Defining Quality

Csilla Orban Bonacci

 

I believe quality is a measure of how well we do something in such a way that it adheres to standards of care while having positive outcomes. I think I agree with Donabedian's approach to measuring healthcare: we need to look at structure, process, and outcomes. It starts with structure and which can affect somewhat process and then the process affects outcomes. I do believe though that even though structure might be affected, process does not mean it has to in every aspect. For example, just because we have 4 nurses instead of 5 working the floor it does not mean that those 4 cannot or should not wash hands before patient care just because there is one less nurse on the floor. I think even if the structure is a bit weak, there are areas where nurses can still do well by adhering to standards of care. I do believe that some structural issues can affect processes, too, but I just believe not all processes should be affected because of structural issues. Process however can greatly affect outcomes. Not using sterile instruments on a patient can lead to infection or sepsis ( Berwick, 2016).

In terms of wasteful practices I have found that a lot of the big hospitals waste a lot of products by not using certain products of using them by mistake by untrained staff. For example, many new nurses do not know the difference between the tubing used for regular IV and those for blood administration. So, he or she picks one up from the clean supplies room and opens the bag in the patient room only to realize it was the wrong tubing. Same thing happens with dressings, gauze, etc. I believe patients should have everything available even if it costs the hospital money. Quality care is given by using enough resources and quality resources; however, waste happens that costs the hospital money when we do not appropriately train staff to recognize products. This is just one example of an area where waste occurs. Then we are out of products we need and we have to make do with other products until the hospital orders more. This can delay appropriate care using the right products, right tools, and right materials. Not using the appropriate medicines, gauze, dressing, etc. can affect patient care; it can affect the quality of care. Donabedian believed that quality is measured by "the end results of healthcare"(Berwick, 2016).

References

Berwick D, Fox DM. "Evaluating the Quality of Medical Care": Donabedian's Classic Article 50 Years Later. Milbank Q. 2016 Jun;94(2):237-41. doi: 10.1111/1468-0009.12189. PMID: 27265554; PMCID: PMC4911723.