no clear pathway suited to all organizations, the following information is an attempt to provide resources to help you establish your own health care quality assurance strategy.
Effective Approaches to Quality Assurance
West Midlands Quality Review Service and The Evidence Center, conducted a review of over 4000 research papers to identify 121 quality studies that revealed a deeper understanding on the variety of approaches to quality assurance.
According to their report, “the most commonly reported types of quality assurance systems include the following, with the most effective solutions highlighted in bold:
- Peer review
- Audit and feedback
- Checklists and logs
- Computerised monitoring systems
- Communication and education strategies
- Guidelines, protocols and registries”
After analysis, these methods shared the following characteristics:
- “A structured approach
- Regularity of review
- Proactive feedback and education
- Stakeholder buy-in and involvement
- Well trained reviewers
- Adequate resourcing
- A collaborative approach
- Adequate IT and infrastructure”
An Effective Health Care Quality Assurance Strategy
Implementing a quality assurance model begins with performance measures. This may include identifying and defining what measures are currently in place or available. Or it may involve developing valid, reliable measures.
According to research compiled by ACEP, the quantified model for delivering health care is: “structure + process = outcome.”
Structure = the physical and organizational structure, including clinician credentialing.
Process = the specific treatment interventions provided to patients that result in an outcome.
Outcome = the actual, true result of the patients interactions with the clinicians. For example, improved functional outcome measures, length of stay, readmission rates and so forth.
To achieve continuous quality improvements, process improvement can be linked to an ongoing cycle of implementing evidence based practice to clinical practice. The ACEP research also highlights that processes are generally easier to develop than outcomes, as once evidence is implemented, indicators and data collection systems need to follow to evaluate if selected processes are associated with, and achieve the most effective outcomes. The outcomes must meet the patient focused endpoints – readmission, length of stay, morbidity, mortality and so forth.
Establishing a quality assurance strategy is not necessarily an easy process, but thankfully there are many resources to help.
- CMS: Quality measures info
- CMS: Guides to quality
- American College of Emergency Physicians: Quality of care and the outcomes management movement
- REPORT: Building a performance measurement system
- Perspective Clinical Research: Quality assurance: Importance of systems and standard operating procedures
- Quality management in clinical trials – give some good insights on components and aspects that could be modeled
- Journal of Vascular Surgery: The role of quality assurance versus continuous quality improvement
- REPORT: Developing an Effective Quality Assurance Program
- REPORT: Preparing your organization for values-based care